ELITE RANGE
Our individual and corporate ELITE options offer the widest range of benefits.
ELITE RANGE
Our individual and corporate ELITE options offer the widest range of benefits.
One Gap Cover policy covers you, your spouse, and all the dependants registered on your and your spouse’s medical aid plan.
ELITE PREMIUMS FOR INDIVIDUALS AND FAMILIES
One Gap Cover policy covers you, your spouse, and all the dependants registered on your and your spouse’s medical aid plan.
CORPORATE ELITE & CORPORATE ELITE PLUS
With our Elite option, we cover five or more employees as an employer group if you join through your employer. If your employer says yes to your spouse and dependants joining, add them to your policy. Premiums and waiting periods are determined by factors such as the group’s size, average age and if cover is compulsory or voluntary.
ASK US FOR A CORPORATE QUOTE!
10 MONTH LIMITED PAYOUT BENEFIT, WAITING PERIODS, BENEFIT AND GENERAL EXCLUSIONS
10 MONTH LIMITED PAYOUT BENEFIT
If you claim from our GAP BENEFIT, CO-PAYMENT BENEFIT, PENALTY or ROBOTIC SURGERY 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 policy’s start date;
• to enhanced benefits when you upgrade to an option that provides more comprehensive cover; and
• each dependant’s cover start date when they’re added to your policy.
Accidental events that occur after your policy’s start date are never subject to any waiting periods.
3 MONTH GENERAL WAITING PERIOD
• You don’t have cover during this period except for accidental events that occur after your policy’s start date.
• A standard 3 Month General Waiting Period applies to our OUT-PATIENT SPECIALIST CONSULTATION BENEFIT.
12 MONTH PRE-EXISTING CONDITION WAITING PERIOD
We don’t cover you during this period for investigations, medical procedures, surgeries or treatments related to any illness or medical condition that was diagnosed, or that you received advice or treatment for within 12 months before your policy’s start date.
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.
Gap Cover is not a medical aid, does not provide similar cover as that of a medical aid and cannot be substituted for medical aid membership.
ELITE PREMIUMS FOR INDIVIDUALS AND FAMILIES
Premiums are determined by age at entry, and there’s no maximum entry age.
One Gap Cover policy covers you, your spouse and all the dependants registered on both your and your spouse’s medical aid plan.
CORPORATE ELITE & CORPORATE ELITE PLUS
We cover five or more employees as an employer group if you join through your employer. If your employer says yes to your spouse and dependants joining, add them to your policy. Premiums and waiting periods are determined by factors such as the group’s size, average age and if cover is compulsory or voluntary.
ASK US FOR A CORPORATE QUOTE!
10 MONTH LIMITED PAYOUT BENEFIT, WAITING PERIODS, BENEFIT AND GENERAL EXCLUSIONS
10 MONTH LIMITED PAYOUT BENEFIT
If you claim from our GAP BENEFIT, CO-PAYMENT BENEFIT, PENALTY or ROBOTIC SURGERY 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 policy’s start date;
• to enhanced benefits when you upgrade to an option that provides more comprehensive cover; and
• each dependant’s cover start date when they’re added to your policy.
Accidental events that occur after your policy’s start date are never subject to any waiting periods.
3 MONTH GENERAL WAITING PERIOD
• You don’t have cover during this period except for accidental events that occur after your policy’s start date.
• A standard 3 Month General Waiting Period applies to our OUT-PATIENT SPECIALIST CONSULTATION BENEFIT.
12 MONTH PRE-EXISTING CONDITION WAITING PERIOD
We don’t cover you during this period for investigations, medical procedures, surgeries or treatments related to any illness or medical condition that was diagnosed, or that you received advice or treatment for within 12 months before your policy’s start date.
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.
Gap Cover is not a medical aid, does not provide similar cover as that of a medical aid and cannot be substituted for medical aid membership.
