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Over the last three decades, we have evolved our insurance offering to ensure that we can address the growing and changing needs of our clients.
We have now taken that evolution a step further by expanding into the world of medical insurance with the launch of Auto & General Medical Gap Cover.
Medical Gap Cover addresses the shortfall between what medical aids will pay and what health practitioners charge, for in-hospital procedures. Often the reason for this shortfall is that medical professionals are not required to adhere to the tariffs determined each year by medical aids. Since they can charge above medical aid tariffs, the member is responsible for paying the outstanding amount.
Medical Gap Cover will assist in covering this shortfall, providing financial relief for you and your loved ones.
For further information on the benefits and options, download our brochure.
These options are available to any member of a registered South African medical aid scheme.
Essential
- 300% Gap Cover – three times the limit of the medical aid tariff.
- R7 500 per annum, per policy, for treatment at a casualty unit linked to a hospital (accidents only. Children under the age of 8 years old only- may be admitted for any treatment, between the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday).
Comprehensive
- 500% Gap Cover – five times the limit of the medical aid tariff.
- Co-Payment benefit of up to R50 000, per policy, per annum.
- A sub-limit benefit on Internal Prostheses of up to R20 000 per annum, per policy.
- R15 000 per annum, per policy, for treatment at a casualty unit linked to a hospital (accidents only. Children under the age of 8 years old only- may be admitted for any treatment, between the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday).
- Lump sum pay-out of R20 000 based on first diagnosis of stage 2 or higher cancer.
Absolute
- 700% Gap Cover – seven times the limit of the medical aid tariff.
- Co-Payment benefit subject to the Overall Annual Policy limit of R165 000, per insured, per annum.
- Internal Prosthesis sub-limit benefit of up to R40 000 per event.
- Oncology Co-Payment benefit.
- Oncology Extender benefit.
- R20 000 per annum, per policy, for treatment at a casualty unit linked to a hospital (accidents only. Children under the age of 8 years old only- may be admitted for any treatment, between the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday).