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.
No. Gap covers mainly in-hospital shortfalls and co-payments, together with certain listed procedures that might be performed on an out-patient basis.
Depending on the gap supplier, there is an opportunity to cover both immediate and extended family members.
Certain products limit the size of the family or require certain criteria e.g. all insured members must belong to a Medical Aid.
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.
Claims are assessed and paid, providing all the relevant documentation is received upfront, within 14 days.
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.
Waiting periods do apply. These vary between suppliers. Special terms exist for groups; please contact us for details.
All ages are catered for at various rates.Once again, these vary between suppliers. Please contact us for details.
A 30 day notice period in writing is required.
Certain dental procedures performed in hospitals are covered under this benefit.
No, faxed or scanned copies are accepted by most gap cover underwriting/administration departments.
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
