Signing up with a gap service provider ensures the financial shortfalls that your medical aid may not fully cover are covered.
This article will examine two leading gap service providers, Total Risk Administrators (TRA) and Dischem Gap Cover, highlighting their monthly premiums, coverage, and key benefits.
NB: It is important to note that Gap Cover is not a medical scheme or aid but rather a supplement to it. It provides financial protection against medical treatment payment shortfalls.
Gap Cover
Gap cover is a type of medical insurance that covers the difference between what your medical aid pays and the actual cost of the medical expense.
To qualify for Gap Cover, the member must already be on a medical aid plan. Gap Cover services are essential for avoiding unexpected out-of-pocket expenses and ensuring comprehensive financial protection during medical emergencies and in-hospital treatments.
Side By Side: Gap Cover Providers
For more detailed information, visit the official websites of both service providers.
Dischem: Overview and Features
Company Background:
Dischem Gap Cover is a well-established provider known primarily for its pharmacy and dispensary outlets. It now offers comprehensive gap cover options tailored to meet various medical needs.
Monthly Premium:
- Base Plan
- Principal/Adults: From R141 to R272, depending on age
- Children Under 18: R20
- Summit Plan
- Principal/Adults: From R189 to R370, depending on age
- Children Under 18: R29
- Additional Lifestyle Benefits: Only R55 per month.
Coverage Above Tariff:
- Up to 600%.
Key Benefits:
- In-hospital specialist claims
- Sub-limits
- Co-payment covers for hospital admissions and scans
- Specific out-of-hospital costs
- Cover for certain high-cost treatments
- Childbirth cover
- Oncology benefit
- Low exclusions
- No maximum entry or expiry age
- Automatic adult dependent cover
- Dental reconstruction benefit
- Accidental Casualty
TRA: Overview and Features
Company Background
- Total Risk Administrators (TRA) is a well-known gap service provider with a strong reputation for offering comprehensive coverage options.
Monthly Premium
- 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
Coverage Above Tariff
- Up to 700%.
Key Benefits
- Casualty
- Co-payments
- Sub-limits
- Certain dental procedures
- Global fee benefit
- Maternity private ward rate shortfalls
- Travel benefits
- Add-on options for female cancer cover
- TRA Assist Mobile App
- No maximum entry or expiry age
- Automatic adult dependent cover
- No general waiting period at the start date of the cover (only for specific claims such as maternity – 10 months waiting period)
- High levels of cover for in-hospital and over 50 out-of-hospital procedures
- Co-payment covers for hospital admissions and scans
- High levels of oncology cover
- Accidental Death Cover
- Hepstar Travel Cover
- Fast and efficient claim settlement.
Get To Know Your Gap Cover
Medical Aid Coverage and Benefits:
- TRA offers up to 700% coverage above the tariff, making it ideal for those seeking extensive coverage for a wide range of medical expenses.
- Dischem provides up to 600% coverage above the tariff, focusing on in-hospital specialist claims, sub-limits and a hospital booster benefit.
Cost-to-Value Ratio:
- TRA: More affordable with premiums starting at R99 (for single members).
- Dischem: Higher premiums starting at R141 -R272, depending on age
Overall Customer Service:
- TRA: Known for excellent customer service and a comprehensive support system, including TRA Assist. TRA is often praised for its broader coverage, being rated the top gap cover provider on Hellopeter..
- Dischem: Positive reviews on customer support, particularly appreciated for handling high-cost treatment claims and providing additional healthcare benefits in-store.
Flexibility and Customisation of Your Gap Cover:
- TRA offers a wider range of plans with more tiered options and benefits, allowing you to customise the kind of cover you want rather than being faced with only two options. TRA’s entry-level cover plan includes: Gap Cover, Casualty Cover, Oncology Gap, Policy Extender, Accidental Death Cover and TRA Assist powered by MobiMed.
- With Dis-Chem, there are only two options. The entry-level coverage plan covers Tariff Shortfalls up to a 500% sub-limit for surgical procedures or the shortfall of the internal prosthesis. The Dental Reconstruction Benefit is limited to R45,700, and the Hospital Booster provides a daily lump sum benefit in the event of an accident or premature birth, limited to a maximum of R28,500.
Any Additional Perks:
- TRA Gap cover offers its clients travel benefits with Hepstar and the TRA Assist mobile app, which offers Uber trips.
- The Dis-Chem Health Gap Cover offers lifestyle benefits that allow for additional discounts on its “lifestyle” product range.
For more detailed information, visit the official websites of both service providers.
Let’s Sum It Up
TRA offers extensive coverage and a wide range of benefits at a lower starting premium, making it a cost-effective option for comprehensive gap coverage that can be tailored to your needs.
TRA is best suited for individuals and families seeking extensive coverage across various medical scenarios at a competitive price.
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.