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Man holding his twin daughters walking behind his son in a field of tulips. They are walking towards a weeping willow tree.

GapCover

Bridge the gap between your medical bills and your medical aid in South Africa with gap cover. If you would like an obligation-free gap cover quote, speak to your financial adviser or call us today on 0860 117 859

from

R195 per month

Get GapCover

What is GapCover?

GapCover⁺ bridges the gap between your medical bills and your medical aid cover. You can use your cover to help pay in- and out-of-hospital fees when your medical aid doesn't cover all the costs.

With Momentum GapCover, you can choose a plan suitable for you to make sure you’re prepared for any unexpected shortfall.

GapCover is not a medical aid cover. This product is not a substitute for a medical aid membership.

⁺ You may choose to make use of additional products available from Momentum Metropolitan Holdings Limited (Momentum), to seamlessly enhance your medical aid. Momentum is not a medical scheme and is a separate entity to Momentum Medical Scheme. The complementary products are not medical scheme benefits. You may be a member of Momentum Medical Scheme without taking any of the complementary products.

What are the benefits of having Momentum GapCover?

Shortfall benefits

These benefits aggregate to a maximum benefit of R173 000 per insured person per year.

Medical practitioner costs

Covers up to 3 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.

Co-payments

Covers co-payments applied by your medical aid, subject to a R750 excess per co-payment. You can get this amount back in your HealthSaver⁺ account, if you maintain HealthReturns⁺ level 4 or 5 for 3 consecutive months, have an amber or green Healthy Heart Score and receive HealthReturns into your HealthSaver⁺ account. 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 after the medical aid limit has been reached.

⁺ You may choose to make use of additional products available from Momentum Metropolitan Holdings Limited (Momentum), to seamlessly enhance your medical aid. Momentum is not a medical scheme and is a separate entity to Momentum Medical Scheme. The complementary products are not medical scheme benefits. You may be a member of Momentum Medical Scheme without taking any of the complementary products.

Casualty

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 4 casualty visits and up to R15 000 per policy per calendar year. The medical aid must have paid the first portion of the cost.

One of these casualty ward visits, up to R2 000, may be used in an emergency for child dependants 5 years or younger.

Internal prosthesis

Covers shortfalls on internal prosthesis costs, up to a maximum amount of R30 000 per policy per year. Cover for stents and pacemakers are now included to a max of R6 000 per claim event.

Lump sum benefits

These benefits do not aggregate to the R173 000 cap.

Cancer

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.

Trauma counselling

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 a fixed amount of R750 per session for any trauma counselling you’ve had, limited to R25 000 per family per year.

Additional benefits

Violent crime benefit - R50 000 payable for death or permanent disability due to a violent crime.
Premium waiver benefit - R36 000 payable upon the death or permanent disability of the premium payer.
Pregnancy benefit - Benefit of R2 000 payable when existing GapCover members fall pregnant.

How much does Momentum GapCover cost?

Policy member under 42

R315 pm

Policy member over 42

R445 pm

Policy member over 65

R555 pm

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.

Want to know more?

For more information relating to the below, please view the brochure and navigate to the relevant section.

Waiting periods.

How to claim.

Out-of-hospital/day clinic procedures.

What we do not cover.

Terms and Conditions of cover.

View GapCover (pdf)

Get GapCover today

Be prepared for any unexpected shortfalls.

Get GapCover

Need medical aid advice?

An accredited healthcare consultant will call you to discuss our gap cover and medical aid options and benefits.

Request a call back

You may also want to consider

Available 24 hours a day, 7 days a week, 365 days a year.

Client service, claims and authorisations

0860 117 859

+27 31 573 4008

claims@momentumhealth.co.za

member@momentumhealth.co.za

Business hours are Monday to Friday from 07:30 to 17:00. Saturdays from 08:00 to 12:00. Closed on Sundays and public holidays.

Other Momentum contacts

GapCover

R195 per month

What is GapCover?

What are the benefits of having Momentum GapCover?

Shortfall benefits

Lump sum benefits

How much does Momentum GapCover cost?

Want to know more?

Get GapCover today

Need medical aid advice?

You may also want to consider

HealthWaiver

HealthSaver

HealthReturns

Multiply rewards

Contact Momentum Medical Scheme

For local emergencies

For international emergencies

Momentum Medical Scheme Ethics and Fraud line

Client service, claims and authorisations