CORPORATE MERIDIAN400

Our middle-of-the-range option covers the most often experienced in-hospital medical expense shortfalls.

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.

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.

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 are determined by factors such as the size of the employer group, the average age, and whether cover is compulsory or voluntary.

ASK US FOR A CORPORATE QUOTE!

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, CO-PAYMENT BENEFITS or SUB-LIMIT 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:

  • GAP BENEFIT
  • CO-PAYMENT BENEFITS
  • CANCER BENEFIT
  • SUB-LIMIT BENEFIT
  • FIRST-TIME CANCER DIAGNOSIS 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:

  • GAP BENEFIT
  • CO-PAYMENT BENEFITS
  • CANCER BENEFIT
  • SUB-LIMIT BENEFIT

EXCEPTION TO THE RULE
The following benefits aren’t subject to waiting periods:

  • CASUALTY BENEFIT
  • TRAUMA COUNSELLING BENEFIT
  • ACCIDENTAL DEATH AND DISABILITY BENEFIT

GOOD TO KNOW
Transfer underwriting may apply to applicants who switch cover from another Gap Cover provider.

LIMITED PAYOUT BENEFIT

If you claim from our GAP BENEFIT, CO-PAYMENT BENEFITS or SUB-LIMIT BENEFIT in the first 10 months of cover for any of the medical events listed below, we’ll cover 20% of the approved claim amount subject to benefit limits where applicable:

  • adenoidectomy;
  • cardiovascular procedures;
  • cataract removal;
  • dentistry;
  • hernia repairs;
  • hysterectomy (full cover applies if required due to cancer when 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

• The 10 Month Limited Payout Benefit applies to medical events unrelated to pre-existing medical conditions. If the medical event is related to a medical condition for which you or your dependants received advice or treatment 12 months before your policy’s start date or their cover start date, the claim will be subject to a Pre-Existing Condition Waiting Period.

WAITING PERIODS

Waiting periods 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:

  • GAP BENEFIT
  • CO-PAYMENT BENEFITS
  • SUB-LIMIT BENEFIT
  • CANCER 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:

  • GAP BENEFIT
  • CO-PAYMENT BENEFITS
  • SUB-LIMIT BENEFIT

EXCEPTION TO THE RULE
The following benefits aren’t subject to waiting periods:

  • CASUALTY BENEFIT
  • TRAUMA COUNSELLING BENEFIT

GOOD TO KNOW
• Transfer underwriting applies to applicants who switch cover from another Gap Cover provider. Read more about our Gap Cover Transfer Process for Individuals here
.

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