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 Senior 500 This option is designed to provide additional cover for tariff shortfalls on doctors and specialists accounts for in-hospital procedures, cover for procedure related and oncology co-payments and where sub-limits on biological drugs and in-hospital procedures are imposed by a medical scheme.

MONTHLY PREMIUM

INDIVIDUAL / FAMILY R 188 PER ADULT DEPENDANT R   60     
Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 500 option Plandirect  By Financial Advisors & Brokers in RSA
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   Stratum Senior 500

Stratum Gap Cover Senior 500 option Stratum Gap Cover Senior 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 R15 000 per policy per annum

ONCOLOGY BENEFIT

This benefit provides additional cover for oncology related co-payments and where a sub-limit on biological drugs is imposed by a medical scheme. • Benefit for co-payments and biological drugs (as per the Stratum Benefits formulary) is limited to R100 000 per policy per annum

SUB-LIMIT BENEFIT

This benefit provides additional cover when a sub-limit benefit on a medical scheme option has been reached. Sub-limit: “The limit imposed by a medical scheme for specific in-hospital procedures, but excludes overall annual limits.” • Benefit is limited to R5 000 per event to a maximum of R15 000 per insured    per annum
• Benefit is applicable where a medical scheme sub-limit benefit exceeds R4 000

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 000 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 R2 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 • A total exclusion for any pre-diagnosed cancer is applicable to the Oncology Benefit

GENERAL

• Entry age 70th birthday and older • 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 • The Stratum Benefits policy extends cover to all dependants as registered on the    medical scheme option of either the principal member or the spouse

STRATUM BENEFITS FORMULARY LIMITED TO

Herceptin, Mylotarg, Nexavar, Gleevec, Sprycel, Faslodex, Velcade, Tarceva, Alimta, Zevalin, Avastin, Erbitux, Sutent, Fludara, Mabthera with specific oncological condition and/or specific sub-groups of cancers limited to the sub-groups of the following Cancer Categories: HER 2 + Breast cancer, Acute myeloid leukemia, Advanced hepatocellular carcinoma, Acute lymphoblastic leukemia, Chronic myeloid leukemia, Chronic lymphocytic leukemia, Non-Hodgkins lymphoma, Advanced renal cell carcinoma, Hairy cell leukemia, Myelodysplasia, HER-ve breast cancer, Gastrointestinal stromal tumor, Multiple myeloma, Non-small cell lung cancer, Metastatic colorectal cancer and Head and neck cancer
Stratum Gap Cover Senior 500 option

Gap Cover

Stratum Gap Cover Senior 500 option
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