Total Risk Administrators has four different product options with differing levels of cover. Super Cover Plus is the third level of Gap Cover provided by TRA. This option is sufficient in providing for Gap Cover, Casualty cover and Oncology Gap as standard benefits, and also provides important Co-Payment cover. Super 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-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.)
Some of the benefits which Super Cover Plus offer are:
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 R7500 per policy per annum (subject to the annual limit*) EVEN IF YOUR MEDICAL AID COVERS NOTHING. NB: Subject to the casualty treatment being an accident caused by an external force- no internal symptoms/illness is covered.
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).
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 a 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 premiums for a period of 6 months after the death of the original policyholder.
Note: All material on this 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 judgment 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. https://goo.gl/dAak9u