Stratum Benefits - Access Optimiser Plus Gap Cover
Stratum Benefits Access Optimiser Plus is a booster gap cover option. It provides cover for specific medical procedures and events that your medical aid plan excludes from cover.
It also covers common medical expense shortfalls.
Gap Cover Benefits
| Co-payment benefit |
No Benefit |
|---|---|
| Dental benefit |
Impated teeth (children under 16 yrs) R14,000. Reconstructive surgery due to accident R80,000 |
| Diagnosis benefit |
No Benefit |
| Emergency/casualty benefit |
In the event of an accident, when immediate treatment is required for physical injury. Limited to R1,000 per policy per annum. Subject to OPL |
| Full time students over 21 |
Covered, as long as they are registered as medical scheme dependants on your or your spouse’s medical scheme option |
| Gap cover limits |
Overall Policy Limit (OPL) of R165,000 per person per year, for medical procedures not covered by your medical scheme Covers up to R80,000 per procedure (see list of procedures in policy document) |
| Gap cover percentage benefit |
Cover provides an additional 200% or 500% cover per person per year. Subject to the OPL. Relates to: Doctors & Specialists, radiology, pathology, physiotherapy and ultrasounds. As part of hospital event Basic and Specialised Radiology scans limited to R5,000 per year |
| Lives Covered |
We cover you and your spouse on one policy, even if you belong to different medical schemes or medical scheme options, including all Dependants registered on your or your spouse’s medical scheme option. Where either one, or both individuals are 65 and older the 65+ premium will apply, limited to two insured individuals per policy |
| Maximum entry age |
There is no maximum entry age applicable |
| Oncology benefit |
No Benefit |
| Oncology supplementary benefit |
No Benefit |
| PMB cover |
Stratum Benefits cover all PMB procedures |
| Sub-limit benefit |
No Benefit |
| Trauma counselling |
No Benefit |
Gap Cover Contributions
| Contributions |
Access Optimizer: incl 200% GAP (Family - Under 64 yrs ) R 299 Access Optimizer: incl 500% GAP (Family - Under 64 yrs ) R 383 Access Optimizer: incl 200% GAP (Family - Over 65 yrs ) R 345 Access Optimizer: incl 500% GAP (Family - Over 65 yrs ) R 467 |
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