This article will unpack the medical gap cover insurance offerings from two prominent providers: Total Risk Administrators (TRA) Gap Cover and Sanlam Gap Cover.
Looking at their coverage, premiums, and benefits to help you choose the right plan and provider for your needs.
Understanding Gap Cover
Having medical aid is one thing but having complete peace of mind when it comes to your hospital bills being covered is another.
Not many people know that medical aid only covers a pre-determined rate for in- and specific out-of-hospital treatments. This means that if you have a specialist charging more than that rate, you will be left with the shortfall.
Gap Cover is a supplementary insurance, in addition to medical aid, that covers the difference between what your medical aid pays and the actual cost of medical treatments. This cover helps people avoid unexpected out-of-pocket expenses during hospital stays, surgeries, and out-of-hospital treatments.
TRA Gap Cover:
Company Background:
Total Risk Administrators (TRA) is a trusted provider of comprehensive gap cover plans designed to meet various medical and financial needs. Our expert team, with extensive experience in insurance, clinical, and healthcare administration, ensures you have a seamless experience with our gap cover.
Coverage and Benefits:
- Coverage Above Tariff: TRA provides up to 700% coverage above the medical aid tariff, ensuring protection for high-cost medical treatments.
- Co-payment and Sub-limits: Includes benefits for co-payments related to hospital admissions and specific procedures.
- Maternity and Oncology Cover: High levels of coverage for maternity private ward rates and extensive oncology treatment support.
- Travel Benefits: Provides additional coverage for medical expenses incurred outside of South Africa.
- TRA Assist Mobile App: Easy access to member benefits and quick claims processing through the app.
- No Maximum Entry or Expiry Age: TRA offers gap cover with no age restrictions, making it accessible to a broader demographic.
TRA 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
Sanlam Gap Cover:
Company Background:
Administered by Kaelo Risk and insured by Centriq Insurance, Sanlam Comprehensive Gap Cover offers protection against medical expense shortfalls, helping policyholders manage unexpected medical costs effectively.
Coverage and Benefits:
- Tariff Shortfalls: Sanlam covers up to 500% of the medical aid rate, ensuring that most specialist and hospital costs are fully covered.
- Oncology Coverage: Provides coverage for oncology treatments, including tariff shortfalls, sub-limits, and oncology co-payments (up to 20%).
- Out-of-Hospital Tariff Shortfalls: Covers up to 500% of the medical aid rate for outpatient procedures.
- Family Booster: A lump sum of R15,900 is paid for premature birth.
- Casualty Cover for Child Illness and Accidental Harm: Covers emergency treatments in casualty wards for children under 12 and accidental harm for all insured individuals.
- Hospital Booster: Offers daily cash payouts for hospital stays due to accidents or premature births, with lump sums up to R29,300.
- Mediclinic Extender Benefit: Offers additional cover for co-payments, private ward costs, and cancer lump sum payouts when using Mediclinic hospitals.
Premiums for Sanlam Gap Cover:
- Individuals younger than 60 years: From R246 per month
- Families younger than 60 years: From R429 per month
- Individuals older than 60 years: From R494 per month
- Families older than 60 years: From R864 per month
- Mediclinic Extender Add-on: R43 to R166 per month, depending on age and plan.
Side By Side Analysis
Coverage for Medical Expense Shortfalls:
- TRA: Provides up to 700% coverage above the medical aid tariff, catering to a wide variety of medical treatments and procedures.
- Sanlam: Offers up to 500% coverage above the medical aid rate, with additional benefits like out-of-hospital tariff shortfalls.
Cost-to-Value Ratio:
- TRA: TRA’s competitive pricing starts at R99 per month, offering cover and benefits that cater to both individual and family needs.
- Sanlam: Sanlam Medical Gap Cover starts at R246 per month for individuals and R429 for families, providing a well-rounded plan that includes benefits.
Customer Service and Additional Benefits:
- TRA: Rated as a Top Gap Cover Provider on Hellopeter, complimented for its easy claims process and convenient TRA Assist mobile app.
- Sanlam: Provides additional features like the Mediclinic Extender Benefit and lump sum payments for hospital stays.
Plan Flexibility and Customisation:
- Both TRA and Sanlam offer a range of plans to suit various medical needs and financial situations.TRA’s extensive coverage options allow for more flexibility, while Sanlam’s plans focus on additional benefits, especially for families.
Let’s Sum It Up
TRA and Sanlam offer gap cover solutions, each catering to different needs and preferences.
TRA is ideal for those seeking high coverage limits with affordable premiums, while Sanlam Gap Cover provides comprehensive protection with added features like the Mediclinic Extender Benefit, making it particularly attractive for families and those seeking extra peace of mind in the event of serious medical conditions.
When choosing a comprehensive gap cover plan, consider your medical needs, budget, and the specific coverage you require.
For more detailed information, visit the official websites of both service providers.
TRA’s Take
When choosing a gap service provider, consider your specific medical needs, age, and budget.
Review the benefits and coverage details carefully to ensure you select the provider that best meets your requirements.
Get a quote from TRA today!
For more detailed information, visit the official websites of both service providers.