This is when a shortfall 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 (it is important to note that this is 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).
(Covered by all 4 Gap Cover product options).
What is the TRA Oncology Co-Payment Benefit?
• A co-payment or deductible is the amount 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 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 are to be within the annual scheme oncology limit.
What is the TRA Oncology Extender Benefit?
This benefit iIncludes any approved costs above the annual scheme oncology limit but subject to the scheme covering up to this limit.
(Covered by Absolute Cover Plus only).
DON’T STRESS! THE GAP IS COVERED.