Gap-cover service providers are critical in bridging the financial shortfalls that medical aid schemes may not fully cover.
This article unpacks the gap cover offerings from Momentum Gap Cover and Total Risk Administrators (TRA), comparing their coverage options, premiums, and benefits.
Understanding Gap Cover
The difference between a medical aid scheme and Gap cover is that medical aid covers an allocated amount for a medical procedure (i.e. medical aid rates). However, that doesn’t mean that the specialists will charge within these medical aid rates. Gap cover works above and beyond those rates to protect the gap/shortfall between what your medical aid pays and what the specialist may charge.
Gap cover is supplementary insurance. This means that Gap Cover offered by TRA and Momentum, along with other providers, is not a medical aid (not a medical scheme) on its own. Gap cover is only applicable if clients are already covered by medical aid.
This coverage is essential for avoiding unexpected out-of-pocket expenses during medical emergencies in-hospital and certain out-of-hospital treatments.
Momentum GapCover: Overview and Features
For more detailed information, visit the official websites of both service providers.
Company Background:
Momentum GapCover provides supplementary cover for medical aid shortfalls.
Coverage and Benefits:
- Medical Practitioner Shortfalls: Depending on the plan, Momentum can cover up to 1,200% of the Momentum Medical Scheme Rate.
- Allied Professional Costs: Momentum’s plans cover shortfalls for in-hospital care provided by in-hospital allied professionals (Chiropractors, Clinical technologists, Genetic counsellors, Myotherapists, Occupational therapists, Orthoptists, Osteopaths, Perfusionists, Physiotherapists, Podiatrists, Speech pathologists), up to three times the amount paid by the medical scheme, with a limit of R2 500 per policy per year.
- Co-payments: Covers co-payments for hospital admissions, procedures, and certain day clinic treatments, excluding voluntary non-designated Service Provider (non-DSP) use.
- Oncology Co-payments: Covers a 20% co-payment after reaching the medical scheme limit.
- Casualty Benefits: Momentum covers emergency room fees up to R23,000 per policy per year, subject to certain limits and conditions.
- Internal Prosthesis Shortfalls: Provides up to R35,000 per policy per year (stents and pacemakers are covered for up to R8000 per event), subject to certain limits and conditions.
Assist Benefits:
- Cancer Assist: Provides up to R20,000 for certain cancer diagnoses, with an additional R15,000 if treatment costs exceed R200,000.
- Breast Reconstruction: Offers R15,000 for non-affected breast reconstruction following a mastectomy.
- Accident Assist: Pays R55,000 for death or permanent disability due to an accident, and doubled to R110,000 if caused by a violent crime.
- Premium Waiver: Covers up to R36,000 for dependents if the policyholder dies or becomes permanently disabled.
- Trauma and Bereavement Counselling: Provides up to R30,000 per policy per year.
Momentum GapCover Premiums:
- Under 30 years (Millennial GapCover): R236 per month
- Under 42 years: R379 per month
- From 42 years: R533 per month
- From 65 years: R669 per month
TRA Gap Cover: Overview and Features
Company Background:
Total Risk Administrators (TRA) is known for its comprehensive gap cover options, providing extensive coverage for various medical expenses.
Coverage and Benefits:
- Coverage Above Tariff: TRA offers coverage up to 700% above the tariff, ideal for extensive medical expense coverage.
- Co-payments and Sub-limits: Includes benefits for co-payments and specific sub-limits.
- Maternity Shortfalls: Covers private ward rates for maternity.
- Travel Benefits: TRA offers additional coverage from Hepstar for medical expenses incurred while travelling outside South Africa.
- Oncology Cover: Provides high levels of oncology coverage on higher plans.
- Add-on Options: Includes optional female cancer cover
- Age: No maximum entry or expiry age.
TRA Assist Mobile App Features:
- Home Drive – 6 free Home Drive or Uber trips per policy per annum.
- Panic Button – Access to 24/7 emergency services at the push of a button.
- Roadguard – get security assistance during a breakdown.
- Medical Health and Trauma Counselling Line – get unlimited access to nurses and counselling for trauma related issues.
- Facilitate your claims submissions for fast and efficient settlements.
- Access a comprehensive travel benefit.
- Update your insurance profile details.
TRA Gap Cover Premiums:
- Basic Cover 300: From R99 per month
- Vital Cover Plus: From R300 per month
- Super Cover Plus: From R330 per month
- Absolute Cover Plus: From R590 per month
Let’s Sum It Up
For more detailed information, visit the official websites of both service providers.
Coverage for Medical Expense Shortfalls:
- Momentum GapCover: Offers extensive shortfall coverage up to 1,200%, depending on the plan.
- TRA: Provides up to 700% (regardless of the plan) coverage above tariff, catering to various medical needs.
Cost-to-Value Ratio:
- Momentum: Offers a range of premiums based on age and plan, providing substantial benefits.
- TRA: Offers competitive premiums starting at R99, with extensive benefits.
Customer Service:
- Momentum is known for its seamless claims process and comprehensive coverage. However, no dependants may be added to gap cover if the principal insured is over the age of 65, or on the Millenial GapCover option at the time of applying for the cover.
- TRA: Highly praised for excellent customer service, TRA is rated the top provider in Gap Cover on Hellopeter.
Plan Flexibility and Customisation:
Both providers offer a variety of plans that can be tailored to meet specific medical and financial needs.
Additional Perks:
- Momentum: Offers specific benefits like their Baby Bump benefit and coverage for robotic procedures.
- TRA: Provides travel benefits through a partnership with Hepstar and access to the TRA Assist mobile app.
TRA’s Take
Momentum GapCover and TRA Gap Cover both offer comprehensive solutions to cover medical expense shortfalls.
TRA offers broad coverage at competitive rates, focusing on flexibility (with regard to their plans) and comprehensive benefits.
Choosing the right gap cover provider depends on your specific medical needs, financial situation, and preference for additional benefits. For more detailed information, it is recommended to review the official websites of both service providers.
Get a quote from TRA today!
