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

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

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

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 R9,000 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 R3,000 per event and R8,000 per family per annum.

Medical Aid Assist and premium waiver
We pay a maximum amount of R3,500 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 500 Plus cover for a period of 12 months, provided that the insured member remains insured on the medical aid.