Liberty - Essential Gap Cover
Liberty Essential Gap Cover is affordable gap cover, designed to protect against the most frequent medical expense shortfalls.
Cover includes medical expense shortfall cover up to a specified limit per person per 12-month period, and selected health insurance benefits.
Gap Cover Benefits
| Co-payment benefit |
All co-payments subject to R192 000 per insured person per annum |
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| Dental benefit |
R22 500 Accidental tooth fracture cover is provided per person per year. Limited to R3 200 per tooth, irrespective of cover provided by your medical scheme |
| Diagnosis benefit |
Not applicable. |
| Emergency/casualty benefit |
Injury treatment due to an accident limited to R22 100 per policy per year and subject to R192 000 per insured person per annum. Emergency treatment of up to R2 500 per policy per year for children younger than 11. Please refer to product brochure / policy schedule for terms & conditions. |
| Full time students over 21 |
Covered, as long as they are dependants on your medical scheme. |
| Gap cover limits |
(OAL-Overall Annual Limit) R192 000 overall limit per insured person per year |
| Gap cover percentage benefit |
Shortfall calculated as amount charged by provider (limited to 300% of med aid tariff) less the higher of the medical aid tariff or the amount paid/payable by the medical aid. This includes cover for doctor's, specialists as well as PMB conditions. Cover of up to R33 000 per policy per calendar year for medical expense shortfalls that arise directly from the use of robotic machinery in the course of in-hospital operative treatment. |
| Lives Covered |
Main member & Spouse, even if legally married spouse is not on the same medical scheme; All dependants registered on Main member's or Spouse's medical scheme; Individuals of all ages. |
| Maximum entry age |
There is no maximum entry age applicable. |
| Oncology benefit |
Not applicable. |
| Oncology supplementary benefit |
Not applicable. |
| PMB cover |
Prescribed Minimum Benefits are covered. |
| Sub-limit benefit |
Not applicable. |
| Trauma counselling |
Covers consultation fees up to R26 500 per policy per year with a sub-limit of R800 per counselling session and subject to R192 000 per insured person per annum |
Gap Cover Contributions
| Contributions |
Cover for Individuals Younger than 35 years old R351 per month Cover for Individuals Younger than 55 years old R351 per month Cover for Individuals 55 - 64 years old R439 per month Cover for Individuals 65 years and older R520 per month Cover for Families Where all lives insured are younger than 65 R439 per month Cover for Families Where one or more lives insured are older than 65 R520 per month |
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