2024 Cura Gap Standard Cover
This extends Cura’s Gap Basic Cover to include co-payments or deductibles claimed by health service providers for treatment received whilst a covered member is an in- or out-patient and is further enhanced to provide, 12 Months Medical Scheme premium waiver, Casualty, Trauma Counselling, and a Consumables 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 Standard 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 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. 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 | R6 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 Policy |
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). |
| TRAUMA COUNSELLING | R10 000 per Policy |
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. |
| THE FOLLOWING BENEFITS ARE NOT SUBJECT TO THE ANNUAL AGGREGATE LIMIT OF R193 000 PER INSURED PER ANNUM | ||
| 12 Months Medical Scheme Premium waiver |
Maximum R5 000 per month |
This benefit will cover the monthly premium due to your Medical Scheme in the event of the accidental death and / or 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 | R315.00 per month |
| Family < 64 years | R485.00 per month |
| Individual > 65 years | R485.00 per month |
| Family > 65 years | R670.00 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.
