Although Medical Gap Cover has been designed primarily to cover shortfalls arising from inhospital procedures, additional benefits are payable in the event of shortfalls arising from certain out-patient procedures.
Below are some examples of procedures that are additionally covered on an out-patient basis:
- Chemotherapy or radiotherapy for the treatment of cancer.
- Kidney dialysis on an out-patient basis.
- Coronary Angiogram
- Surgical biopsy of breast lump or prostate
- Cataract removal
There is a waiting period for the following procedures:
- A general 3 month waiting period applies
- Childbirth claims will have an effective 10 month waiting period.
- Joint replacements, arthroscopic procedures, spinal surgery including spinal fusion, nasal surgery including sinus related, cataract surgery, hysterectomy (except for cancer diagnosed after joining), dentistry related claims, all hernia repairs and all cardiac related surgery and procedures will have no benefit for the first 6 months and 50% of the normal benefit for the second 6 months. These waiting periods will not be applicable if the claim is as result of an accident/injury that occurred after the 3 month waiting period.
No benefit is payable in respect of standard exclusions as defined in the policy document. There are also a number of specific exclusions such as cosmetic surgery, treatment for obesity, claims not covered by your medical scheme and private and home nursing.
The maximum benefit limit is R200 000 per individual and R2 000 000 per family per calendar year.
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