Stratum Benefits - Access Optimiser Plus Gap Cover

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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