FREQUENTLY ASKED QUESTIONS

 

 

Whether you’re checking us out because you’re thinking of joining – c’mon, why wait? – or whether you’re an existing client recapping, reading through frequently asked questions is a great way to understand Gap Cover better. 

WHO CAN I ADD TO MY POLICY?

Anyone really, as long as they’re registered dependants on your medical aid plan.

Does your spouse belong to a different medical aid plan? No problem! We’ll cover you and your spouse on one Gap Cover policy, including any dependants registered on your spouse’s medical aid plan. Now that’s bang for your buck!

WILL MY PREMIUM INCREASE FOR EVERY DEPENDANT ADDED?

We don’t charge a premium per person like medical aids do.

However, your policy’s premium can increase if you’re covered on a Single / Individual Policy – meaning you pay a premium for just yourself – and add a dependant that results in your policy changing to a family policy for which a Family Premium is payable. If you’re already paying a Family Premium, your premium won’t increase when additional dependants are added.

Your policy premium can also increase if you’re paying a 64 or Younger Premium – meaning everyone covered on the policy are 64 or younger – and add a dependant who’s 65 or older that results in your policy premium increasing to a higher premium category.

Give us a call, chat to our bot, or WhatsApp us if you’d like more clarity or have a question.

HOW DO I ADD A DEPENDANT TO MY POLICY?

Just pop us an email at yoursupport@stratumbenefits.co.za, or WhatsApp us and let us know who we should add. Don’t forget to send us a certificate of medical aid membership.

CAN MY DEPENDANT STAY ON COVER FOR AS LONG AS THEY WANT?

If you’re asking whether we’ll cancel someone’s cover because of their age, the answer is no. Who would do such a thing? 😉

As long as your dependant is registered on your or your spouse’s medical aid plan, we’re happy to keep them on cover. Happy family, happy policy.

WILL MY DEPENDANT GET WAITING PERIODS WHEN JOINING MY GAP COVER POLICY?
Dependants are subject to underwriting but that doesn’t necessarily mean they’ll receive waiting periods.

We run underwriting concessions throughout the year, and there are standard exceptions to the rule for newlyweds and newborns. Want to know more? Happy to answer any questions you may have.

TELL ME MORE ABOUT OPTION CHANGES…
Going up or down? We accept option change requests throughout the year, and you can change as many times as you like.

When you upgrade to a policy that offers more comprehensive benefits than the option you’re moving from, the enhanced benefits will be subject to a Pre-Existing Condition Waiting Period of up to 12 months unless we’re running a concession with reduced underwriting.

Pop an email to yoursupport@stratumbenefits.co.za with you option change request or complete our online Profile Update Form.

WHAT HAPPENS IF I SKIP A PREMIUM?

When one month’s premium is missed, your cover will either be suspended or cancelled – it depends on the reason for the missed premium.

Our standard process is to deduct the missed premium and the new month’s premium on the next debit order deduction date to get your premiums back on track. Return debits result in a R 25 admin fee.

But if the bank account that we debit your premium from is closed or frozen, your cover will automatically be cancelled because we can’t debit against the account again.

You can make a manual payment to get your cover reinstated.

Don’t worry, we’ll be in close contact with you to guide you on payment options.

I’M GOING FOR A MEDICAL PROCEDURE. WILL YOU COVER ANY SHORTFALLS?
Sending good vibes and well wishes your way!

Gap Cover is an “after the event” insurance policy which is why we can’t pre-authorise or pre-assess claims upfront.

We won’t know ahead of time what your doctor or specialist will charge for the procedure, or what your medical aid will pay towards it and from which medical aid plan benefit. We need this information to accurately assess shortfalls.

For some peace of mind, give us a call so that we can confirm your benefits and give you typical examples of when, and how our cover works.

CO-PAYMENTS AND SUB-LIMITS… WHAT ARE THESE AND DOES MY GAP COVER POLICY COVER IT?

Co-payments, also known as deductibles, are upfront payments that your medical aid wants you to make before you’re admitted to hospital or before you go for certain medical procedures.

We refund in- and out-of-hospital co-payments and deductibles of any amount or percentage. Have a look to see if your Gap Cover policy has a benefit called CO-PAYMENT COVER.

Sub-limits, or annual limits, are benefits that your medical aid plan provides that are limited to specific rand amounts. For example, a cardiac pacemaker costs R 60 000 but your medical aid plan only covers R 40 000 of the device… the difference of R 20 000 is typically what we’ll cover.

Have a look to see if your Gap Cover policy has a benefit called SUB-LIMIT COVER.

BY WHEN MUST I SUBMIT MY CLAIMS?

Within 6 months from the date your medical event occurred.

We also give you up to 90 days to submit any outstanding or supporting documents if we didn’t get it the first time around.

We assess claims within 7 – 10 working days if we receive everything we need to assess your claim.

Have a claim you’d like to submit? For most Gap Cover claims, we need a copy of your medical aid’s claims transaction statement that shows what your healthcare or service provider charged, what your medical aid paid, and from which medical aid plan benefit it was paid.

We also need a copy of your healthcare or service provider’s account, proof of payment – if you’ve made payment directly to the practice – and of course, a fully completed Gap Cover Claim Form.

Have a look at our Basic Guide to Submitting a Claim for helpful do’s and don’ts

Email your claim to yourclaim@stratumbenefits.co.za or submit it online by clicking here.

DOES GAP COVER REALLY COVER EVERYTHING MY MEDICAL AID DOESN’T PAY IN FULL?
Maybe we’re a little biased, but our Gap Cover policies really do fill the gap so that you don’t have to.

Whether it’s a big gap or a small one, it’s a gap you don’t have to worry about because we’ve got it covered.

We believe our cover adds value and makes a big difference in our clients’ lives, but do we cover absolutely everything your medical aid doesn’t? We’re good… in fact, we’re exceptionally good but Gap Cover wasn’t designed to cover everything. If we could, we would but we’d much rather keep your premium as low as possible.

Can’t find the answer to your question? Feel free to give us a call on 010 593 0981, pop an email to yoursupport@stratumbenefits.co.za,  send a message on Chat Box, or WhatsApp us and we’ll get back to you right away.

Gap Cover isn’t medical aid cover, doesn’t provide similar cover as that of a medical aid and can’t be substituted for medical aid membership.