Gap Advanced Cover
This extends Cura’s Gap Standard Cover to include the use of Non-DSP Hospital Co-Payment, Sub-limitation cover (whilst as an in-patient), Sub-Limitation on intra ocular lenses, Cancer Treatment (For the purpose of this policy outpatient treatment excludes specialist’s consultations), International Travel Insurance and Pathology and Radiology Benefits once savings and/or day-to-day has been depleted.
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 Advanced Cover entail?
| Cover | Annual limit | Benefit description |
|---|---|---|
| Overall annual limit of R173 000.00 per insured | ||
| Gap Cover | No penalty shortfalls will be covered under this policy. |
Pays from 100% to 500% of scheme tariff for shortfalls incurred as a result of service providers billing higher tariffs than scheme tariffs for in-hospital procedures/services and certain specified out-of-hospital treatments. Pays shortfalls incurred as a result of service providers billing higher tariffs than scheme tariffs for administering chemotherapy or radiotherapy for the treatment of cancer on an out-patient basis, and/or for kidney dialysis on an out-patient basis. Pays from 100% to 500% of scheme tariff for reconstruction due to a mastectomy, provided that cancer is diagnosed after inception of the Cura policy. |
| Co-payment waiver (whilst as an in-patient and/or outpatient) | Subject to overall annual limit per family. | A benefit equal to the charges in the form of a co-payment or deductible applied for treatment received whilst as an in-patient and/or outpatient (including co-payments on MRI and CT scans in and out of hospital). |
| Use of Non-DSP Hospital Copayment |
R7 500 per family per annum. | The use of a Non-DSP hospital which results in a co-payment will be covered up to R7 500 per family per annum (Included in Sub Limit Benefit). |
| Sub-limitation cover (whilst as an in-patient) | R15 000.00 per family per annum. | A benefit equal to charges above any sub-limitation imposed by the Medical Scheme for treatment received whilst as an in-patient. |
| Pathology and Radiology Benefits | R10 000.00 per annum per family. | A combined capped amount of R15 000 for Pathology and Radiology services where a member’s available out-of-hospital benefits are depleted. (Included in Sub-limitation benefit) – Only available for out-of-hospital Pathology and Radiology where the Medical Scheme offers the benefit out-of-hospital. |
| Sub-Limitation on intra ocular lenses | Included in Sub-limitation Cover above, limited to R9 000 per lens per insured per annum | Charges above any sub-limitation imposed by the Medical Scheme for intra ocular lenses. |
| Cancer Treatment (For the purpose of this policy outpatient treatment excludes specialist’s consultations) |
Cancer treatment in a private hospital is subject to an excess of R200 000.00 (meaning the scheme must have an oncology limit of at least R200 000.00 or more) per treatment cycle, provided such treatment was received in a private institution and limited to the overall annual limit of R100 000 per insured per treatment cycle. | This benefit covers costs over the sub-limitation and/or the co-payment imposed by the medical scheme for treatment in a private facility for cancer. Treatment includes in-hospital expenses, biological drugs, chemicals, medication and outpatient radiotherapy or chemotherapy. |
| Casualty Benefit | R10 000.00 per family per annum | The cost of a medical or a surgical procedure following an emergency incurred in the casualty unit of a hospital where such costs are not covered by the medical scheme |
| Trauma Counselling | R10 000.00 per family per annum | This benefit covers counselling sessions with a registered counsellor or clinical psychologist that may be required after a serious or traumatic event due to violence, an accident or on the diagnosis of a dread disease, restricted to the insured lives on the Cura policy. Must receive counselling within (1) one year of trauma incident. |
| Additional benefits (these benefits do not aggregate to the R173 000 cap) | ||
| International Travel Insurance | R5 000 000 per insured person. | Up to 90 days. Maximum age is 80 years next birthday. |
| Medical Scheme - Premium Waiver (Death or Total and Permanent Disability) | Maximum of R5 500 per month. | Following the death or the Total and Permanent Disability of the Principal Member of the Medical Scheme, a benefit equal to the total value of Medical Scheme Contribution calculated for 12 months on the Medical Scheme Option of the Registered Medical Scheme within the stated limitations. Only members who have not reached the age of 65, qualify for disability cover. |
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
- An underwriting process will determine the waiting period applicable to each case.
Maximum Entry Age:
There is no maximum entry age on this policy.
Premium:
| Entry Age | Monthly Premium |
|---|---|
| 64 or younger | R412.00 per month |
| 65+ | R567.00 per month |
Premiums (incl. VAT) are for a family, or a single person.
Terms and conditions apply in terms of exclusions and claim procedures.
