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Combined Cover

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This product consists of the following components:

Gap Cover:

This product is a short-term insurance stated benefit product that covers the difference between your Medical Scheme Rate and private rates charged by a Registered Medical Professional for in-hospital treatment. Gap cover will settle up to a total of 500% of your Medical Scheme Rate. No annual limit will apply.

 

CoPay and Admission Fee Cover:

This product is a short-term insurance stated benefit product that will cover your co-payments for procedures performed, as an in-patient or as an out-patient. This includes MRI, CT and Ultrasound scans. In addition, cover is provided for the admission fees payable to a hospital as imposed in terms of your Medical Scheme rules.

An incident limit of R12 500.00 will apply per claim. This means that your co-payment / admission fees will be covered, up to a maximum amount of R12 500.00 per insured per incident. Utilisation per beneficiary is limited to no more than three claims per annum and an overall annual limit of R100 000.00 per family.

 

Out-Patient Cover:

This product is a short-term insurance stated benefit product that covers the difference between your Medical Scheme Rate and private rates charged by a Registered Medical Professional. The policy will cover you for any out-patient surgical procedure that would normally be performed as an in-patient.

An incident limit of R3 500.00 will apply per claim. This means that your specified out-patient treatment will be covered, up to a maximum amount of R3 500.00 per insured per incident. Utilisation per beneficiary is limited to no more than three claims per year and an overall annual limit of R15 000.00 per family.

Premium per month R170.00.

Important Information

– Every application is subject to underwriting

– First 100% of the Medical Aid Rate is not covered by Gap Cover even if this is not paid by your Medical Aid

– Preferential terms for groups

– Standard 3 month waiting period

– Pre-existing conditions may be excluded for minimum 12 months

– This brochure is for information purposes only; any claim is subject to the policy wording

– There is no maximum entry age

– Terms and Conditions apply on all Products and might change due to changes in Legislation

Product can be used with any medical aid