FAQ

Are gap products a substitute for a Medical Aid?
No. Gap products fall under the definition of “accident and health policy”, in the Short Term Insurance Act No.53 of 1998, or the Long-term Insurance Act, 1998.

Does it cover day to day procedures?
No. Gap covers mainly in-hospital shortfalls and co-payments, together with certain listed procedures that might be performed on an out-patient basis.

Does this cover my whole family?
Depending on gap supplier, there is an opportunity to cover both immediate and extended family members.

Does it matter how large my family is?
Certain products limit the size of the family or require certain criteria e.g. all insured members must belong to a Medical Aid.

Is it only hospital procedures that are covered, or are some out-of-hospital procedures, e.g. visits to my General Practitioner, covered?
Out–of–hospital benefits are not covered; however certain listed procedures are covered on an out-patient basis. Refer to the policy document for more comprehensive details.

How long does it take to assess a claim?
Claims are assessed and paid, providing all the relevant documentation is received upfront, within 14 days.

Who gets paid when my claim is settled – the doctors or me?
In order to comply with the definition of “accident and health policy”, in the Short Term Act, service providers MAY NOT be settled directly. All monies are therefore paid to the principal member.

What happens if I am sick/pregnant/about to have an operation when I take out this policy?
Waiting periods do apply. These vary between suppliers. Special terms exist for groups; please contact us for details.

What is the maximum entry age and how long do I stay on thereafter?
All ages are catered for at various rates.Once again, these vary between suppliers. Please contact us for details.

How do I cancel membership?
A 30 day notice period in writing is required.

Does this plan cover dental procedures?
Certain dental procedures performed in hospital are covered under this benefit.

Do you need original accounts?
No, faxed copies are accepted by most gap cover underwriting/administration departments.

Are the premiums Tax deductible?
No, the policies fall under the definition of “accident and health policy”, in the Short Term Insurance Act No.53 of 1998, or the Long-term Insurance Act, 1998 and not the Medical Schemes Act, 1998