Monthly premium, per family
By age band, as Stratum publishes it. 2027 premiums take effect on 1 January 2027.
| Age | 2026 | 2027 | Change |
|---|---|---|---|
| 0 to 64 | R217 | R238 | +9.7% |
| 65 and older | R288 | R315 | +9.4% |
What it covers
What it pays
Limits and joining
Who is covered
In Stratum’s own words.
- Premiums are based on your age at entry, with no maximum entry age. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p11
- One Gap Cover policy covers you and your spouse, even if you belong to different medical aid plans, including the dependants registered on either medical aid plan, up to a maximum of 8 individuals per policy. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p11
- Child dependants registered on your or your spouse’s medical aid plan may remain on your Gap Cover policy regardless of age. However, when a child dependant applies for their own medical aid membership, they must apply for their own policy. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p11
- A full-time student 26 or younger may remain on your policy even if they belong to a different medical aid plan, provided proof of full-time studies is submitted annually. Distance and online learning don’t qualify. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p11
What each benefit means
In Stratum’s own words, with its examples of when it pays and when it doesn’t.
Gap Cover
Gap Cover is a non-life medical expense shortfall policy that complements your medical aid. It is not a medical aid, does not provide the same cover as a medical aid, and cannot replace a medical aid membership. Depending on your policy’s benefits, Gap Cover may help cover certain medical expense shortfalls, co-payments, selected medical aid exclusions, and a range of healthcare-related expenses that can arise before, during, or after a medical event, subject to policy terms, conditions, and benefit limits.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p2
Access Benefit
Our benefit helps with the cost of a planned medical procedure if: your medical aid plan excludes it from cover, or your plan only covers Prescribed Minimum Benefit (PMB) medical procedures, and your procedure isn’t listed as a PMB. PMBs are specific benefits your medical aid must provide for a defined list of medical procedures.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p46
Radiology Cover — MRI, CT and PET Scan Sub-Limits
When your medical aid covers the cost of: in- or out-of-hospital MRI, CT, or PET scans from a sub-limit or annual limit, but the rand amount available under the sub-limit or annual limit doesn’t cover the total cost, we’ll cover the difference.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p17
Casualty Benefits — Accidental Events
Visit any registered medical facility within 24 hours of an accident, such as the doctor’s room or emergency unit at the nearest hospital, when anyone in the family requires medical treatment for bodily injury.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p18
Casualty Benefits — Illness Events (Children 12 or younger)
Children 12 years or younger are covered for after-hours illness-related events at any registered casualty facility between 19:00 and 7:00 Monday through Friday and all day Saturday, Sunday, and public holidays.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p18
Casualty Benefits
We’ll cover the shortfalls when your medical aid pays part of the cost of a casualty event from a risk, insured day-to-day or block benefit, or refund the total cost when paid from your medical savings account or pocket, subject to our benefit limits.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p18
Accidental Death and Disability
In the event of accidental death or total and permanent disability due to an accident, a benefit amount is payable on each insured person’s life. Our benefit compensates you for any current or future costs and expenses, including any potential loss of earnings.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p20
Wellness Careline
Through our partnership with Reality Wellness Group, you and your dependants have access to confidential counselling with registered counsellors and social workers, telephonically or virtually. Support is available 24/7, 365 days a year, in all 11 official languages.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p21
2027 product range update
Introducing our new option: LUMA300
Stratum 2027 The Stratum Times brochure 2027, p1
Waiting periods
In Stratum’s own words.
