Vital Cover Plus is our second entry level product, which is sufficient in providing for Gap cover, Casualty cover, Co-Payment cover, Sub-Limit cover and a separate Oncology benefit that provides Oncology Gap cover and Oncology Co-Payment cover.
R300 p/m
R300 p/m
R450 p/m
The Vital Cover Plus option 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.
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.
Provides cover towards a policyholder’s medical aid contribution in the case of the accidental death of the main policyholder. Cover is limited to the lower of the actual medical aid contribution or the maximum amount allowed. 6 months. Up to a max. of R4 400 per month.
*Annual Limit: The Basic Gap, Casualty and Oncology Gap benefits are subject to the aggregate gap cover annual limit of R198 660 per insured person per annum. (This limit may change due to regulatory amendment).
Ezra saved R 74 569.15. By choosing Vital Cover Plus, you can too.
Your medical aid, just like Ezra’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.
Eliminate the financial worry from the stress of a hospital operation or stay
Attending Doctor
Orthopaedic Surgeon
Specialist Anaesthesiologist
Private Rate
R 135 269.03
R 42 516.76
R 177 785.79
Medical Aid Tariff
R 87 464.90
R 14 343.06
R 101 807.96
Gap Cover
R 47 804.13
R 26 765.02
R 74 569.15
Your Share
R 0
R 0
R 0
TERMS AND CONDITIONS APPLY
Ezra saved R 74 569.15. By choosing Vital Cover Plus, you can too.
Your medical aid, just like Ezra’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.
Eliminate the financial worry from the stress of a hospital operation or stay.
TERMS AND CONDITIONS APPLY
Ezra saved R 74 569.15. By choosing Vital Cover Plus, you can too.
Your medical aid, just like Ezra’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.
Eliminate the financial worry from the stress of a hospital operation or stay.
Attending Doctor
Orthopaedic Surgeon
Specialist Anaesthesiologist
Private Rate
R 135 269.03
R 42 516.76
R 177 785.79
Medical Aid Tariff
R 87 464.90
R 14 343.06
R 101 807.96
Gap Cover
R 47 804.13
R 26 765.02
R 74 569.15
Your Share
R 0
R 0
R 0
TERMS AND CONDITIONS APPLY
Ezra saved R 74 569.15. By choosing Vital Cover Plus, you can too.
Your medical aid, just like Ezra’s, may not cover 100% of the private rate of the medical practitioner, resulting in a shortfall payment due from you.
Eliminate the financial worry from the stress of a hospital operation or stay.
Attending Doctor
Orthopaedic Surgeon
Specialist Anaesthesiologist
Private Rate
R 135 269.03
R 42 516.76
R 177 785.79
Medical Aid Tariff
R 87 464.90
R 14 343.06
R 101 807.96
Gap Cover
R 47 804.13
R 26 765.02
R 74 569.15
Your Share
R 0
R 0
R 0
TERMS AND CONDITIONS APPLY
Gap Cover is an insurance policy that covers the difference between what your medical aid pays and what service providers charge for in-hospital expenses.
Claims – Manual and Automatic Processes
The policyholder is responsible for ensuring that claims are submitted and received by TRA within six (6) months from the treatment date. The policyholder should also ensure that TRA has the correct banking details into which we must pay the claim.
Claims – Manual Process
Policyholders need to submit the following:
Claims – Automatic Process
TRA receives claims submitted by selected medical aid schemes on behalf of the policyholder. Should your medical aid company have such an agreement with TRA, it is optional for the policyholder to submit their claim to TRA.
TRA will receive an electronic version of the claim and will process the said claim within seven working days of receipt thereof.
Co-payment and sub-limit claims must always be submitted manually by the policyholder (in addition to all the required claims documentation, please also provide proof of any direct payment/s made to these service providers).
Should a claim be rejected because additional information (e.g. pre-authorisation letter, medical aid statement, doctor’s account or the first two pages of the hospital account) is not received, all the information must be submitted to TRA within 31 days from the date of the request or the claim will be rejected as late/stale in terms of this policy and will not be paid.
Most people purchase medical aid and assume they will take care of all their medical bills. Unfortunately, this is not always true. Medical shortfalls can occur if you need medical care for any reason – accident or illness. You don’t want to add financial worry to the stress of being hospitalised, which is why you need Gap Cover.
Gap Cover ensures you don’t receive a massive bill if there’s a shortfall between what the doctors charge and what your medical aid will pay for in-hospital procedures.
Discrediting common Gap Cover misconceptions with Total Risk Administrators, revealing its crucial role in complementing medical aid.
Gap cover has become an essential safeguard against unforeseen medical expenses for South Africans. With so many options available, understanding
Total Risk Administrators (TRA) is committed to offering comprehensive gap cover for various out-of-hospital procedures. The following article expands on
16 Jersey Drive, Longmeadow
Business Estate East
16 Jersey Drive, Longmeadow
Business Estate East
16 Jersey Drive, Longmeadow
Business Estate East
Copyright © 2023. | Terms and Conditions Apply. | Errors and Omissions Excepted.
Copyright © 2023. | Terms and Conditions Apply. | Errors and Omissions Excepted.