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Another potential out-of-pocket expense for medical scheme members is co-payments for in- and out-of-hospital procedures. This co-payment is an excess amount imposed and specified by the medical scheme.

Owners of a CoPay Cover policy, also a short-term insurance product, enjoy cover for co-payments on procedures performed as in- and out-patients, hospital admission fees, and for co-payments charged on MRIs, CTs and ultrasound scans.

Including additional cover up to R12 000 co-payment for the use of a non-DSP (Designated Service Provider) Hospital, limited to 1 event per calendar year, per policy.

Who qualifies for CoPay Cover?

  • Most open medical schemes in South Africa impose co-payments on certain procedures, for instance scopes and specialised radiology. So, members of these schemes could all benefit from cover against these co-payments.
  • As with GapCover®, one CoPay Cover policy will provide benefits to the principal member, the spouse or life partner and biological or legally adopted children that are registered as such on his/her medical scheme certificate.
  • To ensure cover, please ensure that your dependants are registered on the CoPay Cover policy as well.

How and when will CoPay Cover apply?

  • A CoPay Cover claim will be paid when your medical scheme charged a co-payment for an in- or out-of-hospital procedure (which includes an MRI, CT or ultrasound).
  • There is a R12 000 limit per event
  • A co-payment claim does not cover penalties that resulted in the member not following scheme rules
  • CoPay Cover is subject to underwriting and exclusions as per the policy contract

What does it cost?

  • CoPay Cover is available at R70 per month per family (R12 000 limit per event)
  • There is also GapCover® available at only R160 per family, per month
  • Or, get GapCover® and CoPay combined at only R215 per family, per month
    (if you’re part of an employer group, click HERE)

Find out more

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