- Waiting periods apply from your and your dependants’ cover start dates, but never to accidental events that occur after your cover start dates. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p56
- There’s no cover during this period except for accidental events that occur after your and your dependants’ cover start dates. Unless we confirm otherwise, the following benefits are subject to this waiting period: ACCESS BENEFIT; GAP BENEFIT; CO-PAYMENT BENEFITS; SUB-LIMIT BENEFITS; CANCER BENEFITS; PRIVATE ROOM BENEFIT; PREVENTATIVE CARE BENEFIT; FIRST-TIME CANCER DIAGNOSIS BENEFIT; MRI, CT AND PET SCAN TOP-UP BENEFIT; OUT-PATIENT SPECIALIST CONSULTATION BENEFIT. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p56
- There’s no cover during this period for investigations, medical procedures, surgeries or treatments related to any illness or medical condition diagnosed or for which advice or treatment was received 12 months before your or your dependants’ cover start dates. Unless we confirm otherwise, the following benefits are subject to this waiting period: ACCESS BENEFIT; GAP BENEFIT; CO-PAYMENT BENEFITS; SUB-LIMIT BENEFITS; CANCER BENEFITS; PRIVATE ROOM BENEFIT; MRI, CT AND PET SCAN TOP-UP BENEFIT; OUT-PATIENT SPECIALIST CONSULTATION BENEFIT. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p56
- The following benefits aren’t subject to waiting periods: CASUALTY BENEFITS; TRAUMA COUNSELLING BENEFIT; PHYSICAL REHABILITATION TOP-UP BENEFIT; ACCIDENTAL DEATH AND DISABILITY BENEFIT; MEDICAL AID CONTRIBUTION WAIVER BENEFIT; STRATUM POLICY PREMIUM WAIVER BENEFIT. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p56
- Unless we confirm otherwise, the Limited Payout Benefit applies from your and your dependants’ cover start dates. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p56
- If you claim from our GAP BENEFIT, CO-PAYMENT BENEFITS or SUB-LIMIT BENEFITS for any of the listed medical procedures or scans in the first 10 months of cover, we’ll pay 20% of the approved claim amount, subject to applicable benefit limits. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p56
- Transfer underwriting applies to applicants who switch cover from another Gap Cover provider. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p56
- 0 Month General Waiting Period Remainder of any other existing waiting period will be carried over Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- 3 Month General Waiting Period on the FIRST-TIME CANCER DIAGNOSIS BENEFIT Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- 6 Month Pre-Existing Medical Condition Waiting Period (reduced from 12 months) Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- 10 Month Pre-Existing Pregnancy and Childbirth Waiting Period Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- 12 Month Pre-Existing Cancer Waiting Period Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- 6 Month Pre-Existing Medical Condition Waiting Period on enhanced benefits (reduced from 12 months) Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- 6 Month Limited Payout Benefit (reduced from 10 months) Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- Not applicable, but planned procedures in the first 10 months of cover is limited to 20% of the approved claim amount (applies to the entire claim) Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- Not reapplied, but remainder of any existing period will be carried over Stratum 2027 Gap Cover Underwriting Concessions for Individuals brochure 2027, p1
- If you switch cover while your current policy is still subject to a General Waiting Period, the remaining portion will carry over to your new policy. We won’t impose a General Waiting Period on any benefits, except for the OUT-PATIENT SPECIALIST CONSULTATION BENEFIT available on ELITE500 and LUMA300, which is subject to a 3 Month General Waiting Period unless it’s a like-for-like benefit. Stratum Gap Cover Transfer Process for Individuals brochure 2027, p1
- If we offer benefits that aren’t available on your current policy, a 12 Month Pre-Existing Medical Condition Waiting Period will apply to those enhanced benefits. Stratum Gap Cover Transfer Process for Individuals brochure 2027, p1
- If you claim within the first 10 months of your policy start date for a planned medical procedure that was disclosed when switching, we’ll pay 20% of the approved claim amount, subject to the applicable benefit limits. This applies to the entire claim. If you claim within the first 12 months of your policy start date for a planned medical procedure that wasn’t disclosed when switching, your claim may be rejected due to non-disclosure. Stratum Gap Cover Transfer Process for Individuals brochure 2027, p1
How to claim
In Stratum’s own words.
Claiming
To claim, send us cost estimates from all your chosen providers, such as the hospital or day clinic, surgeon, and anaesthetist, along with a completed claim form. We’ll review the quotes. If approved, we’ll issue a guarantee of payment to your providers as an undertaking to pay them directly after your procedure. After your procedure, submit the final invoices. We’ll settle them in the order received, up to the procedure benefit limit. Any costs above the limit will be for your pocket.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p46
What each document is for
| Document | Where to get it | Why Stratum needs it | Note |
|---|---|---|---|
| 2027 Gap Cover Client Offer Form. Policy document dated not older than 31 days. Cancellation certificate. | The policy document and/or cancellation certificate must confirm your cover start and end dates, the option you were covered under, the benefits available on your policy, and whether any waiting periods applied. | If you don’t provide the supporting documents, standard waiting periods will apply. Once you receive your Cover Acceptance Letter, you’ll have 60 days to request an amendment to the underwriting decision. |
Stratum Gap Cover Transfer Process for Individuals brochure 2027, p1
Claim examples
In Stratum’s own words.
- Having a 100% medical aid plan doesn’t mean your medical aid will cover all healthcare expenses. Even a more comprehensive 300% plan only pays a portion of what private healthcare providers charge. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p55
- Our GAP BENEFIT covers shortfalls up to an additional 500%, 400% or 300% of your medical aid plan’s rate when your healthcare providers charge private fees not fully covered by your medical aid. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p55
- The below represents a childbirth claim. If your medical aid pays 100% of the medical aid rate, and the specialists charge 400%, you’ll be left with a 300% shortfall. When submitting a claim for the shortfalls, the Medical Aid Rate column on the medical aid statement is our reference point for assessing them. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p55
What it does not pay for
Stratum’s exclusions (38)
- events that occurred before your cover start date, except when claiming from our TRAUMA COUNSELLING BENEFIT.
- events during waiting periods, except for accidental events that occur after your cover start date.
- line items that don’t meet the South African medical coding standards, such as CPT, NHRPL, and ICD-10.
- events your medical aid pays as concessions, exceptions, or ex-gratia payments.
