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 R192 000 per insured person per annum. 1 Co-payment up to an amount of R11 600 per policy per year for the voluntary use of a hospital or Day Clinic outside your medical scheme's Designated Network

Dental benefit

All in-hospital specialist shortfalls and co-payments, for medical scheme approved dental procedures (including removal of impacted wisdom teeth), are covered. Dental implants and other material are not covered. 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

Once-off payment of R30 000 per beneficiary when you are diagnosed with stage 2 cancer or stage 1 prostate cancer where the Gleason score is 8 or higher and Oncology treatment is required. Standard 12 month waiting period is applicable from start date of policy. This benefit can be increased to a total amount of R100 000 or R200 000 for an additional premium

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

R192 000 overall limit per insured person 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 R38 500 per policy per year for cover shortfalls on the cost of Internal Prosthesis. Intraocular lenses, breast & cochlear implants and pacemakers are excluded. R3 200 per insured for Stents per year. Subject to R192 000 per insured person per annum. Once a medical aid sublimit has been reached, we will still cover the difference between what the specialists charged and what the medical aid would have paid. Client liable for Hospital Bill and what the medical aid would have paid. Subject to the R192 000 per insured person per annum.

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

R478 per month


Cover for Individuals

Younger than 55 years old

R478 per month​


Cover for Individuals

55 - 64 years old

R606 per month​


Cover for Individuals

65 years and older

R710 per month​


Cover for Families

Where all lives insured are younger than 65

R606 per month


Cover for Families

Where one or more lives insured are older than 65

R710 per month

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