Sanlam designed gap cover to cater for the shortfall in health bills. Surveys have shown that most in-hospital procedures will cost up to five times more than what any medical aid scheme is willing to pay for. Thus, it becomes imperative that clients find another way to cover or pay for the remaining portion of the bill. Sanlam medical gap cover protects clients’ money from sudden and unexpected health costs.
Who Qualifies?
For one to qualify for Sanlam Medical Gap Cover, they have to be a member of a listed medical aid. Sanlam allows members to add their spouse and as many children as they wish to the cover. Granted that they are younger than 27 years old.
Members may also add their elderly parents as beneficiaries. But, the defendants must be members of the same aid scheme as the principal member, to benefit from the Gap Cover scheme. Only members aged 60 or younger may apply for gap cover.
While the Sanlam Gap Cover scheme is subject to a three-month waiting period before cover takes full effect, special conditions have their own specified waiting periods. Maternity and other pre-existing conditions are subject to a 12 month waiting period before benefits take effect.
Sanlam medical gap cover does not include;
Sanlam designed their gap cover scheme to cover the shortfall on any bill a clients’ medical aid fails to pay fully. But even so, Sanlam medical gap cover will not pay for everything.
There are some exclusions, which include, medical procedures that are considered luxurious or merely elective based on the client’s health choices. As well as treatments for obesity or elective cosmetic surgery procedures not caused by some trauma or accidental injury.
In addition to this gap cover will not pay for bills that the medical aid refuses to cover, due to the client’s failure to meet their obligation in terms of premium payments or their failure to adhere to the benefits claims procedure.
Sanlam only takes gap cover claims after the medical aid pays their portion. Further, members must clearly state the amount they want to claim. Also, Sanlam does not pay out claims made longer than six months after the treatment.
Sanlam medical gap cover offers
Sanlam has two Gap Cover products. These are the Standard and the Comprehensive Medical Aid Gap Cover. Standard premium rates apply for each of these options. Since Sanlam Gap Cover is an insurance broker, the claim procedure is the same as any other insurance product.
The claims are verified by Xelus Pvt Ltd. Also, all amounts are paid out to the policyholder, who in turn pays the medical supplier.
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