Rather have it and not need it then not have it and need it! Medical aid costs can run into the hundreds of thousands and having a medical aid plan in place (along with gap cover too!) can be the difference when an emergency happens. Even if you are the fittest and healthiest person – accidents can happen and it is important to have a plan in place.

Why is Medical Aid so important?

The cost of healthcare especially in this country is incredibly high and should you find yourself in any kind of accident or medical situation, a Medical aid can be the saving grace for any individual or family when it comes to the financial implications of an emergency situation. What’s great about a Medical Aid plan is it’s not really a one size fits all and you can choose a plan to suit your needs. You can look after your family with peace of mind.

In order to get the right plan for you and your family, it’s important to do some research and really figure out what costs you can afford for the type of plan that you will need. There are various Medical Aid websites to visit to get comparisons as well as Medical Aid that you can talk to, who can give the information that you need before you sign up.

Common Medical Aid terms explained by Sanlam Reality:

(View the full list visit here.)

Prescribed Minimum Benefits or PMBs:
Currently there is a list of 270 medical conditions (including HIV/AIDS, cancer and strokes) and 25 chronic conditions (such as diabetes, asthma and high blood pressure) for which all medical schemes have to provide diagnostic and treatment cover.

Out-of-hospital/day-to-day cover:
These are medical costs that do not involve a stay in hospital. These include visits to your GP or treatment and medicine for colds and other common ailments.

These are the out-of-pocket payments you would have to make for the shortfall between what your medical aid will cover and what your healthcare provider charges. Note: Healthcare providers are not obliged to charge medical aid rates, and their fees can be higher than what your scheme will cover, so it’s worthwhile finding out what this difference will be before your consultation. In certain situations, medical schemes will waive the co-payment if you don’t have another treatment option, other treatments haven’t worked or it’s an emergency.

This refers to the prior consent in the form of a pre-authorisation number that you require from your medical aid if you are going into hospital for a scheduled or pre-arranged procedure.

Late-joiner penalty:
In very simple terms, medical aids rely on healthy members to subsidise older and sicker members. Therefore your premiums are higher if you join a scheme at age 35 or older because you’re perceived as being a bigger risk.

This is where your day-to-day medical expenses are paid out of that savings account, if you have one with your medical aid plan.

Waiting period:
When you join a medical aid for the first time or haven’t been a member for 90 days, you’ll be subjected to a waiting period before you can start claiming.

Medical Gap Cover Questions & Queries

A Gap Cover plan is what you can also get, in order to cover any medical aid in-hospital shortfalls. Having a medical aid is the first step, but even then, you might have to cover costs to cover the differences between what a doctor may charge over and above medical aid rates.

If you have any more queries or questions regarding anything related to TRA Gap Cover, why not reach out to our helpful specialists here. You can also visit our Gap Cover here.


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 any matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgment 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.