Liberty - Essential Gap Cover

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

Co-payments charged by medical schemes for hospital admissions, scans and medical procedures are covered.

Dental benefit

R19 250 accidental tooth fracture cover due to an external blow to the mouth is provided per individual per year. This cover is payable at a rate of R2 750 for each tooth, irrespective of cover provided by the medical scheme.

Diagnosis benefit

Not applicable.

Emergency/casualty benefit

Cover for R20 000 per calendar year for treatment in a hospital’s casualty ward within 48 hours following accidental injury. Fees charged by prosthetists, orthotists, and for items such as crutches, neck braces, knee and ankle guards, post treatment and recuperative devices are not covered by this benefit.

Full time students over 21

Covered, as long as they are dependants on your medical scheme.

Gap cover limits

All individuals and family members are covered up to a medical expense shortfall limit of R165 000 per year.

Gap cover percentage benefit

Shortfalls are covered on doctors’ and specialists’ charges of up to 300% of the Medical Scheme Tariff (MST). The shortfall cover amount provided is calculated as: doctors’ and specialists’ charges (limited to 3 times MST) less the greater of either the medical scheme’s contribution to these costs or the MST. Cover of up to R30 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

Cover is available to individuals and families on any South African medical scheme without maximum entry age restrictions. Individual Cover is for those who don’t have any medical scheme dependants. Family Cover is for main members and their family dependants as recorded by their medical scheme. Cover will also extend to spouses that have their own separate medical scheme membership.

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

Cover of R750 per session for counselling is provided following any individual insured under the policy being subject or witness to an act of violence or traumatic accident. Counselling must commence within 6 months of the traumatic event and will be covered to a maximum policy limit of R25 000 over a period of 6 months

Gap Cover Contributions

Contributions

Cover for Individuals

Younger than 55 years old

R296 per month


Cover for Individuals 55-64 years old

R372 per month


Cover for Individuals 65 years and older

R424 per month


Cover for Families

Where all lives insured are younger than 65

R372 per month


Cover for Families 

Where one or more lives insured are older than 65 

R424 per month

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