Jenius gap cover is the ideal protection against unbudgeted for expenses that medical aids do not cover.
Very often, medical aids only cover a portion of the rates the hospitals and specialists charge, consequently leaving a gap that the medical aid member needs to pay. That can also have a significantly great effect on your savings. Therefore, this is the reason why Medical gap cover is so important.
Medical aids and hospital plans have maximum limits or expect co-payments for specified procedures or treatments; this is where gap cover can help.
Shortfall insurance is the ideal addition to your existing medical aid plan; this is because it will provide you with peace of mind that any unexpected medical costs will be covered. This gap cover also provides some additional benefits.
The Smart Way to Cover Medical Aid Shortfalls
Who Qualifies for Jenius Gap Cover?
If one is a member of medical aid, individuals 60 years of age or under or groups under 65 years old can apply for Jenius Gap Cover.
Terms for Gap Medical Cover
- Members are subject to a three-month waiting period.
- Pregnancy and maternity benefits, as well as pre-existing conditions, are subject to a 12 month waiting period.
- Any pre-diagnosed cancer is excluded from Jenius Gap Cover.
- This gap cover will also provide for the primary member, spouse and all children, provided they are all on the same medical aid scheme.
Jenius Gap Cover Limits
- Jenius Gap Cover has an annual overall limit of R1 000 000 per policy
- Co-payments for cancer are restricted to a maximum of 20% or R100 000 per year.
- There is a R25 000 per incident limit on the sub-limit enhancer
- There is a R5 000 limit on hospital consumables
- However, Jenius Gap Cover does not impose any annual sub-limit co-payments
- Fees are paid up to 500% of the medical aid tariff
- Also, the cover for cancer or oncology-related surgery is provided at up to 600%.
Benefits of Jenius Gap Cover:
- Up to 500% cover for MRI, CT and PET scans
- Jenius also covers all co-payments at up to 20%
- Sub-limits for in-hospital is up to R30 000
- In the event of death or permanent disability of a member, there is a waiver of premiums for six months
- Permanent disability or death resulting from an accident cover is R 20 000
- Permanent disability or death resulting from an illness cover is R 10 000
- There is no sub-limit for cancer surgery, and the gap cover pays benefits at up to 600%
- Also receive cover of up to 600% is provided for surgical correction of congenital disabilities, intracranial neurosurgery and post trauma reconstructive surgery to the face.
- Jenius covers premature birth to the amount of R10 000
- If trauma or oncology necessitates dental reconstruction surgery, the cover will be provided.
- Blood tests have no sub-limits
- Also, the annual overall limit is R1 000 000 per family.
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All info was correct at time of publishing