Super Cover Plus is TRA’s mid-range Gap Cover product option which provides 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. 2020 has introduced two new and exciting benefits: The Global Fee Benefit and the Breast Reconstruction Surgery shortfall benefit. These benefits are currently subject to an overall annual limit of R165 000 per insured person per annum.
The Super 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 for in-hospital expenses, TRA will provide for this gap, subject to the annual limit.
Should an emergency happen and you need to be rushed to casualty due to an accident, often a medical aid does not always cover the total costs in full. Whether payment comes from your medical scheme savings account or day-to-day benefit, the gap will be covered. Sometimes, your medical aid will not account for anything regarding your casualty visit, leaving you to cover the bill in full. This benefit will cover you for up to R10 000 per policy per annum.
These days most medical aid schemes insist that members pay an upfront amount for certain diagnostic and endoscopic procedures like gastroscopies and colonoscopies, this amount is known as a co-payment or a deductible. With this benefit you will be covered up to R50 000 per policy per annum (subject to the annual limit) for co-payment or deductible costs imposed by your medical aid, provided you make use of your medical aid’s designated service provider network. No cover is provided where a policyholder voluntarily chooses to make use of a service provider that is not part of their medical aid’s service provider network.
Nowadays most medical aid schemes impose a sub-limit on in-hospital internal prostheses costs. Members may be out of pocket and will have to cover these costs themselves. This benefit provides an amount of up to R10 000 per policy per annum.
The Oncology Gap Benefit:
Up to an aggregate of R165 000 per insured person per annum. The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for medical aid approved oncology treatment plans. (NB: Subject to: the Gap Cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within annual scheme oncology limit).
For 2020: Oncology Gap Benefit:
Breast Reconstruction Surgery; The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for medical aid approved oncology related breast reconstruction surgery, including the unaffected breast. (NB: Subject to: the Gap Cover percentage; and medical aid approved treatment plan being covered up to scheme tariff and within the annual scheme oncology limit). Up to R10 000 per policy per annum.
Oncology Co-Payment Benefit: Up to R50 000 per policy per annum
The co-payment or deductible that your medical aid charges you for certain in-hospital procedures. This co-payment is NOT related to the scheme tariff and service provider charge shortfall or designated service provider none arrangements, OR
For claims where the medical aid will only pay a percentage for the approved treatment and the policyholder needs to pay the remaining percentage of the account.
All costs to be within the annual scheme oncology limit.
Accidental Death Cover: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. This benefit will provide an amount of R7 500 in the event of death of the insured and / or spouse, and R3 750 in the event of the death of a dependant, caused by violent, accidental, external, or visible means.
Policy Extender: We often hear of cases where one of our policyholders passes away leaving their loved ones to pick up the pieces. They are left with the challenge to make sure that the Gap Cover they were used to is funded for a period of time. This benefit will provide for your Gap Cover premiums for a period of 6 months after the death of the original policyholder.
TRA Assist Mobile app: TRA also provides all Gap Cover policyholders with TRA Assist, which is powered by ER24 ASSIST. The benefits include a Home Drive service (which now includes access to Uber trips), a Panic Button and a Medical Health and Trauma Counselling Line.
To find out more information about TRA’s Gap Cover product options, contact your intermediary (who could give you advice on which Gap Cover product option to choose) or go to our website 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.