As an adviser on medical shortfall benefits, Gap4U has decided to only market the best product with the best coverage.
Never will you be in a situation where you wish you had a better gap cover policy, because it did not cover everything you thought it would.
We offer the ULTIMATE GAP COVER product, which is underwritten by Sirago.
For ease of understanding, we will explain the MAIN BENEFITS of our product first, and then the ancillary benefits.
Main Benefits of Our Product
We have negotiated the best possible terms, which means that we can offer you:
- NO GENERAL 3-MONTH WAITING PERIOD
- NO MAXIMUM ENTRY AGE
- BENEFIT PAID STRAIGHT INTO YOUR BANK ACCOUNT
- PREMIUMS THAT ARE LOWER THAN THE OPEN MARKET
GAP COVER – Covers the difference between the Medical Scheme Rate and private rates charged by a Registered Medical Practitioner for in-hospital treatment, up to a difference of 500%. No annual limit will apply.
COPAY, ADMISSION & PENALTY FEE COVER – Covers Co-payments on scopes, scans, etc. as well as Admission and Penalty fees imposed in terms of your Medical Scheme Rules.
CANCER COVER – Pays you a lump sum on the initial diagnosis of cancer as defined, as well as cover for Co-payments that your medical scheme imposes. Annual limit of R400 000 per annum.
SPECIALIST OUT-PATIENT CONSULTATION FEE – Covers your Gap component for consultations with a Medical Specialist outside of hospital as defined. OAL R5 000.
OUT-PATIENT COVER – Provides you with Gap cover for out-patient surgical procedures that would normally be performed as an in-patient. No annual limit will apply.
EMERGENCY ROOM COVER – Covers your Emergency Treatment Costs when you visit the Emergency Room of a hospital in a medical emergency regardless of whether you are admitted into hospital from the Emergency Room. Subject to OAL of R6 000 per policy. For accident and trauma related incidents only.
PMB COVER – Prescribed Minimum Benefits (PMB’s) is a set of benefits as defined in the Medical Schemes Act and Regulations which ensures that all Scheme members have access to certain minimum health benefits. This benefit will cover your Gap, Co-Pay and Penalty Fee. No annual
limit will apply.
HOSPITAL ACCOUNT SHORTFALLS – Covers the shortfall on your hospital account as defined. OAL R5 000.
ADDITIONAL CARE COVER – Provides your Gap Cover component for any of the listed procedures/diagnosis or treatment as defined. OAL R5 000.
SUB LIMIT ENHANCER – R100 000 per annum, sublimit of R20 000 per incident.
HEALTH PREMIUM WAIVER – Only in event of death and/or total permanent disability. R3 500 per month for a 6-month period.
ACCIDENTAL DEATH – R10 000 per principal insured, R10 000 per adult dependant and R5 000 per child.