Super Cover Plus is our mid-range product which provides Gap cover, Casualty cover, Co-Payment cover and Sub-Limit cover, as well as a separate Oncology benefit that provides Oncology Gap cover, Oncology Co-Payment cover and Oncology Extender cover.
R330 p/m
R330 p/m
R490 p/m
The Super Cover Plus option covers up to 700% above medical aid scheme tariff.
This means that if your service provider charges anything up to 7 times what your medical aid will cover, TRA will provide for this GAP, subject to the annual limit.
These days most medical aid schemes impose a sub-limit on in-hospital internal prostheses costs. Members may be out of pocket and will have to cover these costs themselves
Accidents happen! Unfortunately, some severe accidents may even result in death. The situation is made worse if that person was the main breadwinner. Costs can run into the thousands and often funds are tied up to an estate.
Benefits include but are not limited to:
These days most medical aid schemes insist that members pay an upfront amount for certain diagnostic and endoscopic procedures like gastroscopies and colonoscopies.
Oncology Gap Benefit: Up to an aggregate of R198 660 per insured person per annum. The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for medical aid approved oncology treatment plans. (NB: Subject to: the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit).
Oncology Gap Benefit: Breast Reconstruction Surgery; The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for medical aid approved oncology related breast reconstruction surgery, including the unaffected breast. (NB: Subject to: the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within the annual scheme oncology limit). R18 000 per policy per annum
Oncology Co-Payment Benefit:
Oncology Co-Payment Benefit (In Network): Up to R60 000 per policy per annum.
Oncology Co-Payment Benefit (Out Of Network i.e. voluntary use of a non-designated service provider): 1 co-payment per policy per annum. Up to R5 000.
Oncology Extender Benefit: Includes ANY approved costs above annual scheme oncology limit but subject to the medical aid scheme covering up to this limit. Up to R35 000 per policy per annum.
Oncology “New Tech” Benefit: We cover the shortfall / co-payment on new technology oncology treatment (specifically Keytruda®,Xalkori®, Tagrisso®, Yervoy®, Zelboraf®, Imbruvica®). Subject to a medical aid authorised treatment plan and designated service providers being utilised. Up to R8 200 per policy per annum.
We often hear of cases where one of our policyholders passes away leaving their loved ones to pick up the pieces. They are left with the challenge to make sure that the gap cover they were used to is funded for a period of time.
Where a global fee has been negotiated between a medical aid and service providers for a specific procedure e.g. robotic surgery (which includes ALL costs related to that procedure) and service providers charge mounts in excess of this global fee (not related to a tariff rate, co-payment or sub-limit).
Up to R12 000 per policy per annum.
Dental Benefit: Up to an aggregate of R198 660 per insured person per annum. The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for authorised dental procedures performed in hospital or in doctor’s rooms and paid from the in-hospital or major medical benefit only.
The cover is limited to a percentage of the original scheme tariff, as follows:
Adults and dependants over 18 years of age: Treatment of impacted wisdom teeth, extractions, apicectomies or loss of teeth due to oncology or trauma ONLY.
Dependants up to 18 years of age: Any procedure or treatment.
The shortfall between the General Ward Rate and the Private Ward Rate, for hospitalisation for childbirth, where an admission to a Private Ward occurred. Limited to a maximum of R500 per day, for a total of 3 consecutive days.
Provides cover towards a policyholder’s medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed. 6 months. Up to a max. of R5 500 per month.
*Annual Limit: The Basic Gap, Casualty and Oncology Gap benefits are subject to the aggregate gap cover annual limit of R198 660 per insured person per annum. (This limit may change due to regulatory amendment).
Sashnee saved R89 591.78. By choosing Super Cover Plus, you can too.
Your medical aid, just like Sashnee’s, may impose a co-payment on Endoscopic or Laporoscopic Procedures, Hysterectomies as well as Colonoscopies.
Eliminate the financial worry from the stress of a hospital operation or stay.
Attending Doctor
Specialist Surgeon
Anaesthetist
Subtotal
Private Rate
R 118 420.34
R 12 673.87
R 131 094.21
Medical Aid Tariff
R 39 473.02
R 5 529.41
R 45 002.43
Gap Cover
R 78 947.32
R 7 144.46
R 86 091.79
Your Share
R 0
R 0
R 0
Medical Aid imposed co-payment (R 3 500.00)
Total
R 3 500.00
R 89 591.78
R 0
R 0
TERMS AND CONDITIONS APPLY
Sashnee saved R89 591.78. By choosing Super Cover Plus, you can too.
