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GapCover

Helps you avoid unexpected in-hospital medical aid shortfalls, not covered by your medical aid.

from

R190 per month

Request a quote

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. With Millennial GapCover, members under 30 years pay a reduced premium.

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.

⁺ You can choose to make use of additional products available from Momentum, part of Momentum Metropolitan Life Limited, to seamlessly enhance your medical aid. Momentum is not a medical scheme, and is a separate entity to Momentum Medical Scheme. These voluntary complementary products range from a world-class lifestyle rewards programme, Multiply, to the innovative HealthReturns solution. These complementary products are not medical scheme benefits. You can be a member of Momentum Medical Scheme without taking any of the complementary products that Momentum offers.

What are the benefits of having GapCover?

Shortfall benefits

These benefits aggregate to a maximum benefit of R165 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.

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 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.

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.

Lump sum benefits

These benefits do not aggregate to the R165 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 any trauma counselling fees paid by you up to R750 per session, 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 - R30 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 will it cost?

Policy member under 42

R296 pm

Policy member over 42

R417 pm

Policy member over 65

R537 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.

⁺You can choose to make use of additional products available from Momentum, part of Momentum Metropolitan Life Limited, to seamlessly enhance your medical aid. Momentum is not a medical scheme, and is a separate entity to Momentum Medical Scheme. These voluntary complementary products range from a world-class lifestyle rewards programme, Multiply, to the innovative HealthReturns solution. These complementary products are not medical scheme benefits. You can be a member of Momentum Medical Scheme without taking any of the complementary products that Momentum offers.

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

Want a quote?

You'll get a quote reflecting the medical aid contribution at the end of the process.

Get an online quote

Need advice?

Discuss the benefits of having medical aid with a certified financial adviser.

Request a call back

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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