2024 Cura Gap Basic Cover
Our Gap Basic Cover launches you into the world of Gap Cover, offering essential benefits and covering medical expense shortfalls for Specialists up to 500% of Medical Scheme tariff, co-payments or deductibles claimed by health service providers for treatment received whilst a covered member is an in-patient and a Casualty Benefit.
Designed and priced for young individuals or newlyweds. This launches you into the world of Gap Cover, offering essential benefits and covering medical expense shortfalls for all Healthcare Providers in hospital (e.g., technologists, Midwives, GP’s, Specialists and PMB’s) up to 500% of medical scheme rate. The basic options are the most price-effective Gap Cover.
This is not a medical scheme, and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
What does Cura Gap Basic Cover entail?
| cover | annual limit | Benefit description |
|---|---|---|
| Overall Annual Limit (OAL) of R201 000 per Insured (Limits are subject to regulatory amendments) |
||
| Gap Cover |
Up to 400% (In-hospital procedures) |
The shortfall that arises after your medical aid has processed your account, as a result of the service providers charging above scheme tariff for authorised in-hospital procedures. The benefit pays up to 400% of scheme tariff less the higher of the amount paid by the scheme or the scheme tariff for in-hospital procedures/treatment. You must belong to a registered South African medical scheme to qualify for Gap Cover. |
| Cover for all Prescribed Minimum Benefits (PMB’s) | Cover for PMB’s |
A set of defined benefits, as per the Medical Schemes Act, in terms of which all medical schemes must cover the costs related to the diagnosis, treatment and care of any emergency medical condition; a limited set of 270 medical conditions; and 27 chronic conditions. |
| In-hospital Co-payments / Deductibles (Includes out-of-hospital MRI and CT scans) |
R20 000 per incident, subject to OAL |
A co-payment or deductible is an upfront amount that needs to be paid to the hospital/day clinic/radiologist before undergoing certain procedures, as specified by your Medical Scheme. When you experience a co-payment for a procedure or scan (as specified by your Medical Scheme) you would need to pay for the co-payment up-front and then claim the amount back from your Cura Gap Policy. If your Medical Scheme pays for co-payments from your day-to-day benefits, you may still claim the amount. This benefit includes out-of-hospital MRI/CT scans. |
| Shortfall on Consumables In-Hospital |
R4 000 per Insured |
Benefit equal to the cost of consumables not covered by the Medical Scheme for treatment received for an in-patient treatment. Covers shortfalls on disposable items such as surgical gloves, bandages, and gauze. |
| Casualty Benefit |
R10 000 per Family |
The cost of emergency medical treatment or a surgical procedure performed in the hospital casualty unit, should such cost not be covered by the medical scheme. Emergency Triage Index applies. (Include: Orange and Red triage). This excludes medical appliances such as crutches, braces, wheelchairs, and take-home medication. “Emergency” means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or death. The determination of an Emergency will be done through diagnosis (through classification by the attending Medical Practitioner and / or the Casualty Unit) and not on symptoms presented. Emergency Triage Index applies (Orange and red triage). |
Waiting periods:
- A 3 months’ general waiting period applies.
- A 12 months’ waiting period applies for pre-existing conditions.
- A 9 months’ waiting period applies to pregnancy.
Concessions on the above waiting period will be considered for group schemes.
Maximum Entry Age:
No maximum entry age is applicable to this policy.
Child dependants are covered until they reach the age of 21 years, with the option to continue cover as a principal insured and no new underwriting or waiting periods will apply. The age of 21 may be extended up to 26 years in respect of an unmarried child dependant who is a full-time student, provided proof thereof can be provided to Cura Administrators.
All new-borns must be registered on this policy within 30 days after birth.
Premium:
| Entry Age | Monthly Premium |
|---|---|
| Individual < 64 years | R200.00 per month |
| Family < 64 years | R310.00 per month |
| Individual > 65 years | R310.00 per month |
| Family > 65 years | R470.00 per month |
Premiums are paid monthly and are VAT inclusive. Premiums are reviewed and may be adjusted annually.
Terms and conditions apply in terms of exclusions and claim procedures.
