CORPORATE ACCESS
CO-PAY PLUS300
Our booster option covers specific medical procedures, treatments, scans, and surgeries that some medical aid plans exclude. It also covers the most often experienced in- and out-of-hospital medical expense shortfalls for medical procedures that aren’t excluded, and refunds co-payments and deductibles.
CORPORATE ACCESS
CO-PAY PLUS300
Our booster option covers specific medical procedures, treatments, scans, and surgeries that some medical aid plans exclude. It also covers the most often experienced in- and out-of-hospital medical expense shortfalls for medical procedures that aren’t excluded, and refunds co-payments and deductibles.
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. When a child dependant moves to their own medical aid plan, they must apply for cover on their own policy. We cover 5 or more employees as an employer group if you join through your employer. Ask your employer if your spouse and dependents may also join. If your employer says yes to your spouse and dependant joining, add them to your policy. Premiums and waiting periods are determined by the group’s size, average age and whether cover is compulsory or voluntary.
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CLICK THE IMAGE BELOW TO VIEW OR DOWNLOAD OUR COMPREHENSIVE OR CONDENSED CORPORATE ACCESS CO-PAY PLUS300 BROCHURE.
LIMITED PAYOUT BENEFIT
Unless we confirm otherwise, the Limited Payout Benefit applies from your and your dependants’ cover start dates.
HOW IT WORKS
If you claim from our GAP BENEFIT or CO-PAYMENT BENEFIT in the first 10 months of cover for any of the medical procedures or scans listed below and the medical event isn’t related to a pre-existing medical condition, we’ll pay between 20% and 100% of the approved claim amount, subject to the benefit’s rand amount limits, where applicable:
- adenoidectomy;
- cardiovascular procedures;
- cataract removal;
- dentistry;
- hernia repair;
- hysterectomy (full cover if due to cancer diagnosed after the General Waiting Period);
- joint replacements;
- MRI, CT and PET scans;
- myringotomy (grommets);
- nasal and sinus surgery;
- pregnancy and childbirth;
- scopes (including medical events where a scope is used);
- spinal procedures; or
- tonsillectomy.
GOOD TO KNOW
• If your medical event is related to a medical condition for which you received advice or treatment 12 months before your cover start date, the claim may be subject to a Pre-Existing Medical Condition Waiting Period.
WAITING PERIODS
- ACCESS BENEFIT
- GAP BENEFIT
- CO-PAYMENT BENEFIT
- ACCESS BENEFIT
- GAP BENEFIT
- CO-PAYMENT BENEFIT
- CASUALTY BENEFIT
- ACCIDENTAL DEATH AND DISABILITY BENEFIT
LIMITED PAYOUT BENEFIT
Unless we confirm otherwise, the Limited Payout Benefit applies from your and your dependants’ cover start dates.
HOW IT WORKS
If you claim from our GAP BENEFIT or CO-PAYMENT BENEFIT in the first 10 months of cover for any of the medical procedures or scans listed below and the medical event isn’t related to a pre-existing medical condition, we’ll pay between 20% and 100% of the approved claim amount, subject to the benefit’s rand amount limits, where applicable:
- adenoidectomy;
- cardiovascular procedures;
- cataract removal;
- dentistry;
- hernia repair;
- hysterectomy (full cover if due to cancer diagnosed after the General Waiting Period);
- joint replacements;
- MRI, CT and PET scans;
- myringotomy (grommets);
- nasal and sinus surgery;
- pregnancy and childbirth;
- scopes (including medical events where a scope is used);
- spinal procedures; or
- tonsillectomy.
GOOD TO KNOW
• If your medical event is related to a medical condition for which you received advice or treatment 12 months before your cover start date, the claim may be subject to a Pre-Existing Medical Condition Waiting Period.
WAITING PERIODS
Waiting periods may apply from your and your dependants’ cover start dates, but never to accidents that occur after your cover start dates.
3 MONTH GENERAL WAITING PERIOD
There’s no cover during this period except for accidents 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 BENEFIT
12 MONTH PRE-EXISTING CONDITION WAITING PERIOD
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 BENEFIT
EXCEPTION TO THE RULE
The following benefits aren’t subject to waiting periods:
- CASUALTY BENEFIT
- ACCIDENTAL DEATH AND DISABILITY BENEFIT
GOOD TO KNOW
Transfer underwriting may apply to applicants who switch cover from another Gap Cover provider.
