+27 10 593 0981 info@stratumbenefits.co.za

2025 GAP COVER
ENHANCEMENTS & CHANGES

Every year, we enhance benefits while keeping premium increases low.

We’re pleased to announce an average premium increase of 9.8% across all individual Gap Cover options.

Employer groups receive premium increases based on benefit utilisation and other factors.

Existing 2024 policies will receive option-specific benefit enhancements effective 1 January 2025.

Click here to download a PDF version of our This is 2025 document that summarises the enhancements and changes for the new benefit year.

2025 GAP COVER
ENHANCEMENTS & CHANGES

Every year, we enhance benefits while keeping premium increases low.

We’re pleased to announce an average premium increase of 9.8% across all individual Gap Cover options.

Existing 2024 policies will receive the option-specific benefit enhancements effective 1 January 2025.

Click here to download a PDF version of our This is 2025 document that summarises the enhancements and changes for the new benefit year.

ACTIVE RANGE

COMPACT300 and CORPORATE COMPACT300
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective.
    1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
  • DENTAL COVER
    • Benefit limit for dental procedures such as implants and wisdom teeth extractions increased from R 6 000 to R 30 000 per policy.
    • Benefit for dental procedures due to accidental events or cancer treatment is no longer limited to R 32 000 but subject to the OPL.
    • 📢 New benefit exclusion: Effective 1 January 2025, out-of-hospital dental-related procedures will no longer be covered under our GAP BENEFIT or CO-PAYMENT BENEFITS.
    • 📢 General exclusion removed: Maxillofacial surgery and related medical conditions or procedures are covered only when related to accidental events or cancer treatment.
      Effective 1 January 2025, the general exclusion for maxillofacial surgery unrelated to accidental events or cancer treatment will be removed. Claims for all maxillofacial surgery shortfalls and co-payments will be assessed.
MERIDIAN400 and CORPORATE MERIDIAN400
  • CORPORATE MERIDIAN400
    📢 MERIDIAN400, designed to cover the most often experienced in-hospital medical expense shortfalls, was added to our 2024 Gap Cover Product Range as a non-corporate option. Due to popular demand, this option has now been added to our 2025 Corporate Product Range.
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
  • DENTAL COVER
    • Benefit limit for dental procedures such as implants and wisdom teeth extractions increased from R 7 000 to R 10 000 per policy.
    • Benefit limit for dental procedures due to accidental events or cancer treatment increased from R 14 000 to R 28 000 per policy.
    • 📢 General exclusion removed: Maxillofacial surgery and related medical conditions or procedures are covered only when related to accidental events or cancer treatment.
      Effective 1 January 2025, the general exclusion for maxillofacial surgery unrelated to accidental events or cancer treatment will be removed. Claims for all maxillofacial surgery shortfalls and co-payments will be assessed.
CORPORATE NOVA500
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
  • DENTAL COVER
    • Benefit limit for dental procedures such as implants and wisdom teeth extractions increased from R 5 000 to R 8 000 per policy.
    • Benefit limit for dental procedures due to accidental events or cancer treatment increased from R 10 000 to R 15 000 per policy.
    • 📢 General exclusion removed: Maxillofacial surgery and related medical conditions or procedures are covered only when related to accidental events or cancer treatment.
      Effective 1 January 2025, the general exclusion for maxillofacial surgery unrelated to accidental events or cancer treatment will be removed. Claims for all maxillofacial surgery shortfalls and co-payments will be assessed.
ELITE500, CORPORATE ELITE500 and CORPORATE ELITE PLUS500
  • CORPORATE ELITE PLUS500
    • Effective 1 January 2025, CORPORATE ELITE500 and CORPORATE ELITE PLUS500 will merge, with CORPORATE ELITE500 being the option name in the future.
    • CORPORATE ELITE500 policyholders will automatically receive the additional benefits offered on CORPORATE ELITE PLUS500 without underwriting, namely:
      • CANCER BENEFIT | BREAST RECONSTRUCTION
      • OUT-PATIENT SPECIALIST CONSULTATION BENEFIT
      • 12 MONTH STRATUM POLICY PREMIUM WAIVER (increases from a 6-month benefit period)
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
  • DENTAL COVER
    • Benefit limit for dental procedures such as implants and wisdom teeth extractions increased from R 8 000 to R 50 000 per policy.
    • Benefit for dental procedures due to accidental events or cancer treatment is no longer limited to R 48 000 but subject to the OPL.
    • 📢 New benefit exclusion: Effective 1 January 2025, out-of-hospital dental-related procedures will no longer be covered under our GAP BENEFIT or CO-PAYMENT BENEFITS.
    • 📢 General exclusion removed: Maxillofacial surgery and related medical conditions or procedures are covered only when related to accidental events or cancer treatment.
      Effective 1 January 2025, the general exclusion for maxillofacial surgery unrelated to accidental events or cancer treatment will be removed. Claims for all maxillofacial surgery shortfalls and co-payments will be assessed.
  • SUB-LIMIT BENEFITS
    • COLONOSCOPIES, ENTEROSCOPIES AND GASTROSCOPIES
      Benefit limit increased from R 5 000 to R 6 500 per person per event.
    • INTERNAL PROSTHETIC DEVICE TOP-UP
