It’s important to read through the Terms and Conditions of your Medical Gap Policy to ensure that you know exactly what will and what won’t be covered. Do remember that Gap Cover is there to assist with medical expenses where there might be a shortfall between what your medical aid will pay and what the private doctors charge.
Most Medical Gap Insurance exclusions
> Ward costs in a hospital facility
> Upgrades to a private room
> Medication (in-hospital and out-of-hospital)
> External prostheses
> Wheelchairs or crutches
> Routine medical examinations, such as ultrasounds
> Mental health disorders
> Cosmetic procedures
> Out-of-hospital dental treatments
> Home or private nursing
> Co-payments for any procedure while you are still in a waiting period
> MRI, CT, and PET scans where your medical aid does not pay any portion of the account
Your Gap Plan may cover the following
> Some out-of-hospital procedures that used to require hospitalisation
> Co-payments for certain specified hospital procedures
> A contribution to cancer treatment costs once your cancer benefit on your medical scheme has run out
> The shortfall on internal prostheses up to a stipulated maximum
> A lump-sum for first-time cancer diagnosis (terms and conditions usually apply)
> Lump-sum benefit for accidental death or permanent total disability
> Dental repairs in the case of accidental injury
> Some casualty costs
Terms and Conditions Apply
Emergency visits to the Emergency Room at a hospital for accidents
If you have a medical aid with a Medical Savings Account, you would usually be able to claim this visit from your savings. Many of the medical gap plans will allow you to claim a reimbursement for this trauma room visit under the casualty unit benefit. This may apply to accidents only, or, for children under the age of 8 during certain days and times.
If you require more information on our Medical Gap Policy Insurance, you can have a look at our TRA Gap Cover brochure to get you and your family covered. For any other queries, contact our Total Risk Administrators specialists today: www.totalrisksa.co.za
