Are you aware of the annual aggregate limit for your medical aid or gap cover provider and how it can affect you and your family?
Terms used in insurance can often be complicated and overwhelming. However, medical aid members need to understand what these terms mean and how they affect their medical scheme and short-term insurance products.
What is the annual aggregate limit?
The annual aggregate limit refers to the maximum amount of money that your medical aid or gap cover provider will pay for all claims that you submit over one year.
This could affect you and your family if your medical expenses exceed this amount, as you will be expected to cover the costs of procedures and medical bills for the remainder of the year.
How do insurers decide their annual aggregate limit?
All TRA Gap Cover policies are governed by the demarcation regulations, which allow this figure to be increased every April by an amount linked to South Africa’s inflation rate.
However, this often meant that the limit was inconsistent and was open to interpretation from different insurance product suppliers.
The demarcation regulations recently issued a definitive table of figures for determining a scheme’s annual aggregate limit. This will ensure that medical aid and gap cover providers offer a consistent and stable limit.
What is TRA’s annual aggregate limit?
As a result of the issued table of figures, the current annual aggregate limit for TRA gap cover is R 219 845 per insured person.
This limit came into effect on 1 April 2025 and will change on 1 April 2026. It is important that our policyholders are aware that the annual aggregate limit has changed from R 210 580 per insured person, which was effective from 1 April 2024 to 31 March 2025.
How do I know when the limit has changed?
When the limit changes, notifications will be sent across various digital platforms to policyholders and brokers.
A table showing our latest limit amount can be viewed in our 2025 gap cover brochure.
Contact our team for further queries.
