Benefits: Super Cover Plus*
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.*
*Annual Limit: The Basic Gap, Casualty, Oncology Gap & co-payments benefits are subject to the aggregate gap cover annual limit* of R158 000 per insured person per annum. (This limit may change due to regulatory amendment).
- Sometimes emergencies occur and you need to rush to casualty.
- Your medical aid does not always cover the total costs in full. Whether payment comes from your medical scheme savings account or day-to-day benefit, the gap will be covered.
- Sometimes, your medical aid will not account for anything regarding this casualty visit, leaving you to cover the bill in full.
- This benefit will cover you for up to R7 500 per policy per annum (subject to the annual limit*) EVEN IF YOUR MEDICAL AID COVERS NOTHING.
- Oncology Gap Benefit: Up to an aggregate of R158 000 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 Co-Payment Benefit: Up to R50 000 per policy per annum
- The co-payment or deductible that your medical aid charges you for certain in-hospital procedures. This co-payment is NOT related to the scheme tariff and service provider charge shortfall or designated service provider none arrangements, OR
- For claims where the medical aid will only pay a percentage for the approved treatment and the policyholder needs to pay the remaining percentage of the account.
- All costs to be within the annual scheme oncology limit.
- These days most medical aid schemes insist that members pay an upfront amount for certain diagnostic and endoscopic procedures like gastroscopies and colonoscopies.
- This amount is known as a co-payment or deductible.
- This benefit will cover you for up to R50 000 per policy per annum (subject to the annual limit*) for copayment or deductible costs imposed by your medical aid, provided you make use of your medical aid’s designated service provider network.
- NO cover is provided where a policyholder voluntarily chooses to make use of a service provider that is not part of their medical aid’s service provider network.
- 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.
- This benefit will provide an amount of R6 000 in the event of death of the insured and/or spouse, and R3 000 in the event of the death of the dependant, caused by violent, accidental, external, or visible means.
- 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.
- This benefit will provide for your gap cover contributions for a period of 6 months after the death of the original policyholder.
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- Benefits: Home Drive, Panic Button, Nurse Line.
*CO-PAYMENT EXAMPLES THAT MAY BE IMPOSED BY MEDICAL AID – 2019
|Endoscopic Procedures||R3 026.00|
|Laporoscopic Procedures||R3 630.00|
*Cover provided by Super Cover Plus and Absolute Cover Plus only.
OBSTETRIC CARE/CHILDBIRTH – C SECTION (PMB EXAMPLE) – 2019
|Attending Doctor||Private Rate||Medical Aid Tariff||*Gap Cover||Your Share|
|Gynaecologist||R 24 763.01||R 7 167.65||R 17 595.36||NIL|
|Specialist Anaesthesiologist||R 18 553.05||R 5 767.14||R 12 785.92||NIL|
|TOTAL||R 43 316.06||R 12 934.79||R 30 381.28||NIL|
*Cover provided by all 4 Gap products.
*Subject to Product Option benefits and Imposed Waiting Periods.
*Subject to the aggregate gap cover annual limit of R158 000 per insured person per annum.
(This may change due to regulatory amendment).