      📢 New benefit added: Covers the cost of an internal prosthetic device when the medical aid plan’s limit has been reached, limited to R 10 000 per person per event.
  • OUT-PATIENT SPECIALIST CONSULTATION BENEFIT 
    Benefit increased from 3 to 4 consultations, limited to R 1 300 per consultation per policy.
  • CASUALTY BENEFITS 
    • ACCIDENTAL EVENTS (Individuals of all ages) and ILLNESS EVENTS (Children 10 years or younger)
      Benefit limit increased from R 12 000 to R 15 000 per policy.
    • ILLNESS EVENTS (Individuals 11 years or older)
      Benefit limit increased from R 1 500 to R 2 000 per policy.
  • PREVENTATIVE CARE BENEFIT
    Benefit limit increased from R 1 600 to R 1 800 per policy.
  • PRIVATE ROOM BENEFIT
    Benefit limit increased from R 3 000 to R 3 500 per policy.
  • LIFESTYLE BENEFIT | INTERNATIONAL TRAVEL INSURANCE
    Our international travel insurance partner’s cover doesn’t apply when similar cover is in place through medical aid or other insurance policies.
    Effective 1 January 2025, cover will apply, but our travel partner will only be liable to pay a pro-rata portion of the claim submitted in terms of the policy.
ACCESS OPTIMISER and CORPORATE ACCESS
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
  • CASUALTY BENEFITS | ACCIDENTAL & ILLNESS EVENTS
    Benefit limit increased from R 2 000 to R 3 000 per policy.
  • ACCESS BENEFIT
    • Benefit limit for adenoidectomy, myringotomy (grommets) or tonsillectomy increased from R 5 000 to R 15 000 per person.
    • Benefit limit for arthroscopic surgery increased from R 55 000 to R 72 000 per person.
    • Benefit limit for back or neck surgery increased from R 55 000 to R 72 000 per person.
    • Benefit limit for bunion surgery increased from R 19 000 to R 20 000 per person
    • Benefit limit for dental procedures for impacted teeth (children younger than 18) increased from R 28 000 to R 30 000 per person.
    • Benefit limit for joint replacement surgery increased from R 55 000 to R 60 000 per person.
ACCESS CO-PAY PLUS300 and CORPORATE ACCESS CO-PAY PLUS300
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
  • CO-PAYMENT BENEFIT | ADMISSION AND PROCEDURE CO-PAYMENTS
    Benefit limit increased from R 5 000 to R 6 500 per policy.
  • DENTAL COVER
    • Benefit limit for dental procedures such as implants and wisdom teeth extractions increased from R 6 000 to R 30 000 per policy.
    • Benefit for dental procedures due to accidental events or cancer treatment is no longer limited to R 32 000 but subject to the OPL.
    • 📢 New benefit exclusion: Effective 1 January 2025, out-of-hospital dental-related procedures will no longer be covered under our GAP BENEFIT or CO-PAYMENT BENEFITS.
    • 📢 General exclusion removed: Maxillofacial surgery and related medical conditions or procedures are covered only when related to accidental events or cancer treatment.
      Effective 1 January 2025, the general exclusion for maxillofacial surgery unrelated to accidental events or cancer treatment will be removed. Claims for all maxillofacial surgery shortfalls and co-payments will be assessed.
  • CASUALTY BENEFITS | ACCIDENTAL & ILLNESS EVENTS
    Benefit limit increased from R 2 000 to R 3 000 per policy.
  • ACCESS BENEFIT
    • Benefit limit for adenoidectomy, myringotomy (grommets) or tonsillectomy increased from R 5 000 to R 15 000 per person.
    • Benefit limit for arthroscopic surgery increased from R 55 000 to R 72 000 per person.
    • Benefit limit for back or neck surgery increased from R 55 000 to R 72 000 per person.
    • Benefit limit for bunion surgery increased from R 19 000 to R 20 000 per person.
    • Benefit limit for dental procedures for impacted teeth (children younger than 18) increased from R 28 000 to R 30 000 per person.
    • Benefit limit for joint replacement surgery increased from R 55 000 to R 60 000 per person.
CORPORATE ACCESS PLUS500
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
  • DENTAL COVER
    • Benefit limit for dental procedures such as implants and wisdom teeth extractions increased from R 6 000 to R 30 000 per policy.
    • Benefit for dental procedures due to accidental events or cancer treatment is no longer limited to R 32 000 but subject to the OPL.
    • 📢 New benefit exclusion: Effective 1 January 2025, out-of-hospital dental-related procedures will no longer be covered under our GAP BENEFIT.
    • 📢 General exclusion removed: Maxillofacial surgery and related medical conditions or procedures are covered only when related to accidental events or cancer treatment.
      Effective 1 January 2025, the general exclusion for maxillofacial surgery unrelated to accidental events or cancer treatment will be removed. Claims for all maxillofacial surgery shortfalls and co-payments will be assessed.
  • CASUALTY BENEFITS | ACCIDENTAL & ILLNESS EVENTS
    Benefit limit increased from R 2 000 to R 3 000 per policy.
  • ACCESS BENEFIT
    • Benefit limit for adenoidectomy, myringotomy (grommets) or tonsillectomy increased from R 5 000 to R 15 000 per person.
    • Benefit limit for arthroscopic surgery increased from R 55 000 to R 72 000 per person.
    • Benefit limit for back or neck surgery increased from R 55 000 to R 72 000 per person.
    • Benefit limit for bunion surgery increased from R 19 000 to R 20 000 per person.
    • Benefit limit for dental procedures for impacted teeth (children younger than 18) increased from R 28 000 to R 30 000 per person.
    • Benefit limit for joint replacement surgery increased from R 55 000 to R 60 000 per person.

