Total Risk Administrators has four different product options with differing levels of cover. Absolute Cover Plus is the top level of Gap Cover provided by TRA. This option is sufficient in providing for Gap Cover, Casualty cover, Oncology Gap and Co-Payment cover as standard benefits, and also provides Sub-Limit cover, as well as an Oncology Extender benefit.
Absolute Cover Plus 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.
The Basic Cover, Casualty, Oncology Gap, Co-Payment cover, Sub-Limit cover and Oncology Extender benefit 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).
Some of the benefits which Absolute Cover Plus offer are:
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. This benefit will cover you for up to R15 000 per policy per annum FOR EMERGENCY MEDICAL TREATMENT IN A HOSPITAL CASUALTY UNIT ONLY (subject to the annual limit) EVEN IF YOUR MEDICAL AID COVERS NOTHING.
Oncology Gap:
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 Extender:
Includes any approved costs above annual scheme oncology limit but subject to scheme covering up to this limit. Unlimited per policy per annum but subject to R158 000 per insured person per annum.
Sub-Limit:
These days most medical aid schemes impose a sub-limit on in-hospital prostheses costs and some even limit the monetary amount that is available for MRI and CT and PET scans. In both cases, members may be out of pocket and will have to cover these costs themselves. Prosthesis sub-limit: Unlimited but subject to R158 000 per insured person per annum. Up to R30 000 per event. MRI / CT / PET scans sub-limit: This benefit provides for 2 MRI or CT or PET scans per policy per annum and up to R4 000 per scan, subject to the annual limit. No other sub-limits are included in this benefit.
Co-Payment:
This benefit will cover you for up to R50 000 per policy per annum (subject to the annual limit) for co-payment or deductible costs imposed by your medical aid, provided you make use of your medical aid’s designated service provider network. This benefit will cover you for up to R50 000 per policy per annum (subject to the annual limit) for co-payment or deductible costs imposed by your medical aid, provided you make use of your medical aid’s designated service provider network.
Accidental Death:
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 R8 000 in the event of death of the insured and / or spouse, and R4 000 in the event of the death of a dependant, caused by violent, accidental, external, or visible means.
Policy Extender:
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 premiums for a period of 6 months after the death of the original policyholder.
To find out more, click on the Absolute Cover link here.
