2020

Premiums & Benefits

OPTION BENEFITS
Gap Cover:

The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for authorised in-hospital procedures. The cover is limited to a percentage of the original scheme tariff.

700%

Prescribed Minimum Benefits:

A set of de ned bene ts, as per the Medical Schemes Act, in terms of which all medical schemes have to cover the costs related to the diagnosis, treatment and care of: any emergency medical condition; a limited set of 270 medical conditions; and 27 chronic conditions.

Covered, subject to medical aid review

Casualty Unit Benefit:

Accidents only.
Children under the age of 8 ONLY – May be admitted for any treatment at a casualty unit linked to a hospital between
the hours of 7pm to 7am from Monday to Friday, from 7pm on a Friday until 7am on a Monday, and all day on a public holiday.

Up to R20 000 per policy per annum

Co-payment Benefit: (in Network)
The co-payment or deductible that your medical aid charges you for certain in-hospital procedures.
This co-payment or deductible is NOT related to the scheme tari and service provider charge shortfall or designated
service provider arrangements.

Unlimited but subject to R165 000 per insured person per annum

Co-payment Benefit: (Out of Network i.e. Voluntary use of a non-designated service provider)
The co-payment or deductible that your medical aid charges you for certain in-hospital procedures.
This co-payment or deductible is NOT related to the scheme tari and service provider charge shortfall or designated
service provider arrangements.

No Benefit

Co-payment on Specialised Procedures
The co-payment or deductible that your medical aid charges you for certain specialised procedures.
This co-payment or deductible is NOT related to the scheme tari and service provider charge shortfall or designated
service provider arrangements.

R1 500 per incident.
As authorised by Medical Aid for procedures performed out of hospital

Sub-limit Benefit: Internal Prostheses
The shortfall on a service provider account that is not covered because you have reached the sub-limit for Internal Prostheses imposed by your medical aid and this is directly related to an authorised hospitalisation event.

Unlimited but subject to R165 000 per insured person per annum. Up to R30 000 per event

Sub-limit Benefit: MRI / CT / PET Scans
The shortfall on a service provider account that is not covered because you have reached the sub-limit for MRI / CT and/ or PET scans imposed by your medical aid and this is directly related to an authorised hospitalisation event.

2 MRI / CT / PET scans per policy per annum up to R4 000 per scan

Global Fee Benefit:
Where a global fee has been negotiated between a medical aid and service providers for a speci c procedure (which includes ALL costs related to that procedure) and service providers charge amounts in excess of this global fee (not related to a tari rate, co-payment or sub-limit).

Up to R10 000 per policy per annum

ONCOLOGY
Oncology Gap Benefit
The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tari for medical aid approved oncology treatment plans. (NB: Subject to: the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tari and within annual scheme oncology limit).

Up to an aggregate of R165 000 per insured person per annum

Oncology Co-payment Benefit

The co-payment or deductible that your medical aid charges you for certain in-hospital procedures. This co-payment is NOT related to the scheme tariff and service provider charge shortfall or designated service provider arrangements, OR

For claims where the medical aid will only pay a percentage for the approved treatment and the policyholder needs to pay the remaining percentage of the account.

All costs to be within the annual scheme oncology limit.

Unlimited but subject to R165 000 per insured person per annum

Oncology Extender Benefit
Includes ANY approved costs above annual scheme oncology limit but subject to the medical aid scheme covering up to this limit.

Unlimited but subject to R165 000 per insured person per annum

Oncology Gap Benefit: Breast Reconstruction Surgery
The shortfall that arises after your medical aid has processed your account and is due to service providers charging above scheme tariff for medical aid approved oncology-related breast reconstruction surgery, including the una ected breast. (NB: Subject to: the gap cover percentage; and medical aid approved treatment plan being covered up to scheme tari and within the annual scheme oncology limit).

Up to R20 000 per policy per annum

PRODUCT
Accidental Death Cover

Insured / Spouse : R10 000
Dependant: R5000

Policy Extender
The full gap cover premium is covered in the case of the death of the main policyholder.

6 months

TRA ASSIST
Powered by ER24 Assist
Home Drive
Home Drive designated driver service (now includes Uber).
6 free trips per policy per annum. Limited to a 50km radius.

Panic Button
24-hour access to a crisis manager who will guide you through an emergency.
Medical Health and Trauma Counselling Line
Unlimited access to quali ed nurses 24 hours a day for telephonic emergency medical advice, assessment of symptoms, explanation of medical terms, etc.
Submit Claim
Submit your claims documents via the mobile app.

Individual Premiums

Premium based on age of policyholder at date of joining

R100 per person per month

R260 per person per month

R360 per person per month

R560 per person per month

Family Premiums

Premium based on age of oldest member of family

R385 per person per month

R460 per person per month

R660 per person per month

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+27 21 852 6740