Your medical aid, just like Sashnee’s, may impose a co-payment on Endoscopic or Laporoscopic Procedures, Hysterectomies as well as Colonoscopies.
Eliminate the financial worry from the stress of a hospital operation or stay.
TERMS AND CONDITIONS APPLY
Sashnee saved R89 591.78. By choosing Super Cover Plus, you can too.
Your medical aid, just like Sashnee’s, may impose a co-payment on Endoscopic or Laporoscopic Procedures, Hysterectomies as well as Colonoscopies.
Eliminate the financial worry from the stress of a hospital operation or stay.
Attending Doctor
Specialist Surgeon
Anaesthetist
Subtotal
Private Rate
R 118 420.34
R 12 673.87
R 131 094.21
Medical Aid Tariff
R 39 473.02
R 5 529.41
R 45 002.43
Gap Cover
R 78 947.32
R 7 144.46
R 86 091.79
Your Share
R 0
R 0
R 0
Medical Aid imposed co-payment (R 3 500.00)
Total
R 3 500.00
R 89 591.78
R 0
R 0
TERMS AND CONDITIONS APPLY
Sashnee saved R89 591.78. By choosing Super Cover Plus, you can too.
Your medical aid, just like Sashnee’s, may impose a co-payment on Endoscopic or Laporoscopic Procedures, Hysterectomies as well as Colonoscopies.
Eliminate the financial worry from the stress of a hospital operation or stay.
Attending Doctor
Specialist Surgeon
Anaesthetist
Subtotal
Private Rate
R 118 420.34
R 12 673.87
R 131 094.21
Medical Aid Tariff
R 39 473.02
R 5 529.41
R 45 002.43
Gap Cover
R 78 947.32
R 7 144.46
R 86 091.79
Your Share
R 0
R 0
R 0
Medical Aid imposed co-payment (R 3 500.00)
Total
R 3 500.00
R 89 591.78
R 0
R 0
TERMS AND CONDITIONS APPLY
Gap Cover is an insurance policy that covers the difference between what your medical aid pays and what service providers charge for in-hospital expenses.
Claims – Manual and Automatic Processes
The policyholder is responsible for ensuring that claims are submitted and received by TRA within six (6) months from the treatment date. The policyholder should also ensure that TRA has the correct banking details into which we must pay the claim.
Claims – Manual Process
Policyholders need to submit the following:
Claims – Automatic Process
TRA receives claims submitted by selected medical aid schemes on behalf of the policyholder. Should your medical aid company have such an agreement with TRA, it is optional for the policyholder to submit their claim to TRA.
TRA will receive an electronic version of the claim and will process the said claim within seven working days of receipt thereof.
Co-payment and sub-limit claims must always be submitted manually by the policyholder (in addition to all the required claims documentation, please also provide proof of any direct payment/s made to these service providers).
Should a claim be rejected because additional information (e.g. pre-authorisation letter, medical aid statement, doctor’s account or the first two pages of the hospital account) is not received, all the information must be submitted to TRA within 31 days from the date of the request or the claim will be rejected as late/stale in terms of this policy and will not be paid.
Most people purchase medical aid and assume they will take care of all their medical bills. Unfortunately, this is not always true. Medical shortfalls can occur if you need medical care for any reason – accident or illness. You don’t want to add financial worry to the stress of being hospitalised, which is why you need Gap Cover.
Gap Cover ensures you don’t receive a massive bill if there’s a shortfall between what the doctors charge and what your medical aid will pay for in-hospital procedures.
Discrediting common Gap Cover misconceptions with Total Risk Administrators, revealing its crucial role in complementing medical aid.
Gap cover has become an essential safeguard against unforeseen medical expenses for South Africans. With so many options available, understanding
Total Risk Administrators (TRA) is committed to offering comprehensive gap cover for various out-of-hospital procedures. The following article expands on
16 Jersey Drive, Longmeadow
Business Estate East
16 Jersey Drive, Longmeadow
Business Estate East
16 Jersey Drive, Longmeadow
Business Estate East
Copyright © 2023. | Terms and Conditions Apply. | Errors and Omissions Excepted.
Copyright © 2023. | Terms and Conditions Apply. | Errors and Omissions Excepted.