Total annual limit
Subject to the Overall Annual Limit (OAL) of R198,600 per insured person. 

Tariff shortfalls – + 500%
We pay up to an additional 500% to cover any shortfalls your medical aid scheme does not fully cover for in-patient and/or out-patient procedures deemed to be in hospital or paid from risk.

Co-payments / deductions
We pay the full defined co-payment/deductible amount that medical aid schemes have specified for co-payments or deductibles.

Sub-limits
We pay for defined procedures and events that medical aid options often place sub limits on, e.g., internal prosthetics.

Casualty Benefit
We pay when you have accidental trauma-related or crime-related injuries, which require treatment in a hospital out-patients or casualty unit. The limit is R19,000 per event. Illness-related emergencies for infants and children under the age of 8 will be covered at any time of the day or night. Illness-related emergencies for members 8 years and older will be covered between 6pm and 8am. All illness-related emergencies are limited to R4,500 per event and R13,000 per family per annum. 

Cancer Diagnosis Benefit
We pay you a once-off R22,000 cash payment on the first diagnosis of cancer, provided you are on a registered oncology programme.

Cancer treatment
We pay for cancer treatment such as chemotherapy, radiation and cancer biological drugs. Most medical schemes place limits on their payment for this treatment.

Medical Aid Assist and premium waiver
We pay a maximum amount of R6,000 per month for a period of 6 months to assist with medical aid premiums should the principal member on the policy suffer a total and permanent disability. We will also provide free Gap Comprehensive cover for a period of 6 months, provided that the insured member remains insured on the medical aid.

Non-DSP hospital co-payment
We pay you up to R20,000 per annum for any penalty fee that the medical scheme may impose should you choose to voluntarily use a hospital or day clinic outside the medical scheme’s designated network.

Consumables
We pay for shortfalls on medicine, materials and appliances used during an in-hospital procedure or used by doctors during procedures performed in rooms that are deemed by the medical scheme to be ‘in-hospital’. Annual limit of R5,000, limited to R500 per event.