Liberty - Universal Gap Cover

Liberty - Universal Gap Cover

Liberty Universal Gap Cover is comprehensive gap cover, providing medical scheme top-up protection across a wide range of treatment cost shortfalls.

Cover includes comprehensive medical expense shortfall cover up to a specified limit per person per 12-month period, as well as a number of health insurance benefits.

Gap Cover Benefits

Co-payment benefit

All co-payments subject to R165 000 per insured person per annum. 1 Co-payment up to an amount of R10 000 per policy per year for the voluntary use of a Hospital or Day Clinic outside your medical scheme's Designated Network.

Dental benefit

Dentistry shortfalls are covered on doctor, dentist and specialist charges of up to 500% of the Medical Scheme Tariff (MST). The shortfall cover amount provided is calculated as: doctors and specialists’ charges (limited to 5 times MST) less the greater of either the medical scheme’s contribution to these costs or the MST. 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

Lump sum cover of R30 000 in the event of first-time diagnosis with stage 2 cancer. Payment of this benefit is subject to registration on the medical scheme’s oncology treatment programme. This is a fixed benefit payment that is not reliant on verification of actual treatment costs. This cover excludes skin cancer and applies to cancer diagnosed after the commencement of cover and after completion of the 12-month waiting period.

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

Shortfall calculated as amount charged by provider (limited to 500% 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 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

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

Cover is available to individuals and families on any South African medical scheme without maximum entry age restrictions.

Oncology benefit

Up to an aggregate of R165 000 per insured person per annum and is applicable to the co-payment specified by the medical scheme for Oncology treatment including chemo/radiotherapy and once Oncology treatment limit has been reached. Cover is subject to a maximum co-payment of 25% in any one claim. Up to R20 000 cover for surgical costs not covered by your medical scheme for breast reconstruction of the non-affected breast in the event of a single mastectomy resulting from cancer.

Oncology supplementary benefit

Where a cancer treatment cost limit is imposed and where no further treatment is funded by the medical aid, this benefit will subsidise 20% of the ongoing treatment costs. This benefit can be used to cover general treatment and the costs of biological drugs and other specialised treatments.

PMB cover

Prescribed Minimum Benefits are covered.

Sub-limit benefit

Cover of up to R35 000 for each policy each year is provided for co-payments and shortfalls on the cost of internal prostheses such as artificial joints after the exhaustion of the medical scheme specified limit or threshold. This benefit does not cover intraocular lenses or prostheses that are not replacing a body part.

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

R401 per month


Cover for Individuals

55-64 years old

R506 per month​


Cover for Individuals

65 years and older

R568 per month​


Cover for Families

Where all lives insured are younger than 65

R506 per month


Cover for Families

Where one or more lives insured are older than 65

R568 per month

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