When choosing gap cover, you do not have to go to the same company that provides your medical aid. That said, Sanlam has come to an agreement with Fedhealth to provide medical gap cover for Fedhealth members.
Medical Gap Cover for Fedhealth Members
The gap cover funds the gap between what Fedhealth pays out and the rates that are charged.
This gap continues to increase because medical specialists are charging more and more for services. In some cases, this may be a substantial difference.
Taking out medical gap cover for Fedhealth, or any other medical scheme, ensures that you do not have to pay the difference yourself. It means being able to afford better medical treatment and not having to accrue substantial medical bills.
The more specialised the procedure, the higher the difference is.
Do You Qualify for Sanlam Gap Cover?
Check the following to see if you qualify:
- You are a current member of one of South Africa’s medical aids, such as Fedhealth
- Your spouse and children younger than 27 may be covered if they are a member of your medical aid
- More than one dependent is allowable as long as conditions are met
- You have not turned 60 yet
When Does Full Cover Kick In:
Sanlam does apply normal waiting periods as follows:
- No cover at all for the first three months
- There is no cover for pre-existing conditions for the first year
- No cover for maternity-related expenses for the first year
Sanlam will not pay out in the following instances:
- Claims that are more than six month’s old
- Cosmetic surgery when this is elective. If the surgery is because of trauma, Sanlam will pay.
- Claims related to obesity treatments such as stomach stapling
- Co-payments based on a percentage of the total cost rather than a set cost
- Claims related to rejected claims or penalties where you have not followed the rules of your medical aid
- Cosmetic dentistry that is elective. If the dentistry is required because of trauma, or cancer, Sanlam will pay.
How You Can Lodge a Claim
You need to lodge claims through Xelus as they administer the claims. You can email or fax claims as follows:
Email claims to [email protected]
Fax claims to 086 501 8521
Start by downloading and completing the claims form and attaching the supporting documentation as follows:
- Your proof of payment from the medical aid
- The doctor’s bills where applicable
- The account from the hospital, along with details of when you were admitted and discharged and the ICD codes.
- A certificate from your medical aid confirming membership as your card will not suffice
Alternatively, you can contact Xelus and give them a written authority to get the documentation as required.
Sanlam does pay out approved claims on a day to day basis.
You receive both an SMS and email to confirm that the claim has been captured and documentation has been received. You will receive an SMS and email to confirm that the claim is approved.
The funds are then paid directly into your bank account.
To get your medical gap cover quote for Fedhealth, complete then submit the short form
