When it comes to Gap Cover, many are unsure as to exactly what Gap Cover is, and how it can assist them with in-hospital expenses. In most circumstances with a medical aid, there may be a difference in what your medical scheme will pay and what private doctors charge. This means that not all of your in-hospital costs will be covered and you may be left out of pocket with extra medical bills. A Gap Cover policy is a short-term insurance product, designed to provide extra cover and financial protection to those already utilizing medical aid. Gap Cover can cover the cost of the shortfall between your Medical Scheme Tariff and the rates charged by private healthcare providers.
How does a Gap Cover plan work?
A Gap Cover plan is quite straightforward. You’ll first need to sign up for a Gap Cover product option which suits you, and provide all of your relevant details. Gap Cover is normally charged as a monthly premium, and this will most likely be charged to your account via a direct debit every month.
When it comes to a Gap Cover plan, there are many options available to you. It’s wise to take some time to look at each package, and find out how much cover you will need for you, or your family, and review what extra benefits are included. Entry-level Gap Cover products may only cover you for things like Casualty Cover and Oncology Cover, whereas more premium products will include additional benefits such as Co-Payment Cover, Sub-Limit Cover and more!
With every TRA Gap Cover option, we include our unique and complementary mobile app service, TRA Assist ( Powered by ER24 Assist).This service includes great benefits, such as a Home Drive Service (including Uber), an Emergency Panic Button, a Medical Health Line, a Trauma Counselling Line and Claims Submissions.
How much Gap Cover do I need?
Deciding how much Gap Cover you will need can be a difficult and daunting decision. You’ll always want to have the best cover for your personal situation and it’s wise to take into account how much you can afford on a monthly basis and other lifestyle preferences which will guide your decision in picking a Gap Cover package. Deciding on the best Gap Cover package for you may come down to what extra benefits you may need.
TRA offers four Gap Cover packages tailored to your needs, these are:
> Basic Cover 300, starting at R99 p/m
> Vital Cover Plus, starting at R220 p/m
> Super Cover Plus, starting at R250 p/m
> Absolute Cover Plus, starting at R450 p/m
Our TRA Brochure breaks down each one of our products in an easy to consume manner, allowing you to decide what benefits are included and what you may need. Download it here:https://totalrisksa.co.za/wp-content/uploads/2020/08/TRA_2020-Booklet-2.pdf
What is the waiting period for Gap Cover?
When first signing up for Gap Cover or other medical insurance products, medical schemes are authorised by the Medical Schemes Act to impose a 3 month general waiting period, or up to a 12-month condition specific waiting period for pre-existing medical conditions.
Put simply, a General waiting period of up to three months means that members are entitled to pay their monthly contribution, but are not allowed to claim for benefits.
A Condition-specific waiting period of up to 12 months follows the same protocol. Members are entitled to pay their monthly fees, however, any pre-existing medical conditions will be exempt and the medical costs related to these pre-existing conditions are for the member’s own pocket.
For the TRA Gap Cover options, there is no general three (3) month waiting period. If a membership certificate is provided to show proof of a previous membership on another legitimate Gap Cover provider (and this membership is for a period of at least 24 months with no break in cover to the benefit start date of this policy), the relevant pre-existing condition Gap waiting periods i.e. 10 months, 9 months and 6 months which run concurrently, may be waived.
To find out more detail on TRA’s existing medical condition waiting periods and what waiting periods apply to which medical conditions, read our detailed article here: https://totalrisksa.co.za/what-is-the-waiting-period-for-gap-cover/
How do I claim from Gap Cover Insurance?
Submitting a claim may vary from provider to provider. At TRA , we have a manual and automatic process of filing claims. It remains the policyholder’s responsibility to ensure that claims are submitted to and are received by TRA within six (6) months from the date of treatment, as well as ensuring that TRA has the correct banking details into which the claim must be paid.
Generally, submitting a manual claim will require policyholders to submit all the required documentation to substantiate their claim. This will depend on the insurance provider, but may include submitting a copy of the hospital account, as well as the Medical Aid statement showing the payment of the Service Provider claim and reason for short payment.
With TRA, Claims documents can be emailed to firstname.lastname@example.org, submitted online via our website www.totalrisksa.co.zaor submitted via our mobile app, TRA Assist. Alternatively, TRA may be contacted directly on +27 (11) 372 1540. One of our highly qualified and friendly claims specialists will gladly assist.
Some providers may also offer an automatic claims process. If there is an agreement between your specific Medical Aid provider and Gap Cover provider, your claim will automatically be submitted electronically by your Medical Aid provider. In the instance of TRA, an automatic claim will be processed within 7 working days, however, co-payment and sub-limit claims must always be submitted manually by the policyholder.
Gap Cover Questions & Queries
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.