TRA has a range of medical gap products in South Africa. Gap cover administered by Total Risk Administrators (TRA) is designed to provide an additional funding safety measure for members of medical schemes.
Gap cover pays for the difference in costs for what medical specialists charge for in-hospital procedures and what your chosen medical aid is willing to pay. Please note that Gap cover is not a substitute for a medical aid but rather an additional product designed to increase your medical scheme coverage.
Why do I need Gap Cover?
In South Africa, ever-increasing medical costs have placed increased pressure on your medical aid, making Gap cover in the broader sense mandatory. Getting Gap cover with no waiting period is exceptionally important, especially in instances whereby there are dependants on medical aid policies.
It is essential to understand Gap cover and the subsequent waiting periods generally imposed on medical policies in South Africa.
How can I get Gap cover with No waiting period?
A waiting period on any medical scheme can often prove confusing, and a Gap cover waiting period is no different.
At Total Risk Administrators, we have tailored our Gap cover to have no general three-month waiting period. And, if you can provide proof of a pre-existing medical expense shortfall policy, with active membership not longer than 90 days prior, the pre-existing condition waiting periods may be reduced or waived.
For more information and a comprehensive breakdown of TRA’s waiting periods, please click here.
What waiting periods are generally imposed on Gap cover policies in South Africa?
Waiting periods may be applicable from the policy join date until the specified period is complete.
We can break down the Gap cover policy for waiting periods in South Africa into four major categories:
1. General waiting period:
The general three-month waiting period means that you cannot claim or submit a claim for the first three months from the join date on Gap cover. In most cases, this general waiting period will be waived if the policyholder claims as a result of an accident.
2. Specified procedure waiting period:
This waiting period is imposed on Gap cover policies for a specific list of procedures for a certain period which is usually 12 months. Operations that involve joint replacement, spinal procedures, scopes, hernia repairs, cardiovascular procedures, and cataract removal are generally included here. This waiting period, once again, may be waived if it is a required accidental injury.
3. Cancer-related waiting period:
It is not uncommon for Gap cover policies to include a 12-month waiting period for pre-diagnosed cancers. This waiting period is calculated from the original join date.
4. Pre-existing illness waiting period:
Depending on your provider, pre-existing illnesses generally include a waiting period of between 6 and 12 months, unless there is an accident that requires treatment.
How much does Gap cover cost?
Total Risk Administrators offers four different Gap cover packages to choose from according to your requirements:
- Basic Cover 300, starting at R99 p/m
- Vital Cover Plus, starting at R250 p/m
- Super Cover Plus, starting at R280 p/m
- Absolute Cover Plus, starting at R495 p/m
Each package is individually designed to meet your chosen level of cover over and above your medical scheme. It is strongly advisable not to base your chosen Gap cover provider on price but on what coverage is required over and above your current medical aid scheme.
For more information on the product benefits, visit the TRA Gap cover page here.
How do I claim from gap cover?
TRA has a variety of claims submission tools that include the online claim tool that can be accessed here.
Other methods of submitting a claim include our Mobile App as well as contacting the claims department directly: https://totalrisksa.co.za/contact-us/
What Our Customers Say:
TRA is proud to announce that we rank as a top Gap Cover provider according to Hello Peter.
It is crucial that our customer service levels remain above expectations, and we value individual feedback.
Should you require more information on TRA Gap cover, you can have a look at the TRA Gap cover brochure. For any other queries, contact Total Risk Administrators to speak to one of the qualified specialists today.
Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply. Click here for terms and conditions.
Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply. Please follow the link to our terms and conditions: https://totalrisksa.co.za/downloads/TRA-GapCover-Terms-Conditions-Doc2022.pdf">https://totalrisksa.co.za/downloads/TRA-GapCover-Terms-Conditions-Doc2022.pdf