Our strategic national footprint ensures that you are always covered no matter where you are in the Republic of South Africa.

WHEN WE COVER YOU

  • You are covered when your service providers charge a rate considerably more than what your medical scheme pays from your medical scheme hospital benefit and not from your medical scheme savings account or day-to-day benefit
  • You are covered for medical procedures performed both in-hospital as well as in doctors’ or specialists’ private rooms, day clinics or other registered facilities
  • You are covered for Prescribed Minimum Benefit (PMB) medical procedures
gap

GAP BENEFIT

WHAT WE COVER YOU FOR

Our 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 or 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)</ul>

Why it is important to have GAP cover?

Our GAP BENEFIT leaves you feeling assured that, when your doctor or specialist charges a rate considerably more than what your medical scheme pays, the unexpected difference you are liable for, won’t leave you out of pocket.

  • GAP BENEFIT
  • CO-PAYMENT BENEFIT
  • ONCOLOGY BENEFIT
  • ONCOLOGY OPTIMISER BENEFIT
  • DIAGNOSIS BENEFIT
  • SUB-LIMIT BENEFIT
  • CASUALTY BENEFITS
  • TRAUMA COUNSELLING BENEFIT
  • ADDITIONAL BENEFITS
  • HOSPITAL OPTIMISER
  • ACCESS OPTIMISER

Who is coverd by my GAP Cover Policy?

Gap Cover Product Range – We cover you and your spouse even if you are not on the same medical scheme or medical scheme option as well as all dependants registered on your or your spouse’s medical scheme option. Individuals of all ages are covered. All applicants reflecting on your medical scheme membership must also reflect on your Stratum Benefits Cover Certificate at the time of a claimable event.

Dental & Corporate Assure Options – We cover you, your spouse and any child dependant of whom you are the parent or legal guardian. Full time students between the ages of 21 and 28 will pay a child dependant premium provided proof of studies is submitted yearly. A maximum entry age of 65 applies to all options.

Primary Healthcare Range – We cover you, your spouse and any child dependant of whom you are the parent or legal guardian. Full time students between the ages of 21 and 28 will pay a child dependant premium provided proof of studies is submitted yearly. A maximum entry age of 55 applies to all options other than EMERGENCY & ACCIDENTAL BENEFITS where the maximum entry age is 60.