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 Benefits:

  • 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.


Day-to-Day Benefits:

  • 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.


Additional Benefits:

  • 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.