Major Medical Benefits:
- Gap Cover: Covers the the short-payment by your Scheme for In-Hospital treatment.
- Co-Payment: Covers the excess amount imposed by your Scheme for undergoing a specific procedure.
- Admission Fee: Covers the amount imposed by your Scheme if you are admitted as an in-patient.
- Penalty Fee: Covers the penalty fee imposed by your Scheme when you are admitted to a hospital not part of the approved network.
- Appliance Benefit: Provides cover for any short-payment by your Scheme for a list of medical appliances.
- ER Benefit: Covers an unexpected event that requires immediate medical attention in an Emergency Room.
- Hospital Account: Covers amounts charged by the hospital and not paid by your Scheme.
- Day Hospitals: Provides cover for the short-payment by your Scheme for procedures done in a day-hospital that would normally be done in a hospital.
- Sub-Limit Enhancer: Covers internal prosthesis, MRI and CT scans where you have reached your benefit limit as set by the Scheme.
- Cancer Initial Diagnosis: Lump sum payment in the event that one of the insured persons are diagnosed with cancer as defined in the policy wording.
- Cancer Shortfall Cover: Covers any short-payment, co-payments or related expenses incurred during treatment of cancer as part of the Scheme oncology treatment plan.
- Cancer Top-Up: Provides additional benefit where your Scheme has imposed a Rand amount limit on your cancer benefit and this limit has been reached.
- Reconstructive Benefit: Covers the the short-payment by your Scheme for reconstruction of the effected breast as well as an additional amount for the reconstruction of the non-effected breast.
- Primary Care Benefit: Covers short-payment of consultation fees with a GP, dentist or alternative care provider.
- Specialist Consultations: Covers short-payment of consultation fees with a specialist doctor.
- Preventative Care: Covers short-payment by your Scheme for preventative care treatments.
- Accidental Death: Lump sum payment in the event of accidental death of one of the insured persons.
- Gap Premium Waiver: GapX premiums are waived in the event of death or disability of the premium payer.
- Medical Aid Contribution Cover: Pays towards your contributions of your Medical Scheme in the event of death or disability of the premium payer.