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Understanding The Benefits: TRA Gap Cover Explained

TRA gap cover benefits

As the cost of medical expenses continues to rise, having comprehensive healthcare coverage cannot be overlooked. While general medical aid schemes in South Africa offer valuable protection, they may not cover all medical costs and expenses applicable in various situations. This can leave families and individuals vulnerable to potential financial burdens as bills rack up.

Whether month-to-month medical expenses or procedure-induced medical costs, having gap cover in place can save you in the long run. By understanding the benefits of the gap cover options offered by Total Risk Administrators (TRA), our clients are better equipped to know they are covered when they need it most.

What is Gap Cover?

Gap cover is a supplementary insurance option that works hand-in-hand with medical aid cover to step in to fill the gap between what is charged by a medical practice and what is covered by a medical aid provider for in-hospital expenses. With medical procedures or treatments being needed in various cases, the coverage and costs will vary accordingly. Unfortunately, quite frequently, individuals can be left to fit the bill of what is outstanding due to medical expense shortfalls.

Gap cover ensures that these costs and financial burdens are mitigated as much as possible, depending on the coverage plan in place. In essence, it is an extra layer of protection, offering peace of mind and added financial security alongside existing medical aid cover. At TRA, we are dedicated to delivering exceptional gap cover benefits to our members to ensure the safeguarding of their health and that of their loved ones.

Why Have Gap Cover?

Gap cover is designed to bridge the financial gap between the medical fees charged by healthcare providers and the limited coverage provided by traditional medical aid schemes.

Medical aid plans can often impose reimbursements that are significantly lower than the actual costs charged by hospitals, medical specialists, or other medical practitioners. This can often result in a member being responsible for the excess amount, sometimes being unrealistic to be covered by the member alone. Having gap cover in place can mean these unforeseen excess amounts can be covered or at least contributed to by the gap cover provider and not solely left to the individual to pay.

This ensures that gap cover policyholders are not burdened with unexpected bills that can result from medical expense shortfalls. It must be noted that members must be aware of applicable waiting periods and policy benefits before deciding on committing to gap cover.

TRA Gap Cover Benefits

TRA offers a range of benefits associated with our gap cover plans. Depending on which plan a member opts for, the benefits will differ, but they can include the following:

Travel Benefit

When our members plan to take a trip abroad, they can enjoy access to a range of travel benefits provided by TRA gap cover products.

TRA travel benefits include but are not limited to:

  • Emergency Medical and Related expenses: R600 000. Excess R500.
  • COVID-19 Extension: Emergency inpatient or outpatient treatment due to COVID-19 R600 000. Excess R500.
  • Medical evacuation, repatriation or transportation to a medical centre – FULL COST covered when arranged by Hepstar Financial Services. Hospital Cash benefits R500 per day (max R3 000).
  • Inconvenience Cover: Baggage Cover: R5 000 for theft, damage or loss by travel supplier.

Members are only eligible for travel benefits if they:

  • Are named as a policyholder on a TRA Gap Cover policy on the Policy Schedule;
  • Are a resident of South Africa travelling to another country;
  • Are under the age of 71 years;
  • Are travelling for business or leisure purposes, not with the intention to permanently or temporarily reside or take up work in another country;
  • Are travelling no more than 180 consecutive days;
  • Are healthy, fit to travel and are not travelling against the advice of a Medical Practitioner.

Uber Benefit

Our members can enjoy six Uber trips per policy per annum (limited to a 50km radius). This is our way of encouraging responsible driving and making sure our members are safe and sound. This can come in handy when one is left with a broken down car, needing a lift home after drinking at an event, or needing to get to a doctor when driving themself is not an option.

Maternity Private Ward Benefit

For our members looking forward to welcoming their babies into the world, TRA offers maternity private ward benefits that provide our mothers-to-be with R1000 per day for a total of three consecutive days should they use a private ward

Panic Button

Our members across all of our gap cover plans have 24-hour access to a crisis manager included. This entails members being supported by a trained professional in crisis management who will guide them through an emergency.

Other Gap Cover Benefits

As members of TRA gap cover, our clients can access a wide range of gap cover benefits when they need it most. The extent of eligibility will depend on the type of plan a member is part of, with most benefits being applicable to members on the higher packages. TRA gap cover plans range from Basic Cover 300 and Vital Cover Plus to Super Cover Plus and Absolute Cover Plus – all differing across the board with what they include, offer and cover.

The variety of other gap cover benefits can include:

  • Prescribed minimum benefits
  • Co-payment benefits (in-network, out-of-network or out-of-hospital scans)
  • Sub-limit benefits (internal prostheses, MRI/CT/PET scans, colonoscopies and gastroscopies
  • Dental benefit for authorised trauma and oncology dental hospitalisation
  • Global fee benefit
  • Oncology gap benefit
  • Oncology co-payment benefit (in-network or out-of-network)

Bridging the Gap with TRA

As a leading gap cover provider in South Africa, TRA offers a range of innovative products and services designed to bridge the gap and provide our members with added protection regarding their healthcare expenses. Besides the list of benefits that come alongside our gap cover, TRA is a trusted gap cover provider for reasons that extend far beyond just that.

Offering gap cover plans at competitive rates, we aim to make gap cover accessible to a wide range of individuals across South Africa. We understand that a member’s medical aid can be a substantial expense. By paying a relatively modest premium, you can gain access to substantial financial protection against potential medical cost shortfalls.

Aiming to streamline the claims process, we also ensure that our members experience minimal hassle when submitting their gap cover claims. With a focus on quick turnaround times, TRA works diligently to process and settle claims from medical aid shortfalls efficiently.

Covering Your Peace Of Mind

In a country where quality healthcare should be accessible to all, TRA’s gap cover benefits offer a ray of hope to those facing medical uncertainties. By covering the gap left by medical aid schemes, TRA provides individuals and families with a safety net that shields them from exorbitant in-hospital medical expenses.

With TRA’s gap cover, South Africans can embrace the future with confidence, knowing that their health and financial well-being are in safe hands. To learn more about how you can benefit from TRA, explore our website or contact us today to get the process started.

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 and 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.


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