- medical events for which pre-authorisation hasn’t been obtained from your medical aid or when your medical aid’s rules haven’t been followed, except if your policy offers a benefit.
- events when benefit limits or your policy’s overall limit has been reached.
- shortfalls that exceed the 500%, 400% or 300% GAP BENEFIT your policy provides.
- events your policy doesn’t cover or provides an appropriate benefit to claim from.
- additional shortfalls when your healthcare or service provider increases their fees after we’ve finalised your claim.
- additional shortfalls when your healthcare or service provider agrees to a discount but increases their fee after we’ve finalised your claim.
- costs related to medical documents, such as prescriptions, medical reports and the completion of chronic medicine registration forms.
- split billing charges.
- allied healthcare professionals, except if your policy offers a benefit.
- assisted reproductive therapy (ART), fertility treatments or contraceptives, except for contraceptive device implants, tubal ligations, and vasectomies if your policy offers a benefit.
- a second breast reconstruction or any subsequent reconstruction procedure.
- diagnosing or treating sleeping disorders.
- elective, prophylactic (preventative), routine procedures or physical examinations, such as annual check-ups and medical tests for insurance purposes, risk-reducing mastectomies, and scopes based on family history, except if your policy offers a benefit.
- external medical items, such as spectacles, arm slings, compression socks, crutches, moon boots and neck braces, except when claiming from our CASUALTY BENEFIT for items received at the medical facility.
- external prosthetic devices, such as artificial limbs.
- home or private nursing or admission to a step-down or sub-acute facility, such as frail care centres, hospice centres, mental health facilities, and rehabilitation facilities, except if your policy offers a benefit.
- hospital charges, such as ward fees.
- treating mood disorders or emotional or psychological illnesses, except when claiming for counselling from our TRAUMA COUNSELLING BENEFIT.
- obesity or treatments required due to obesity.
- prescription or take-home medication, except when claiming prescription medication from our CANCER BENEFITS.
- reconstructive cosmetic surgery, except if your policy offers a benefit.
- robotic-assisted surgery co-payments, except when claiming from our ROBOTIC SURGERY CO-PAYMENT BENEFIT.
- specialised mechanical or computerised devices, such as CPAP machines, glucometers, insulin pumps, oxygen machines, and ventilators.
- stem cell harvesting or treatments.
- attempted suicide, suicide, or intentional self-injury.
- deliberate exposure to exceptional danger, except if trying to save a human life.
- events covered by legislation, such as contractual liability and consequential loss.
- illegal behaviour or breaking the law of the Republic of South Africa.
- events outside the borders of the Republic of South Africa.
- illness or injury caused by using drugs or narcotics, except if prescribed by a healthcare provider, provided the healthcare provider isn’t an insured person.
- illness or injury caused by using alcohol.
- nuclear weapons, nuclear material or ionising radiation.
- participation in active military, police or police reservist duty, civil commotion, invasion, labour disturbance, political act, rebellion, riot, strike, terrorist activity, war, or the activity of locked-out workers.
- transport charges or healthcare services provided while being transported in an emergency vehicle, vessel, or aircraft.
Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p57
Words used
As Stratum defines them.
- Overall Policy Limit (OPL)
- An OPL of R 226 880 per insured person per year, or any higher amount published by the Regulator during the year, applies to the following benefits. All approved claim amounts will be deducted from the available OPL. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p12
- Prescribed Minimum Benefit (PMB)
- Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p12
- Split billing
- Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p12
- Accident
- means a sudden, unplanned and unexpected accidental event resulting in bodily injury caused by physical impact. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p20
- Total and permanent disability
- means bodily injury resulting in complete and absolute disablement beyond hope of improvement, preventing an employed insured person from following their usual occupation or similar work for which they’re suited by education or training. If the insured person is an individual or pensioner who’s not gainfully employed, total and permanent disability will mean the loss of both hands or feet, one hand and one foot, or the sight of both eyes. Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p20
- Premiums and tax
- Stratum 2027 Individual Gap Cover Client Offer Form brochure 2027, p4
- Underwriter
- Stratum 2027 Individual Gap Cover Product Range Brochure Single page view brochure 2027, p1
Questions about Access Optimiser
Answered from Stratum’s brochures.
How much does Access Optimiser cost in 2027?
From 1 January 2027: R238 a month at 0 to 64; R315 a month at 65 and older. The same premium for one person or a family.
How much is Access Optimiser going up for 2027?
For a family at 0 to 64, from R217 to R238 a month, +9.7%.
Is there a waiting period?
Yes. 3 months general, and 12 months for conditions you had before joining.
Does Access Optimiser cover cancer?
No. Access Optimiser does not include cancer cover.
Is there a limit on what it pays?
Yes. R226 880 per person a year.
Factual information from Stratum’s published brochures. It is not advice. Compiled by Eldon de Waal, CFA, the licensed advisor behind AURA. Catalogue v175, built 2026-10-19.