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Why should you choose
GapCover®Elite
GapCover®Elite is a medical shortfall cover which covers the difference (or gap) between your medical scheme tariff and the tariff charged by the private doctor or specialist for in-hospital procedures.
Shortfalls are covered on gastroscopies & colonoscopies performed in the GP or specialist’s rooms up to 500% of scheme tariff limited to 2 scopes/beneficiary/annum.
New / Additional Benefits to the GapCover®Elite option include:
- Non-DSP Specialist tariff shortfalls for planned PMB admissions
- Hospital Cash Back Benefit from day 3
- Oncology benefit
- Sub-limit benefit – internal prosthesis and specialised radiology
- Cash Back Benefit
Individual
WHY SHOULD YOU CHOOSE
GAPCOVER®ELITE
Individuals younger than 30 years
R236
Individuals between 30 to 59 years
R353
Individuals older than 60 years
R583
Family
WHY SHOULD YOU CHOOSE
GAPCOVER®ELITE
Families younger than 30 years
R362
Families between 30 to 59 years
R542
Families older than 60 years
R834
MAKE SURE YOU’RE COVERED FOR SHORTFALLS!
GapCover® is a short-term insurance product that offers you affordable cover for your whole family against medical expense shortfalls occurred for in-hospital procedures.
HOW DOES THE CLAIMS PROCESS WORK?
All GapCover® claims are paid out directly to the member. You can find out more about our easy claims process by clicking the button below, or getting in touch with us through the contact page.
ELITE COVER CORE BENEFITS
IN-HOSPITAL BENEFITS
Benefits in this section will provide cover for the difference in the amount charged by a Registered Medical Professional and the Medical Scheme Rate for services rendered while admitted in hospital.
Benefits in this section will provide cover for procedural co-payments (the excess imposed in terms of your Medical Scheme Rules) for procedures performed as an In-Patient, hospital admission fees, as well as Specialised Radiology such as MRI and CT Scans limited to R18 640 per event.
Co-payments for the use of a non-DSP (Designated Service Provider) Hospital limited to R18 105 once per calendar year, per policy.
Co-payments for the use of a non-DSP (Designated Service Provider) Hospital limited to R18 105 once per calendar year, per policy.
Benefit provides cover for shortfalls on all dental procedures paid from risk limited to R8 945 per policy, per annum.
Benefit provides cover for procedural co-payments on all dental procedures limited to R8 945 per policy, per annum.
Benefit provides cover for procedural co-payments on all dental procedures limited to R8 945 per policy, per annum.
OUT-OF-HOSPITAL BENEFITS
Benefit provides cover for shortfalls on Gastroscopies and Colonoscopies performed in the GP or Specialist’s rooms, limited to 2 scopes per beneficiary, per annum.
Benefits in this section will provide cover for procedural co-payments (the excess imposed in terms of your Medical Scheme Rules) for procedures performed as an Out-Patient (Gastroscopies and Colonoscopies performed in the GP or Specialist’s rooms limited to 2 scopes per beneficiary, per annum) as well as Specialised Radiology such as MRI and CT Scans limited to R18 640 per event.
Benefit provides cover for the shortfalls on cost incurred for the treatment of an injury caused by an external force at an emergency ward limited to 2 events to a maximum benefit of R6 925 per policy, per annum provided that payment was made by the Medical Scheme.
Benefit provides cover for out of hospital physiotherapy limited to R2 665 per policy, per annum for postoperative joint replacement/back surgery rehabilitation provided that payment was made by the Medical Scheme for services rendered within 30 days after discharge.
Additional Benefits
The lump sum benefits in this section are payable where an insured party is admitted to hospital, and such an insured event occurred as a direct result of either accidental harm or premature birth, as defined in the policy. Covered under this benefit per annum: from day 3 to day 5 R320 per day, day 6 to day 10 R425 per day & day 11 to day 20 R535 per day subject to an overall maximum benefit of R26,625 per annum.
Subject to the overall maximum Compensation limit and the treatment of a Covered Event; equal to the Co-Payment applied (subject to a maximum of 20%) once related costs have exceeded, limited to R53,250 per policy, per annum
This benefit provides for a once-off 10% cash back bonus of all premiums paid over the first 5 years of cover on GapCover Elite, on condition that there were no claims submitted or interruption of cover.
Non-DSP Specialist Tariff Shortfalls for planned Prescribed Minimum benefits (PMB) admissions subject to a Max R15,070 per policy, per year.
Where the charges relating to the service supplied has exceeded a relevant Benefit sub-limit of the member’s Medical Scheme Benefit option, The maximum compensation is limited to R42,250 per policy, per annum. a) internal prosthesis limited to 1 (one) claim per policy, per annum, up to a maximum of R33,800 per Covered Event; and b) specialised radiology limited to 2 (two) scans per policy, per annum, up to a maximum of R5,600 per Covered Event.
Dental Reconstruction limit of 1 claim per policy per annum, due to Accidental Harm or Oncology Treatment limited to R7,350 per policy, per annum.
GapCover® is underwritten by Western National Insurance Company Ltd, Reg. No: 2005/017349/06,
FAIS: Juristic Representative under (FSP 9465).
Administered by, GapRisk Administrators (Pty) Ltd Reg. No.2021/500446/07, an authorized financial services provider (FSP: 51758).