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086 111 3499

Gap Cover & Health Insurance for Real People

FREQUENTLY ASKED QUESTIONS

 

 

Gap Cover policies are short-term insurance policies that are designed to cover the shortfalls that you must pay when the private fees charged by your healthcare providers are more than what your medical aid pays, subject to specific t’s and c’s of course…

But that’s not all it covers. From co-payments and top-up cover for cancer treatment, to cover for out-patient specialist consultations and casualty events, it’s a must-have insurance policy for every individual belonging to a registered South African medical aid.

IS COVER AVAILABLE TO INDIVIDUALS OF ALL AGES?

Whether you’re a single 18-year-old or vibey 66-year-old, all are welcome. We cover  individuals and families and premiums are determined by age at entry.

THERE ARE SO MANY OPTIONS AVAILABLE. HOW DO I BEGIN TO DECIDE WHICH OPTION IS BEST FOR ME?

Are you the type of person who wants basic cover and upgrade as you go along, or are you an all-or-nothing kind of person? The point is… we have an option that’s got your name on it.

It really depends on your individual healthcare needs, which medical aid plan you’re on and the level of cover you require, but your right fit is ready and waiting.

WHAT IS THE PROCESS WHEN I WANT TO CHANGE MY GAP COVER OPTION TO ANOTHER OPTION, AND WILL I RECEIVE NEW WAITING PERIODS?

Changing your Gap Cover option is as easy as 1, 2, 3 and what’s more, you can change your option as many times as you need to.

Send an email to yoursupport@stratumbenefits.co.za or send your option change request online.

When you change to an option that offers enhanced benefits, the enhanced benefits will be subject to a 12 Month Pre-Existing Condition Waiting Period, unless a concession exists where a reduced waiting periods may apply.

HOW OFTEN WILL MY POLICY PREMIUM INCREASE?

Once a year when the policy is renewed on the 1st of January. Premium increases are based on the claim ratios experienced across our Gap Cover product ranges and the various options within these product ranges.

CAN I CLAIM MY GAP COVER PREMIUMS BACK FROM SARS?

Unlike medical aids who issue annual tax certificates for income tax purposes, premiums for Gap Cover policies are not tax deductible as these policies are registered as Short-Term insurance policies.

HOW DOES THE OVERALL POLICY LIMIT (OPL) APPLICABLE TO GAP COVER POLICIES AFFECT MY COVER?

The applicable policy limit applies across all benefits offered by the Gap Cover policy. If the policy limit is reached, it means you won’t be able to claim from your policy for the remainder of that benefit year. The OPL renews every year on the 1st of January.

There’s some good news… certain benefits do not form part of the OPL as these benefits are offered over and above the benefits that form part of the OPL. We’re awesome that way!

MY SPECIALIST WANTS ME TO PAY AN UPFRONT CO-PAYMENT DIRECTLY TO THE PRACTICE. CAN I CLAIM IT BACK FROM MY GAP COVER OPTION?

When an upfront co-payment is required from you by your healthcare provider that is not a co-payment that your medical aid requires you to pay, we cannot process a refund because the co-payment must be imposed by your medical aid plan.

Ready to get cover’d? 

Can’t find the answer to your question? Feel free to give us a call on 086 111 3499, pop an email to yoursupport@stratumbenefits.co.za or send a message on Chat Box and we’ll get back to you right away.

Our Gap Cover policy is not a medical aid, does not provide similar cover as that of a medical aid and cannot be substituted for medical aid membership.