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 below Gap waiting periods i.e. 10 months, 9 months and 6 months which run concurrently, may be waived.
The following waiting periods are/were applicable from the ‘Join Date’ until such time as they are completed. The Gap waiting periods all start on the same ‘Join Date’ as specified in the certificate. Where a claim relates to a condition that is described in more than one waiting period definition, the longer of the two definitions shall apply.
10 Month Condition specific waiting period:
No claims may be submitted within the first 10 months of membership for any Gap Cover policy if they relate to any of the following conditions:
Head, neck and spinal procedures (including stimulators) e.g. Laminectomy
All types of hernia procedures
Endoscopic procedures e.g. Colonoscopy, Gastroscopy
Pregnancy and childbirth (including caesarean delivery)
Gynaecological conditions e.g. Hysterectomy
Joint replacement (including Arthroplasty, Arthroscopy, Metatarsal Osteotomy) but excluding treatment due to accidental trauma
Inability to walk / move without pain
Any renal, kidney and bladder conditions
Cardiac (relating to the heart)
Dentistry (unless due to accidental trauma or oncology)
Cataracts and / or eye laser surgery (including all eye and lens procedures) • Neurological conditions and procedures (including stimulators)
Organ transplants (including cochlear implants)
Reconstructive surgery as a result of an incident or condition that occurred prior to membership (including skin grafts)
Mental health or psychiatric conditions (including depression)
Oesophagitis, Gastroenteritis and Gastro-Intestinal Disorders
Male genital system (including prostatectomy)
Carpal Tunnel Syndrome
Any Ear, Nose and Throat procedures (including nasal, sinus, tonsil and adenoid procedures)
Diabetes and related complications
All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.
Cancer diagnosis waiting period:
If a Policyholder is diagnosed with any form of cancer prior to membership, all related claims will be subject to a nine (9) month waiting period. If a Policyholder has previously been diagnosed with cancer and is currently in remission, the Policyholder needs to advise the Insurer by way of medical evidence that the remission period has been for two (2) or more consecutive years.
Pre-existing medical condition/s waiting period:
NO claims relating to any preexisting condition/s that may lead to hospitalisation (excluding cancer: see above) will be covered within the first six (6) months of membership. The Insurer reserves the right to request any clinical information from a Policyholder’s doctor should a claim in this period indicate, and/or relate to, a pre-existing condition. All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.
For more details and information based on our Gap Cover products and waiting periods, speak to your intermediary or visit our website www.totalrisksa.co.za.
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.