Stratum gap cover

Overall limit R219 845 a year.

What it covers

• Benefit booster (per insured)
• Above the scheme’s MRI/CT sub-limit
• Your scheme contributions paid if you die or are disabled
• Your gap premium paid if you die or are disabled
• Cash lump sum on accidental death or permanent disability (per insured)

What it does not cover

• Shortfall on the specialist bill in hospital
• Co-payments and deductibles the scheme imposes
• Co-payment on robotic surgery
• Co-payment on a scope
• Co-payment on an MRI or CT scan
• Internal prosthesis — above the scheme sub-limit
• Shortfall on cancer treatment
• Cancer treatment above the scheme’s oncology limit
• Casualty unit after an accident
• Casualty unit for sudden illness
• Dental work in hospital
• Dental work after an accident
• Childbirth in hospital
• Trauma counselling
• Cash lump sum on a first cancer diagnosis
• The penalty for using a hospital off your network

What it costs

Covers up to 500% of the medical scheme rate. The policy is written as 400% in addition to the 100% your scheme already pays.

Overall limit R219 845 a year.

What it covers

• Shortfall on the specialist bill in hospital (per insured)
• Co-payments and deductibles the scheme imposes (per insured)
• Co-payment on a scope (per policy)
• Dental work in hospital
  DENTAL — SPECIALIST SHORTFALLS (in-hospital).
• Dental work in hospital (per policy)
  DENTAL — Dental procedures such as dental implants and wisdom teeth extractions.
• Dental work after an accident (per policy)
• Childbirth in hospital
• Preventative screening (per policy)
• Dental work in hospital
  RADIOLOGY — RADIOLOGY SHORTFALLS (in- and out-of-hospital).
• Co-payment on an MRI or CT scan (per policy)
• Above the scheme’s MRI/CT sub-limit (per insured)
• Internal prosthesis — above the scheme sub-limit (per policy)
• Shortfall on cancer treatment (per insured)
• Cancer treatment above the scheme’s oncology limit (per insured)
• Casualty unit after an accident (per insured)
• Casualty unit for sudden illness (per policy)
• Trauma counselling (per policy)
• Extras the provider adds at no charge

What it does not cover

• Co-payment on robotic surgery
• Screening scopes
• Specialist consultations out of hospital
• Physical rehabilitation
• Breast reconstruction after a mastectomy
• Kidney dialysis
• Above the scheme’s sub-limit on scopes
• Internal prosthesis — top-up
• A private ward
• Cash lump sum on accidental death or permanent disability
• Cash lump sum on a first cancer diagnosis
• Your scheme contributions paid if you die or are disabled
• Your gap premium paid if you die or are disabled
• Extras the provider adds at no charge
• Co-payment on the scheme’s defined procedure list
• MedBoost
• External appliances
• A daily cash amount while in hospital

Using a hospital off your network

Covered up to R10 500 per policy, 1 claim per annum.

“PENALTY CO-PAYMENTS (in-hospital). Limited to 1 co-payment up to R 10 500 per policy per year.”

What it costs

Covers up to 400% of the medical scheme rate. The policy is written as 300% in addition to the 100% your scheme already pays.

Overall limit R219 845 a year.

What it covers

• Shortfall on the specialist bill in hospital (per insured)
• Co-payments and deductibles the scheme imposes (per policy)
• Co-payment on robotic surgery
• Co-payment on a scope
• Dental work in hospital
  DENTAL — SPECIALIST SHORTFALLS (in-hospital).
• Dental work in hospital (per policy)
  DENTAL — Dental procedures such as wisdom teeth extractions.
• Dental work after an accident (per insured)
• Dental work in hospital
  DENTAL — Admission and Procedure Co-Payments.
• Childbirth in hospital
• Dental work in hospital
  RADIOLOGY — RADIOLOGY SHORTFALLS (in- and out-of-hospital).
• Co-payment on an MRI or CT scan
• Above the scheme’s MRI/CT sub-limit (per insured)
  Sub-limit: mri ct R4 000
• Internal prosthesis — above the scheme sub-limit (per insured)
• Shortfall on cancer treatment (per insured)
• Cancer treatment above the scheme’s oncology limit (per insured)
• Casualty unit after an accident (per policy)
• Casualty unit for sudden illness
• Trauma counselling (per policy)
• Cash lump sum on accidental death or permanent disability (per insured)
• Cash lump sum on a first cancer diagnosis (per insured)
• Extras the provider adds at no charge

What it does not cover

• Co-payment on robotic surgery
• Screening scopes
• Specialist consultations out of hospital
• Physical rehabilitation
• Breast reconstruction after a mastectomy
• Kidney dialysis
• Casualty unit for sudden illness, age 11 and over
• Preventative screening
• A private ward
• Your scheme contributions paid if you die or are disabled
• Your gap premium paid if you die or are disabled
• Extras the provider adds at no charge
• Above the scheme’s sub-limit on scopes
• Internal prosthesis — top-up
• Co-payment on the scheme’s defined procedure list
• MedBoost
• External appliances
• A daily cash amount while in hospital
• Prescribed Minimum Benefit shortfalls

Using a hospital off your network

Covered up to R12 000 per policy.

