ELITE500
Our top-of-the-range option offers the widest range of in– and
out-of-hospital benefits at the highest level of cover.
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.
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PREMIUMS FOR INDIVIDUALS AND FAMILIES
Premiums are determined by age at entry, and there’s no maximum entry age.
IF YOU’RE
64 OR YOUNGER
IF EVERYONE IN THE
FAMILY IS 64 OR YOUNGER
IF YOU’RE
65 OR OLDER
IF YOU OR ANYONE IN THE
FAMILY IS 65 OR OLDER
CORPORATE ELITE500
We cover 5 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!
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 procedures or scans listed below and the medical event isn’t related to a pre-existing medical condition, we’ll pay 20% of the
approved claim amount, subject to the benefit’s rand amount limits, where applicable:
- adenoidectomy;
- cardiovascular procedures;
- cataract removal;
- dentistry;
- hernia repairs;
- 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 will be subject to a Pre-Existing Medical 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
- MRI, CT AND PET SCAN TOP-UP BENEFIT
- OUT-PATIENT SPECIALIST CONSULTATION 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
- SUB-LIMIT BENEFIT
- CANCER BENEFIT
- MRI, CT AND PET SCAN TOP-UP BENEFIT
- OUT-PATIENT SPECIALIST CONSULTATION BENEFIT
- PRIVATE ROOM BENEFIT
EXCEPTION TO THE RULE
The following benefits aren’t subject to waiting periods:
- PHYSICAL REHABILITATION BENEFIT
- 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 applies to applicants who switch cover from another Gap Cover provider. Read more about our Gap Cover Transfer Process for Individuals here.
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 procedures or scans listed below and the medical event isn’t related to a pre-existing medical condition, we’ll pay 20% of the
approved claim amount, subject to the benefit’s rand amount limits, where applicable:
- adenoidectomy;
- cardiovascular procedures;
- cataract removal;
- dentistry;
- hernia repairs;
- 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 will be subject to a Pre-Existing Medical 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
- MRI, CT AND PET SCAN TOP-UP BENEFIT
- OUT-PATIENT SPECIALIST CONSULTATION 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
- SUB-LIMIT BENEFIT
- CANCER BENEFIT
- MRI, CT AND PET SCAN TOP-UP BENEFIT
- OUT-PATIENT SPECIALIST CONSULTATION BENEFIT
- PRIVATE ROOM BENEFIT
EXCEPTION TO THE RULE
The following benefits aren’t subject to waiting periods:
- PHYSICAL REHABILITATION BENEFIT
- 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 applies to applicants who switch cover from another Gap Cover provider. Read more about our Gap Cover Transfer Process for Individuals here.
