Stratum Benefits - Elite Gap Cover

Stratum Benefits - Elite Gap Cover

Opt for the Elite gap cover product and you'll qualify for enhanced oncology-related benefits; enhanced co-payment, trauma and casualty cover; and a sub-limit benefit that takes the sting out of costs associated with internal prostheses, as well as MRI and CT scans.

Elite benefits complement the additional 500 percent in and out of hospital gap cover available across all products.

Gap Cover Benefits

Co-payment benefit

Subject to OPL. Co-payment covered up to R10,000 per policy per annum, for the voluntary use of a non-network hospital; Limited to 1 event per policy per annum. Subject to OPL

Dental benefit

Shortfalls on dental related procedures limited to R6,000, related to accidental injury limited to R12,000per policy per year

Diagnosis benefit

Once-off payment of R30,000 upon first time cancer diagnosis, subject to specific qualifying criteria. This benefit ceases at age 65 and is not subject to the OPL

Emergency/casualty benefit

In the event of an accident, when immediate treatment is required for physical injury. Limited to R12,000 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

Gap cover percentage benefit

Cover provides an additional 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

Limit of R2,500 per policy per year for private ward cover

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

Subject to OPL. Applicable to co-payment and shortfalls on rand value specified by the medical scheme (refer to your policy document for full benefit details)

Oncology supplementary benefit

You are covered when your medical scheme provides you with an oncology benefit but applies a rand amount limit from which you can claim per year and has been reached Breast reconstruction benefit of R30,000 for 1 event per person per lifetime

PMB cover

Stratum Benefits cover all PMB procedures

Sub-limit benefit

Up to R30,000 per event for Internal Prosthesis, Renal Dialysis treatment; or Colonoscopy or Gastroscopy, up to R3,000 pb per event. 2 MRI or CT scans up to an amount of R3,000 per person per event. Subject to OPL

Trauma counselling

Covers the cost of trauma counselling consultation fees, limited to R10,000 per policy per year. Subject to the OPL (refer to policy document for full details)

Gap Cover Contributions

Contributions

Single - Under 64 yrs

R 342


Family - Under 64 yrs

R 420


Single - Over 64 yrs

R 555


Family - Over 65 yrs

R 679

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