“PENALTY CO-PAYMENTS (in-hospital). We refund the penalty co-payments when using day clinics or hospitals outside your medical aid's preferred network. Limited to R 12 000 per policy per year.”

What it costs

Covers up to 400% of the medical scheme rate. The policy is written as 300% in addition to the 100% your scheme already pays.

Overall limit R219 845 a year.

What it covers

• Co-payment on the scheme’s defined procedure list (per insured)
• Shortfall on the specialist bill in hospital (per insured)
• Co-payments and deductibles the scheme imposes (per policy)
  Sub-limit: scopes R7 000
• Dental work in hospital
  DENTAL — SPECIALIST SHORTFALLS (in-hospital).
• Dental work in hospital (per policy)
  DENTAL — Dental procedures such as dental implants and wisdom teeth extractions.
• Dental work after an accident (per insured)
• Childbirth in hospital
• Dental work in hospital
  RADIOLOGY — RADIOLOGY SHORTFALLS (in- and out-of-hospital).
• Co-payment on an MRI or CT scan
• Above the scheme’s MRI/CT sub-limit (per policy)
• Casualty unit after an accident (per policy)
• Casualty unit for sudden illness
• Cash lump sum on accidental death or permanent disability (per insured)
• Extras the provider adds at no charge

What it does not cover

• The penalty for using a hospital off your network
• Co-payment on robotic surgery
• Co-payment on a scope
• Screening scopes
• Shortfall on cancer treatment
• Cancer treatment above the scheme’s oncology limit
• Breast reconstruction after a mastectomy
• Cash lump sum on a first cancer diagnosis
• Above the scheme’s sub-limit on scopes
• Internal prosthesis — above the scheme sub-limit
• Kidney dialysis
• Physical rehabilitation
• Specialist consultations out of hospital
• Trauma counselling
• Preventative screening
• A private ward
• Your scheme contributions paid if you die or are disabled
• Your gap premium paid if you die or are disabled
• Extras the provider adds at no charge
• MedBoost
• External appliances
• A daily cash amount while in hospital

What it costs

Covers up to 600% of the medical scheme rate. The policy is written as 500% in addition to the 100% your scheme already pays.

Overall limit R219 845 a year.

What it covers

• Shortfall on the specialist bill in hospital (per insured)
• Co-payments and deductibles the scheme imposes (per insured)
• Co-payment on robotic surgery (per policy)
• Co-payment on a scope
• Dental work in hospital
  DENTAL — SPECIALIST SHORTFALLS (in-hospital).
• Dental work in hospital (per policy)
  DENTAL — Dental procedures such as dental implants and wisdom teeth extractions.
• Dental work after an accident (per insured)
• Childbirth in hospital
• Dental work in hospital
  RADIOLOGY — RADIOLOGY SHORTFALLS (in- and out-of-hospital).
• Co-payment on an MRI or CT scan
• Above the scheme’s MRI/CT sub-limit (per insured)
  RADIOLOGY — MRI, CT AND PET SCAN SUB-LIMITS (in- and out-of-hospital).
• Above the scheme’s MRI/CT sub-limit (per policy)
  RADIOLOGY — MRI, CT AND PET SCAN TOP-UP (in- and out-of-hospital).
• Above a scheme sub-limit generally (per insured)
• Internal prosthesis — above the scheme sub-limit (per insured)
  SUB-LIMIT — INTERNAL PROSTHETIC DEVICE SHORTFALLS (in-hospital).
• Internal prosthesis — above the scheme sub-limit (per insured)
  SUB-LIMIT — INTERNAL PROSTHETIC DEVICE TOP-UP (in-hospital).
• Kidney dialysis (per insured)
• Breast reconstruction after a mastectomy (per insured)
• Shortfall on cancer treatment (per insured)
• Cancer treatment above the scheme’s oncology limit (per insured)
• Physical rehabilitation (per insured)
• Specialist consultations out of hospital (per policy)
• Casualty unit after an accident (per policy)
• Casualty unit for sudden illness
  CASUALTY — ILLNESS EVENTS (children 10 or younger, out-of-hospital).
• Casualty unit for sudden illness (per policy)
  CASUALTY — ILLNESS EVENTS (individuals 11 years or older, out-of-hospital).
• Trauma counselling (per policy)
• Preventative screening (per policy)
• A private ward (per policy)
• Cash lump sum on accidental death or permanent disability (per insured)
• Cash lump sum on a first cancer diagnosis (per insured)
• Your scheme contributions paid if you die or are disabled
• Your gap premium paid if you die or are disabled
• Extras the provider adds at no charge (per policy)
  INTERNATIONAL TRAVEL INSURANCE (Lifestyle Benefit).
• Extras the provider adds at no charge
  WELLNESS CARELINE.

What it does not cover

• Benefit booster
• Co-payment on the scheme’s defined procedure list
• MedBoost
• External appliances
• A daily cash amount while in hospital
• Recovery after trauma
• Screening scopes

Using a hospital off your network

Covered up to R16 000 per policy, 2 claim per annum.

“PENALTY CO-PAYMENTS (in-hospital). Limited to 2 co-payments up to R 16 000 per co-payment per policy per year.”

What it costs