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Why should you get
Primary Cover
Primary Plan offers you affordable cover against medical expense shortfalls that occur as the private tariff charged by medical practitioners are often higher than what the medical scheme pays out. Accessing Primary Plan is easy and hassle-free.
Primary Plan policy holders receive dedicated support and quality service from a skilled team who ensures that your claim is quickly finalised. There is a preferred rate for cover with Primary Plan.
Why Wouldn’t you get it?
Primary Cover
Shortfalls are covered on gastroscopies & colonoscopies performed in the GP or specialist’s rooms up to 300% of scheme tariff limited to 2 scopes/beneficiary/annum. All of our claims are paid out directly to the member. Benefit confirmation prior to a planned procedure.
Why should you choose
GapCover®Primary
The GapCover Primary Option was created with our first-time clients in mind. This option caters for those clients just entering the market, for our more established clients who need to scale down, especially in our current economic climate. It mimics our very popular Combined option, but, at a much lower cost, and streamlined benefits at 300% coverage.
MAKE SURE YOU’RE COVERED FOR SHORTFALLS!
GapCover® is a short-term insurance product that offers you affordable cover for your whole family against medical expense shortfalls occurred for in-hospital procedures.
HOW DOES THE CLAIMS PROCESS WORK?
All GapCover® claims are paid out directly to the member. You can find out more about our easy claims process by clicking the button below, or getting in touch with us through the contact page.
PRIMARY COVER CORE BENEFITS
IN-HOSPITAL BENEFITS
Benefits in this section will provide cover for the difference in the amount charged by a Registered Medical Professional and the Medical Scheme Rate for services rendered while admitted to hospital, up to 300%.
CoPay Cover on the Primary Plan provides cover for co-payments charged by your medical scheme for in-patient or out-patient procedures. This includes specialised radiology such as MRI and CT scans. CoPay terms and Conditions below:
Limited to R3 000, limited to 2 events, per person, per annum.
Non-DSP hospital co-payments up to R2 000, limited to one event per policy per year.
Limited to R3 000, limited to 2 events, per person, per annum.
Non-DSP hospital co-payments up to R2 000, limited to one event per policy per year.
Dental is limited per family for R2 000 on shortfalls and R2 000 on co-payments.
OUT-OF-HOSPITAL BENEFITS
Benefit provides cover for shortfalls on Gastroscopies and Colonoscopies performed in the GP or Specialist’s rooms, limited to 2 scopes per beneficiary, per annum.
CoPay Cover on the Primary Plan provides cover for co-payments charged by your medical scheme for in-patient or out-patient procedures. This includes specialised radiology such as MRI and CT scans. CoPay terms and Conditions below:
Limited to R3 000, limited to 2 events, per person, per annum.
Non-DSP hospital co-payments up to R2 000, limited to one event per policy per year.
Limited to R3 000, limited to 2 events, per person, per annum.
Non-DSP hospital co-payments up to R2 000, limited to one event per policy per year.
Primary will provide additional benefits for Emergency/Casualty ward benefits, limited to 1 event, up to R1000.00.
Physiotherapy for post-operative joint replacement/back surgery rehabilitation, limited to R700, for 1 event.
Additional Benefits
The lump sum benefits in this section are payable where an insured party is admitted to hospital, and such an insured event occurred as a direct result of either accidental harm or premature birth, as defined in the policy. Covered under this benefit per annum: from day 3 to day 5 R300 per day, day 6 to day 10 R400 per day & day 11 to day 20 R500 per day subject to an overall maximum benefit of R25,000 per annum.
Subject to the overall maximum Compensation limit and the treatment of a Covered Event; equal to the Co-Payment applied (subject to a maximum of 20%) once related costs have exceeded, limited to R50,000 per policy, per annum
This benefit provides for a once-off 10% cash back bonus of all premiums paid over the first 5 years of cover on GapCover Primary, on condition that there were no claims submitted or interruption of cover.
Non-DSP Specialist Tariff Shortfalls for planned Prescribed Minimum benefits (PMB) admissions subject to a Max R13,500 per policy, per year.
Where the charges relating to the service supplied has exceeded a relevant Benefit sub-limit of the member’s Medical Scheme Benefit option, The maximum compensation is limited to R40,000 per policy, per annum. a) internal prosthesis limited to 1 (one) claim per policy, per annum, up to a maximum of R30,000 per Covered Event; and b) specialised radiology limited to 2 (two) scans per policy, per annum, up to a maximum of R5,000 per Covered Event.
Dental Reconstruction limit of 1 claim per policy per annum, due to Accidental Harm or Oncology Treatment limited to R6,600 per policy, per annum.
GapCover® is underwritten by Western National Insurance Company Ltd, Reg. No: 2005/017349/06,
FAIS: Juristic Representative under (FSP 9465).
Administered by, GapRisk Administrators (Pty) Ltd Reg. No.2021/500446/07, an authorized financial services provider (FSP: 51758).