Is Gap Cover a Medical Aid?

No. Gap Cover products are defined either, under the definition of “accident and health policy”, in the Short Term Insurance Act No.53 of 1998, or the Long-term Insurance Act, 1998.

Does it cover day to day procedures?

No. Gap Cover covers mainly in-hospital shortfalls and co-payments, together with certain listed procedures that might be performed on an out-patient basis. 

Does this cover my whole family?

IF YOU SELECT A FAMILY A FAMILY PRCING OPTION  THEN, YES, Your Get Gap Cover policy covers the main member and all dependents listed on the medical aid scheme. It is best to provide a copy of your Medical Aid Membership Certificate with your Get Gap Cover application. IF YOU SELECT AN INDIVIDUAL MEMBER PRICING OPTION THEN ONLY THAT MEMBER WILL BE COVERED.

Does it matter how large my family is?

Certain products limit the size of the family or require certain criteria e.g. all insured members must belong to a Medical Aid. It is your responsibility to notify us of any changes to your medical aid membership due to marriage, and/or births to ensure sufficient coverage for all dependants. Failure to do so will result in out of pocket expenses for you. 

Is it only hospital procedures that are covered or are some out-of-hospital procedures e.g. visits to my General Practitioner, covered?

Out–of–hospital benefits are not covered; however certain listed procedures are covered on an out-patient basis. Refer to the policy document for more comprehensive details.

How long does it take to assess a claim?

Claims are assessed and paid, providing all the relevant documentation is received upfront, within 14 days.

Who gets paid when my claim is settled – the doctors or me?

We reserve the right to negotiate a reduced tariff from the Specialist concerned for direct settlement of the shortfall. Direct settlement or settlement to the policyholder will be communicated to our policyholder via a Claims Payment Summary notice.

What happens if I am sick/pregnant/about to have an operation when I take out this policy?

A 12 month pre-existing medical exclusion is a standard exception on all Gap Cover products. Therefore any ailment that was treated 12 months prior to the inception of the policy will not be cover for a period of 12 months. Special terms exist for groups; please contact us for details.

What is the maximum entry age and how long do I stay on thereafter?

There is no maximum entry age. However, new members joining who are 65 years old and older will need to complete an application form specifically for your age band.

How do I cancel membership?

One calendar months notice period in writing is required.

Does this plan cover dental procedures?
Certain dental procedures performed in hospital are covered under the Dentistry benefit.

Do you need original accounts?
No, scan copies are accepted by the underwriting department.

Are the premiums Tax deductible?
No, the policies fall under the definition of “accident and health policy”, in the Short Term Insurance Act No.53 of 1998, or the Long-term Insurance Act, 1998 and not the Medical Schemes Act, 1998.