Monthly premium, per family
By age band, as Ambledown publishes it. 2027 premiums take effect on 1 January 2027.
| Age | 2026 | 2027 | Change |
|---|---|---|---|
| 18 to 65 | R646 | R698 | +8.0% |
| 66 and older | R847 | R915 | +8.0% |
What it covers
What it pays
Limits and joining
Who is covered
In Ambledown’s own words.
- The minimum entry age for the Principal insured person is eighteen (18) and the maximum entry age is sixty-five (65). Applicants sixty-six (66) and older have the option of selecting products for seniors. Ambledown Ambledown Gap Plus brochure brochure 2027, p7
- Extended Family Dependants: (parents, parents-in-law, adult children, etc.) A family is defined as the principal insured and immediate family, which includes the spouse and eligible children. Extended family dependants are not considered as part of the family. Ambledown Ambledown Gap Plus brochure brochure 2027, p7
- Continuation: Any individual may apply to continue cover if that individual was a member of a group policy and terminates his employment. Ambledown has the right to alter the premium rates to individual rates or adjust the premium for the additional costs of the debit order and other administrative tasks. Terms and conditions shall apply according to the new contract issued. Ambledown Ambledown Gap Plus brochure brochure 2027, p7
What each benefit means
In Ambledown’s own words, with its examples of when it pays and when it doesn’t.
Gap Cover
Gap Cover provides for charges levied by the Medical Practitioners above the Medical Scheme Tariff for associated services in-hospital and/or the necessity for chemotherapy or radiotherapy for the treatment of Cancer on an out-patient basis, and/or the necessity for kidney dialysis on an out-patient basis (as well as other defined out-patient procedures).
Ambledown Ambledown Gap Plus brochure brochure 2027, p4
Gap Cover – exclusions of the benefit
Gap Cover 100 does not provide for charges above the tariff for ward fees, theatre fees, medicines, and materials (e.g., prostheses). Cover is for the services provided by Specialists, General Practitioners and Medical Professionals, such as Physiotherapists, during the period of hospitalisation.
Ambledown Ambledown Gap Plus brochure brochure 2027, p4
Major Medical Co-payment/Deductible Cover
Major Medical Co-payment/Deductible Cover provides for charges in the form of a co-payment or deductible applied for in-hospital admissions and charges in the form of a co-payment or deductible for major medical out-patient treatment limited to specialised diagnostic radiology, namely MRI, CT and PET Scans.
Ambledown Ambledown Gap Plus brochure brochure 2027, p4
Penalty Co-Payment
The benefit includes a once-off payment per family, per year for the penalty imposed by a Medical Scheme for the use of a non-network hospital. The benefit is limited to R15,000.
Ambledown Ambledown Gap Plus brochure brochure 2027, p4
Casualty Ward Benefit
Casualty Ward Benefit covers you for emergency treatment received in a casualty unit of a hospital, provided that such treatment is not for routine physical treatment or any other medical examination or treatment other than emergency medical treatment.
Ambledown Ambledown Gap Plus brochure brochure 2027, p5
Casualty Ward Benefit – detail
You are covered when immediate treatment is required and your Medical Scheme does not provide you with cover and you become liable to pay the cost of the casualty event. This benefit will cover the facility fee, consultations, medications, radiology, and pathology associated with admission to a registered hospital’s casualty facility.
Ambledown Ambledown Gap Plus brochure brochure 2027, p5
Overall limitation
All Gap Cover Benefits listed above are limited to R226,881 per insured person per year or any higher amount which may be published by the Regulator during the year.
Ambledown Ambledown Gap Plus brochure brochure 2027, p5
Specific Limitation – Casualty
Treatment in a casualty unit of a Hospital shall be limited to R11,000 in aggregate per insured person per year.
Ambledown Ambledown Gap Cover Series brochure brochure 2027, p8
Specific Limitation – Penalty co-payment
The maximum benefit payable for the cost incurred for the penalty co-payment imposed by the medical scheme is payable once per year and limited to R15,000 per family per year.
Ambledown Ambledown Gap Cover Series brochure brochure 2027, p8
Waiting periods
In Ambledown’s own words.
