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 |
Covers Admission and Procedure Co-Payments up to the OPL of R185 837 per insured person per year. Robotic Surgery Co-Payment up to R10 000 per policy & Penalty Co-Payment (use of non-DSP hospital) up to R13 000 per policy per year. Subject to OPL . |
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| Dental benefit |
Covers in and out of hospital dentistry related procedures limited to R8 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 R30 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 R12 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 Private Ward, Accidental Death and Disability, First-Time Cancer Diagnosis, Medical Aid Contribution Waiver and Stratum Policy Premium Waiver Benefits |
| Gap cover percentage benefit |
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 |
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 |
CANCER TREATMENT SHORTFALLS covers the shortfalls on service providers’ accounts when the medical aid only pays a portion of the approved oncology treatment. Subject to the OPL of R185 837 per insured person per year. As well as Breast Reconstruction Benefit due to a mastectomy on the unaffected breast limited to R30 000 and 1 event per person per lifetime (subject to qualifying criteria). |
| Oncology supplementary benefit |
CANCER TREATMENT TOP-UP covers the cost of the ongoing cancer treatment according to the cancer treatment plan that your medical aid approved when the benefit limit has been reached. Subject to the OPL of R185 837 per insured person per year. |
| PMB cover |
Covered in full. Subject to OPL per insured person per year. |
| Sub-limit benefit |
Covers the difference in cost when the medical aid pays a portion from a sub-limit or annual limit: Internal Prosthetic Device limited to R30 000 per insured person per event. Renal Dialysis limited to R30 000 per insured person per event. Colonoscopies, Gastroscopies & Enteroscopies limited to R5 000 per insured person per event. As well as MRI and CT Scans limited to R5 000 per insured person per event |
| 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 |
Individual - Under 64 yrs R 404 Family - Under 64 yrs R 496 Individual - Over 64 yrs R 656 Family - Over 65 yrs R 801 |
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