Gap Cover Option

Compare Gap Cover Options Base 500 Co-Evolution 500 Comprehensive Elite Senior 500 Hospital Optimiser Oncology Plus G Force Corporate Elite Stratum Co-Evolution 500 This option is designed to provide additional cover for tariff shortfalls on doctors and specialists accounts for in-hospital procedures as well as cover for procedure related co-payments imposed by a medical scheme.

MONTHLY PREMIUM

INDIVIDUAL / FAMILY R 145 PER ADULT DEPENDANT R   60
Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option Plandirect  By Financial Advisors & Brokers in RSA
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   Stratum Co-Evolution 500

Stratum Gap Cover Insurance Co-Evolution 500 option Stratum Gap Cover Insurance Co-Evolution 500 option

OVERVIEW

GAP BENEFIT

This benefit provides additional cover of 500% above the medical scheme rate. • Benefit is unlimited GAP BENEFIT also includes cover for tariff shortfalls for certain in-hospital related accounts: • Radiology (x-rays) and pathology, limited to R12 000 per insured    per annum • Consumable items, limited to R6 000 per insured per annum • Physiotherapy, limited to R6 000 per insured per annum

CO-PAYMENT BENEFIT

This benefit provides cover for co-payments and deductibles imposed by a medical scheme. Co-payments/Deductibles: “An upfront payment that is required by a medical scheme for the cost of certain procedures.” • Covers all compulsory co-payments for in-hospital procedures,    MRI and CT scans (in- and out of hospital) as well as hospital    pre-admission co-payments (no benefit if a non-designated    service provider is utilised) • Benefit is limited to R40 000 per policy per annum

CASUALTY BENEFIT

This benefit covers the expenses that may occur at a registered casualty facility for treatment required due to an accident. Accident: “Bodily injury caused by violent, accidental and external physical means.” • Benefit is limited to R3 500 per policy per annum

TRAUMA COUNSELLING BENEFIT

This benefit covers counselling sessions with a registered counsellor or clinical psychologist that may be required after a serious or traumatic event due to violence, an accident or on the diagnosis of a dread disease, restricted to the insured lives on the Stratum Benefits policy. Trauma: “A serious injury or shock to the body due to violence, an accident or on the diagnosis of a dread disease that may cause substantial psychological damage.” • Benefit is limited to R3 000 per policy per annum

UNDERWRITING CRITERIA

APPLICABLE FROM INCEPTION OF THE

POLICY

• 3 Months general waiting period (no claims can be submitted    within the first 3 months of cover unless accidental) • 6 Months waiting period for tonsillectomy, myringotomy    (grommets), adenoidectomy, hysterectomy (except where cancer    is diagnosed), joint replacements (unless accidental), hernia    repairs (unless an emergency), cataract surgery, endoscopic    procedures and related surgery and dental procedures • 10 Months waiting period for pregnancy and childbirth • 10 Months waiting period for pre-existing medical conditions and    related surgery

GENERAL

• Entry age before 70th birthday • Children will be accepted as child dependants up to and including    the age of 27, provided they are registered dependants on the    medical scheme option of either the principal member or the    spouse • From the age of 28, a child dependant will be regarded as an adult    and will therefore be charged an adult dependant rate, provided    that the dependant is registered on the medical scheme option of    either the principal member or the spouse • Entry age for adult dependants before 70th birthday • The Stratum Benefits policy extends cover to all dependants as    registered on the medical scheme option of either the principal    member or the spouse

Gap Cover

Stratum Gap Cover Insurance Co-Evolution 500 option
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