INACTIVE RANGE

EDGE200, COMPACT200 and CORPORATE COMPACT200
  • These options are part of an older product range and doesn’t receive benefit enhancements except annual increases in the Overall Policy Limit (OPL). Speak with your financial advisor about changing to an option in our active product range. Now’s an excellent time, since we’re offering an underwriting concession.
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
BASE500, CO-EVOLUTION500, G-FORCE500 and SENIOR500
  • These options are part of an older product range and doesn’t receive benefit enhancements except annual increases in the Overall Policy Limit (OPL). Speak with your financial advisor about changing to an option in our active product range. Now’s an excellent time, since we’re offering an underwriting concession.
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
ACCESS OPTIMISER PLUS200 and ACCESS OPTIMISER PLUS500
  • These options are part of an older product range and doesn’t receive benefit enhancements except annual increases in the Overall Policy Limit (OPL). Speak with your financial advisor about changing to an option in our active product range. Now’s an excellent time, since we’re offering an underwriting concession.
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
HOSPITAL OPTIMISER
  • This option is part of an older product range and doesn’t receive benefit enhancements except annual increases in the Overall Policy Limit (OPL). Speak with your financial advisor to determine if this option is still the best suited for your medical aid plan. Now’s an excellent time, since we’re offering an underwriting concession.
  • OVERALL POLICY LIMIT (OPL)
    Limit increased from R 198 660 to R 210 580 per insured person per year effective 1 June 2024. Another increase can be expected 1 April 2025 or when published by the Regulator.
CHILD DEPENDANTS

We cover child dependants registered on either parent’s medical aid plan. When a child dependant applies for their own medical aid membership, they must apply for their own Gap Cover policy.

📢 New process: Full-time students 26 or younger may remain on the policy even if they belong to their own medical aid plan. Proof of full-time studies will be required annually. Distance and online learning don’t qualify.