Gap cover will settle claims up to 500% of your Medical Scheme rate. Limited to a maximum of 600% or at the stated benefit value
Co-pay Cover:
R40 000 sub-limit per policy per annum. Limited to R10 000 per claim.
Admission Fee Cover:
Paid to a maximum of R3 000 per admission. A maximum of 3 claims per policy per annum. Including the use of a Partial Cover Network Hospital as determined by your Medical Scheme.
Day Hospital / Clinic and/or In Room Surgical Procedures Cover:
We will settle the Gap portion of claims.
Emergency Room Cover:
R4 000 sub-limit. Emergency Room – Accident and Trauma Treatment R2 000. Emergency Room – Illness Treatment R2 000 per policy for the Gap portion only.
PMB Cover:
Limited to R30 000 per claim for the use of Non-DSP facilities for PMB treatments.
Cancer Benefit:
A R100 000 limit per policy applies once your Medical Scheme Oncology benefit limit has been reached and a percentage co-payment is applied. Limited to R15 000 per claim for Cancer co-payments. Cancer Cover incorporates Co-payment cover and biological drugs. In order to access this benefit you need to be on a registered treatment plan with your Medical Scheme.
Hospital Account Shortfalls:
R1 500 sub-limit per policy per annum. Maximum of R500 per claim. Maximum 3 claims per beneficiary per policy per annum.
Contact us at Innov8ions for your GAP cover solutions.