Stratum Benefits - Base Gap Cover
Stratum Benefits’ entry-level gap cover product, Base, is an affordable solution for all age groups.
Gap Cover Benefits
| Co-payment benefit |
No Benefit |
|---|---|
| Dental benefit |
Covers in and out of hospital dentistry related procedures limited to R6 000 per policy per year, provided the scheme part pays from hospital benefit. Subject to OPL per insured person per year |
| Diagnosis benefit |
FIRST-TIME CANCER DIAGNOSIS pays a benefit amount of R5 000 per insured person per lifetime when cancer is diagnosed before the age of 65 for the first time in an insured person’s lifetime, subject to specific qualifying criteria. |
| Emergency/casualty benefit |
Covers the cost of a casualty event, including all related healthcare services provided at a registered medical facility when you need immediate treatment due to an accident. Also covers children 10 years or younger at a registered casualty facility when they are ill and need after-hours medical treatment. Benefit limit is R7 000 per policy per year. |
| 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 |
R185 837 Overall Policy Limit (OPL) per insured person per year applies across all benefits, except when you claim from Accidental Death and Disability and First-Time Cancer Diagnosis Benefits |
| Gap cover percentage benefit |
Cover provides additional 500% cover above your medical aid plan’s rate to cover the difference between what your healthcare providers charge and the rate your medical aid pays from a hospital benefit. This includes cover for doctors, specialists, pathology, physiotherapy, disposable items, medication, specialist shortfalls for robotic surgery, specialised and basic radiology as well as PMB conditions. Subject to OPL per person per year |
| Lives Covered |
Main member & Spouse, even if they are not on the same medical scheme; All dependants registered on Main member or Spouse's medical scheme. |
| Maximum entry age |
There is no maximum entry age applicable |
| Oncology benefit |
No Benefit |
| Oncology supplementary benefit |
No Benefit |
| PMB cover |
Covered in full. Subject to OPL per insured person per year. |
| Sub-limit benefit |
No Benefit |
| Trauma counselling |
Covers the cost of trauma counselling consultation fees, limited to R6,000 per policy per year. Subject to the OPL (refer to policy document for full details) |
Gap Cover Contributions
| Contributions |
R252 for individuals (64<) R296 per family (64<) R488 for individuals & family (65+) |
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