CORPORATE ELITE500
Our top-of-the-range option offers the widest range of in- and out-of-hospital benefits at the highest level of cover.
CORPORATE ELITE500
Our top-of-the-range option offers the widest range of in- and out-of-hospital benefits at the highest level of cover.
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.
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.
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 agrees, 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!
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CLICK THE IMAGE BELOW TO VIEW OR DOWNLOAD OUR COMPREHENSIVE OR CONDENSED CORPORATE ELITE500 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, 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
- SUB-LIMIT BENEFIT
- CANCER BENEFIT
- MRI, CT AND PET SCAN TOP-UP BENEFIT
- PREVENTATIVE CARE BENEFIT
- PRIVATE ROOM 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
- MRI, CT AND PET SCAN TOP-UP BENEFIT
- PRIVATE ROOM BENEFIT
EXCEPTION TO THE RULE
The following benefits aren’t subject to waiting periods:
- PHYSICAL REHABILITATION
- CASUALTY BENEFIT
- TRAUMA COUNSELLING BENEFIT
- ACCIDENTAL DEATH AND DISABILITY BENEFIT
- MEDICAL AID CONTRIBUTION WAIVER BENEFIT
- STRATUM POLICY PREMIUM WAIVER BENEFIT
GOOD TO KNOW
Transfer underwriting may apply to applicants who switch cover from another Gap Cover provider.
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
- SUB-LIMIT BENEFIT
- CANCER BENEFIT
- MRI, CT AND PET SCAN TOP-UP BENEFIT
- PREVENTATIVE CARE BENEFIT
- PRIVATE ROOM 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
- MRI, CT AND PET SCAN TOP-UP BENEFIT
- PRIVATE ROOM BENEFIT
EXCEPTION TO THE RULE
The following benefits aren’t subject to waiting periods:
- PHYSICAL REHABILITATION
- CASUALTY BENEFIT
- TRAUMA COUNSELLING BENEFIT
- ACCIDENTAL DEATH AND DISABILITY BENEFIT
- MEDICAL AID CONTRIBUTION WAIVER BENEFIT
- STRATUM POLICY PREMIUM WAIVER BENEFIT
GOOD TO KNOW
Transfer underwriting may apply to applicants who switch cover from another Gap Cover provider.
