What is GapCover?
Why worry about shortfalls for in-hospital procedures and other healthcare-related expenses not covered by your medical aid? GapCover+ offers you supplementary cover to assist with shortfalls in the event of hospitalisation, involving surgery or medical treatment, as well as for certain procedures performed out-of-hospital.
GapCover is not a medical aid and cover is not the same as that of medical aid. This product is not a substitute for medical aid membership.
What are the benefits of having GapCover?
These benefits aggregate to a maximum benefit of R157 000 per insured person per year.
Medical practitioner costs
Covers up to 2 times the amount paid by the medical aid if there is a shortfall between what is charged by the medical practitioner and what is paid by the medical aid.
Obstetrics and gynaecology, cardiothoracic and neurology are covered up to 2.5 times the amount paid by the medical aid. GapCover also covers you for certain out-of-hospital medical procedures performed in day clinics and other registered facilities.
Covers co-payments applied by your medical aid, subject to a R750 excess per co-payment. This benefit does not cover co-payments payable for voluntary use of non-Designated Service Providers.
Covers the 20% co-payment applied to oncology treatment (biological drugs and specialised medication) after the medical aid limit has been reached.
Covers the casualty cost fees associated with admissions to the emergency room, at a registered hospital casualty facility, due to a medical emergency or accident.
Limited to 3 casualty visits and up to R10 000 per policy per calendar year. The medical aid must have paid the first portion of the cost.
Covers shortfalls on internal prosthesis costs, up to a maximum amount of R30 000 per policy per year.
Lump sum benefits
These benefits do not aggregate to the R157 000 cap.
If you are diagnosed with minimum stage 2 local and malignant cancer, whilst covered on this policy, we will pay you R5 000.
If, however, you are diagnosed with minimum stage 2, regional and malignant cancer, we will pay you R15 000.
If, after receiving the R15 000 benefit, your medical aid pays more than R200 000 for the cost of your oncology treatment within 12 months of your diagnosis, we will pay you a further R10 000.
This benefit is payable once in a lifetime per person covered on the policy.
Accidental death and disability
The benefit of R50 000 is payable for death or permanent disability due to an accident. Subject to one claim per insured per lifetime.
If you are a victim of, or witness to, an act of violence (such as murder, assault, robbery, rape, kidnapping or hijacking) or a traumatic accident, we will refund any trauma counseling fees paid by you up to R750 per session, limited to R25 000 per policy every year.
How much will it cost?
No dependants may be added to GapCover if the principal insured is over the age of 65 at the time of applying for the cover.