For TRA Gap Cover: There is no general three (3) month waiting period. If you as a member can provide a certificate to show proof of a previous membership on another legitimate Gap Cover: provider (provided you have had no break in cover for at least 24 months to the benefit start date of your policy), the below 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 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)
Varicose veins
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 conditions 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.
Gap Cover Questions & Queries
If you have any more queries or questions regarding anything related to Gap Cover, why not reach out to our helpful specialists here. You can also visit our Gap cover page here.
