GapCo SubCa Plus Cover

GapCo Sub Ca Plus

In this flagship option, we cover members to the full extent of the GapCo Sub option, but then include substantial cover for treatment and drugs for cancer patients, including in-hospital expenses, chemicals, medication and outpatient radiotherapy or chemotherapy, subject to certain conditions.

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 Ca Plus Cover entail?

Cover Annual limit Benefit description
Overall annual limit of R157 000.00 per insured
Gap Cover No penalty shortfalls will be covered under this policy.

Pays from 100% to 600% 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 600% 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 - R157 000.00 per insured per annum.
 
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).
Use of Non-DSP Hospital Co-payment R10 000.00 per insured per annum. The use of a Non-DSP hospital which results in a co-payment will be covered up to R10 000.00 per insured per annum. (Included in Co-payment limit).
Sub-limitation cover R70 000.00 per insured per annum. A benefit equal to charges above any sub-limitation imposed by the Medical Scheme for medical / surgical treatment received whilst as an in-patient and/or outpatient (as stated in the Defined Event of Master Policy)
Pathology and Radiology Benefits R15 000.00 per annum per family. A combined capped amount of R15 000 for Pathology and Radiology services where a member’s available out-of-hospital benefits are depleted. (Included in Sub-limitation benefit) – Only available for out-of-hospital Pathology and Radiology where the Medical Scheme offers the benefit out-of hospital.
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.
Consumables R6 000.00 per insured per annum Covers shortfalls on disposable items such as surgical gloves, bandages and gauze
Casualty Benefit R10 000.00 per insured 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 insured 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 R157 000 cap)
Lump sum cancer diagnosis benefit Once-off lump sum of R10 000 per insured person. The Severe Illness benefit provides a once-off lump sum payment to an Insured, following the first accurate diagnosis of Cancer (as defined) - Severity based (stage 2 and up)
Accidental Death Benefit R10 000 per insured person. A Stated Benefit of R10 000 in the event of the death of an Insured Person resulting from accidental injuries.
International Travel Insurance R5 000 000 per insured person. Up to 90 days. Maximum age is 80 years next birthday.
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 R157 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. 
Medical Scheme -  Premium Waiver (Death or Total and Permanent Disability)   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 the 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.
Cura GapCo Sub CA Plus Premium Waiver
(Death or Total and Permanent Disability)
  Following the death or the Total and Permanent Disability of the Principal Insured Person, a benefit equal to the total value of the premiums for this Policy calculated for a period of 12 months.  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:

R494.00 per family or individual per month.

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.net

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.