2024 Cura Gap Ultimate Plus Cover

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 600% 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.

R201 000.00 per Insured per annum.

In-hospital Co-payments / Deductibles       

(Includes out-of-hospital MRI and CT scans)

Co-payment: Non-DSP Hospital

The use of a Non-DSP hospital which results in a co-payment will be covered up to R18 000 per Insured per annum.

Sub-limitations

A benefit equal to charges above any sub-limitation imposed by the Medical Scheme for treatment received whilst as an in-patient.

Internal Prosthesis

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

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

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

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

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

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

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.

External Prosthesis

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

External Medical Appliances

The shortfall on a service provider account that is not covered where you have reached the sub-limit for external appliances imposed by your Medical Scheme AND which has been authorised and paid from the In-Hospital or Major Medical benefit. Limited to CPAP machine, hearing aids and compression stockings (DVT treatment). The benefit only covers the Gap portion or once Medical Scheme limit has been depleted.

Specialist Consultations

Only the gap portion of the Specialist Consultation will be covered for visits up to a maximum of 4 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

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

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.

First Time Cancer Lump Sum Benefit

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.

Accidental Death Benefit

Premature Birth

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

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

12 Months Medical Scheme Premium Waiver

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

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.