- Ambledown will apply the three (3) month general waiting period condition to all applications for new membership. Ambledown Ambledown Gap Plus brochure brochure 2027, p7
- The only time we would not apply the three (3) month general waiting period is: Claims qualifying as an accident in terms of the policy definition, or If the client changes gap cover policies with similar benefits offered by different product providers with the same insurer (GICL). Ambledown Ambledown Gap Plus brochure brochure 2027, p7
- A twelve (12) month pre-existing clause applies. The clause excludes claims for any treatment received for a condition for which treatment or advice has been received in the twelve (12) months prior to the inception of the policy. The intention is to exclude any benefit where treatment or advice was received twelve (12) months prior to inception. Once membership is greater than twelve (12) months, then benefits are payable regardless of the date in which the illness manifested itself or the injury occurred. Ambledown Ambledown Gap Plus brochure brochure 2027, p7
- Benefit upgrades: A three (3) month general waiting period and twelve (12) month pre-existing clause will apply to the additional benefits obtained when a member upgrades cover. The existing benefits enjoyed prior to the upgrade will not be subjected to the waiting periods mentioned. Ambledown Ambledown Gap Plus brochure brochure 2027, p7
Before you join
Printed on Ambledown’s forms.
- I confirm that the Advisor has fully explained the consequences of the replacement of the policy (ies) mentioned in the Replacement Policy Advice Record and I understand the consequences of such replacement(s). I confirm all members of the scheme have been advised accordingly. Ambledown replacement confirmation form 2025, p2
How to claim
In Ambledown’s own words.
Claiming
Claims should be submitted no later than one hundred and eighty (180) days/ six (6) months from the first day of treatment. Claim forms are obtainable from www.ambledown.co.za, and the completed form and supporting documentation should be returned to: Email: claims@ambledown.co.za Postal: Ambledown Financial Services (Pty) Ltd. PO Box 1862, Cramerview, 2060
Ambledown Ambledown Gap Plus brochure brochure 2027, p7
Claiming
Alternatively, you can download the Ambledown App to submit and track your claim, quick and easy. The claim will be assessed and a decision made within ten (10) working days from receipt of all the correct documents.
Ambledown Ambledown Gap Plus brochure brochure 2027, p7
What each document is for
| Document | Where to get it | Why Ambledown needs it | Note |
|---|---|---|---|
Ambledown Ambledown Claim form (Group and Individuals) brochure 2027, p3
Words used
As Ambledown defines them.
- Co-payment
- A Co-payment is an upfront payment charged by the Medical Scheme payable to the Medical Services Provider prior to undergoing the procedure. The co-payment or deductible amounts applied are as per the rules of the patient’s registered Medical Scheme. Ambledown Ambledown Gap Plus brochure brochure 2027, p4
- Sub-limit
- Sub-limits are limits set by the Medical Scheme on Medical Scheme benefits. In certain instances, these limits can be set per procedure type in an effort to manage exposure. Ambledown Ambledown Gap Supreme brochure brochure 2027, p5
- An Eligible Child
- “An Eligible Child” is a natural/biological child, stepchild or legally adopted or foster child of the Principal Insured Person, who has not attained the age of twenty-one (21), is not otherwise insured under this or a similar policy, and is covered by a registered Medical Scheme. Ambledown Ambledown Gap Plus brochure brochure 2027, p7
Questions about Gap Plus
Answered from Ambledown’s brochures.
How much does Gap Plus cost in 2027?
From 1 January 2027: R698 a month at 18 to 65; R915 a month at 66 and older. One premium covers the whole family.
How much is Gap Plus going up for 2027?
For a family at 18 to 65, from R646 to R698 a month, +8.0%.
Can I join after 65?
No. New members join between 18 and 65.
Is there a waiting period?
Yes. 3 months general, and 12 months for conditions you had before joining.
Does Gap Plus cover cancer?
No. Gap Plus does not include cancer cover.
Which co-payments does it cover?
One co-payment a year that your medical scheme charges, up to R15 000 per family.
Is there a limit on what it pays?
Yes. R226 881 per person a year, or any higher amount the Regulator publishes.
Factual information from Ambledown’s published brochures. It is not advice. Compiled by Eldon de Waal, CFA, the licensed advisor behind AURA. Catalogue v175, built 2026-10-19.