Gap Ultimate Cover

2024 Cura Gap Ultimate Cover

Our Gap Ultimate cover provides niche benefits for the more mature members needing even more comprehensive cover. Our premium cover is designed to provide the ULTIMATE cover and offers a vast range of benefits per insured to cater for unforeseen medical expense shortfalls up to 600% and provides comprehensive benefits..

In this flagship option, we cover members to the full extent of the Gap Ultimate Cover with increased limits per person and further enhanced to provide, Lump sum cancer diagnosis benefit, International Travel Insurance, Cura Gap Ultimate Premium Waiver (Death or Total and Permanent Disability) and Accidental Death Benefit.

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 Ultimate 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 600%

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 700% 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)

R201 000.00 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 R15 000 per Insured The use of a Non-DSP hospital which results in a co-payment will be covered up to R15 000 per Insured per annum.
SUB-LIMITATIONS R70 000 per Insured 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

R70 000

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 annum 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 R12 000 per Insured Combined capped amount where a member's available out of hospital benefits are depleted. This benefit provides an amount of R10 000 per insured 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

OAL

(R201 000)

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 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 Insured

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 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 Insured 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.
ADDITIONALCARE COVER  R5 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 R201 000 PER INSURED PER ANNUM

FIRST TIME CANCER LUMP SUM BENEFIT

Once-Off R10 000 per Insured

This benefit will provide a lump sum amount in the event of Stage 2 Cancer and higher. The benefit excludes pre-existing Cancer and Skin Cancer.
PREMATURE BIRTH LUMP SUM BENEFIT

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.

ACCIDENTAL DEATH BENEFIT R10 000 per Insured Must meet the definition of Accidental.
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 No Maximum 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 12 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 12-months.

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 R625.00 per month
Family < 64 years   R735.00 per month
Individual > 65 years R735.00 per month
Family > 65 years R1015.00 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.

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

Physical Address

829 Rubenstein Drive
Moreleta Park
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.