Option 1 – R180pm per family

GAP BENEFIT provides an additional 500% cover when you become liable for the difference between what your service providers charge and what your medical scheme pays from your medical scheme hospital benefit. There is no limit on the number of times you may claim per year for account shortfalls related to the following:

• Doctors and specialists
• Basic black and white x-rays (but not including specialised radiology such as MRI, CT and PET scans)
• Pathology
• Physiotherapy
• Disposable items such as surgical gloves, bandages and gauze
• Medication provided as part of your in- or out-of-hospital event

(but not including take home medication)

*There is however an annual claims  limit of R150 000 per year

 

Option 2 (Co-Payments) – R225pm per family

Includes all the benefits of Option 1 AND:

• You are covered when your medical scheme requires you to settle fee, known as a co-payment or a deductible, prior to undergoing certain in- and out-of-hospital medical procedures
• You will be refunded the co-payment or deductible, which is either settled by you or deducted from your medical scheme savings account
• This option covers in- and out-of-hospital medical procedure related co-payments or deductibles, represented as either a rand amount or a percentage and is limited to R 40 000 per policy per year

 

Option 3 (Oncology Benefit) –R320pm per family

Includes all the benefits of Option 2 AND

 

WHAT WE COVER YOU FOR

• Your co-payment benefit has no annual limit. (No cap)
• You will also be covered for 1 co-payment up to an amount of R 8 250 per policy per year, for the voluntary use of a hospital or a day clinic outside your medical scheme’s designated network

Where a private upfront fee is applied by your doctor or specialist which is not claimable from your medical scheme, cover is not applicable

• The ONCOLOGY BENEFIT covers you when your medical scheme only pays a portion towards your service providers’ accounts and is limited to R 450 000 per person per year

 

All three options have a general waiting period of 3 months and pre-existing condition exclusion of 12 months.

Contact us for more information on other exclusions.