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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, part of the Combined Cover benefits, 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 800 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 the principal member or spouse's 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 800 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 as part of the Combined Cover benefits at R230 per family, per month
  • Or, get GapCover® as a standalone cover at only R171 per family, per month 
    (if you’re part of an employer group, click HERE)

Find out more

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