Gap Advanced Plus Cover

2022 Cura Gap Advanced Plus Cover

Gap Cover is an Insurance Product that provides cover for you and your immediate family for the shortfall (Gap) resulting from any Medical Practitioner charging above the Medical Scheme Tariff for in-hospital surgical procedures and certain out of hospital procedures.

Our Intermediate Cover offers a healthy spectrum of benefits at a very attractive price. It ensures you and your family are covered for the most common types of claims and covers medical expense shortfalls of up to 500%.

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 Standard Cover entail?

cover annual limit Benefit description

Overall Annual Limit (OAL) of R177 800 per Insured

(Limits are subject to regulatory amendments)

Gap Cover Up to 500%

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 500% of scheme tariff less the higher of the amount paid by the scheme or the scheme tariff for in-hospital procedures/treatment and certain specified out-of-hospital procedures/treatments. 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)

R177 800.00 per Insured per annum. 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.

Co-payment: Non-DSP Hospital

R8 000 per Family per annum

The use of a Non-DSP hospital which results in a co-payment will be covered up to R8 000 per family per annum.

Sub-limitations

R25 000 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.

Internal Prosthesis

Included in Sub-Limit

The shortfall on a service provider account that is not covered where you have reached the sub-limit for Internal Prosthesis imposed by your medical scheme AND which has been authorised and paid from the In-Hospital or Major Medical benefit. It covers the difference in Internal prosthesis (examples include hips, knees, and spinal prosthesis, Cochlear Implants, and even cardiac pacemakers.

Sub-limitations on Intra - Ocular Lenses

R9 000 per lens per year

The shortfall on a service provider account that is not covered where you have reached the sub-limit for Intra-Ocular lenses imposed by your Medical Scheme AND which has been authorised and paid from the In-Hospital or Major Medical benefit.

Radiology and Pathology Services

R10 000 per Family per annum

Combined capped amount where a member's available out of hospital benefits are depleted. This benefit provides an amount of R10 000 per family per year for Radiology done by a Radiologist or blood tests done by a Pathologist when all available day-to-day benefits have been depleted. The Radiology benefit includes sonars done by a Radiologist but excludes sonars done by a GP or Gynaecologist.

Oncology treatment

R100 000 per Insured per annum

The co-payment or deductible that your medical aid charges you or approved treatment after the higher of your oncology limit or R200 000 has been reached, including co-payments on items such as biological medication, radiotherapy, and chemotherapy per treatment cycle.

Shortfall on Consumables In-Hospital

R6 000 per Insured per annum

Benefit equal to the cost of consumables not covered by the Medical Scheme for treatment received for an in-patient and/or out-patient treatment (as stated in the Defined event of the Policy Contract). Covers shortfalls on disposable items such as surgical gloves, bandages, and gauze.

Casualty Benefit

R12 500 per Family per annum

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).

“Emergency” means the sudden and 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).

Trauma Counselling

R10 000 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. Insured must receive counselling within (1) one year of trauma incident.

Specialist Consultations

R300 / Claim

Only the gap portion of the Specialist Consultation will be covered for visits up to a maximum of 2 claims per annum. Due to the lack of legislation governing what a specialist may charge for an out of hospital consultation, it has become necessary to provide a benefit where Cura assists the member with the Gap between the Specialist Consultation charged and the medical scheme rate.

Dental procedures

R7 500 per Family per annum

The cost of emergency medical treatment or a surgical procedure due to accidental impact resulting in severe physical injury or due to cancer.  Implants are not included as part of this benefit.

Additional Care Cover

R4 000 per Family per annum

Covers stay at a registered sub-acute or step-down facility for rehabilitation treatment, including therapy provided by on-site therapists (Sub-limit per policy and once Medical Scheme benefit limits are depleted). Includes registered Sub-Acute facilities such as Step-down (where the member needs the level of care which he/she would receive in hospital but does not need to be hospitalised) or rehabilitation facilities when a member needs to be rehabilitated after surgery.

THE FOLLOWING BENEFITS ARE NOT SUBJECT TO THE ANNUAL AGGREGATE LIMIT OF R177 800 PER INSURED PER ANNUM

Premature Birth

R2 500 per Policy

This benefit will provide a lump sum amount in the event of a premature birth (Birth between 24 - 34 weeks of pregnancy) of the Principal Member or spouse.

International Medical Travel Cover

R5 million per Insured

Maximum of 90 days per trip. Maximum age is 80 years at next birthday.

12 Months Medical Scheme Premium Waiver

Maximum R5 500 per month

This benefit will cover the monthly premium due to your Medical Scheme in the event of the accidental death and permanent disability of the Principal Member as a result of an accident for a period of 12-months.

Gap Premium Waiver

6 Months

This benefit will cover the monthly premium of your Gap Cover in the event of the accidental death and permanent disability of the Principal Member as a result of an accident for a period of 6-months.

 
Waiting periods:

  • 3-month general waiting period.
  • 12-month waiting period for pre-existing conditions.
  • 9-month waiting period on 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 R399.00 per month
Family < 64 years                                    R480.00 per month
Individual / Family > 65 years             R670.00 per month

Premiums are paid monthly and are VAT inclusive.

 

Terms and conditions apply in terms of exclusions and claim procedures.

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Get in touch

Tel: 010 021 0260
Fax: 086 500 7713
E-mail: mail@curaadmin.co.za

Physical Address

829 Rubenstein Drive
Moreletapark
0044
Pretoria
Gauteng

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We are an authorised financial services provider: FSP26848

About Us

At Cura we are ready to help you enhance your medical cover without leaving your chosen medical scheme. Enjoy the ultimate in medical cover for total peace of mind. Put the fears for excessive hospital cost shortfalls and unforeseen co-payments for medical services behind you.