What is Comprehensive Gap Cover?

If you are looking for comprehensive gap cover, look no more, since Sanlam offers you the best plans in South Africa and give you value for money. So what is comprehensive gap cover?

For a monthly premium running as little as R166, hospital trips will no longer worry you for fear of gaps.

Although your medical scheme pays you 100% of all your medical plan rates, it does not include what hospital and experts actually charge. In fact, some doctors charge up to 500% of the said limit. Thus, you are required to raise the rest of the cash.

Here is where our comprehensive gap comes to your rescue

You are qualified for the cover if you meet the following:

  • what is comprehensive gap coverMember of a registered medical scheme
  • Aged below 60
  • Your spouse share the same medical plan
  • All your dependants are aged below 27

What are the waiting periods before the cover takes effect?

  • No benefits for the first three months
  • Pre-existing conditions and maternity wait for 12 months
  • Personal assessment of cases, since there might be permanent exclusions in place

Is there anything not covered by the Gap?

  • Cosmetic surgery unless it’s due to trauma or brought about by cancer
  • Obesity treatment, including stomach, stapling
  • Expenses arising from errors on your part
  • Dentistry of a specific nature, unless caused by cancer or trauma
  • Claims submitted six months after rendering of services
So What is Comprehensive Gap Cover and What Can I expect to pay?

The comprehensive shortfall cover pays the balance of what your health insurance pays and the actual medical cost.

Though it’s not something highly considered, what are the chances you will end up in a hospital bed?

However, what if you do? Would you be able to settle the balance upfront, even if a hospital charges are twice the limit and you are still required to pay the difference? And this is without considering hospital stay that could run to thousands

For the basic package, a monthly premium of R166 applies and R198 monthly premium for the comprehensive.

What is the Claims Process?

Xelus administers Sanlam Shortfall cover and as such, claims must go through them. One can either submit the claims online or make a hand delivery. The forms indicate the following:

  • Receipt from your medical scheme showing the amounts paid on your bill
  • A hospital statement, which should include the first four pages where admission and discharge times as well as other ICD codes.
  • Finally, you need an updated certificate of membership from your medical aid scheme.

If you are a medical scheme member, fill in and send us the Form and we will send you a FREE Quote!

All info was correct at time of publishing