GapCo Sub Cover

This option provides the full cover offered by the GapCo MRI option, but is further enhanced to provide a benefit equal to charges above any sub-limitation imposed by the Medical Scheme for treatment received whilst as an in-patient or for intra ocular lenses.

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 GapCo Sub Cover entail?

Cover Annual limit Benefit description
Overall annual limit of R165 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).
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.
Use of Non-DSP
Hospital Copayment
R2 500 per family per annum. The use of a Non-DSP hospital which results in a co-payment will be covered up to
R2 500 per family per annum (Included in Sub Limit Benefit).
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 R50 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 R165 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 R382.00 per month
65+ R530.00 per month

Premiums (incl. VAT) are for a family, or a single person.

 

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

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

Physical Address

829 Rubenstein Drive
Moreletapark
0044
Pretoria
Gauteng

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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.