Covers shortfall payments up to 500% 

Base

Dis-Chem Health Gap – Base, covers you for certain shortfall costs of Hospital treatments and procedures. It also includes value added benefits like Family, Legal & Financial Counselling.

*Gap cover is only available for people who are on a registered South African Medical Scheme.

Base Plan Pricing

 PrincipalAdultsChildren
< 18R18
18 - 39R190R65R25 (Child up to 25)
40 - 49R220R85
50 - 59R265R110
> 60R300R155

Your Benefits

 

Tariff Shortfalls

Cover for certain in and out of hospital specialist shortfalls.

 

Tariff Shortfalls

Cover the difference between what your specialist charges and what the Medical Scheme pays according to their rate. Limited to an additional (500%) that of the medical scheme tariff. 

 

Examples of Procedures: (in-hospital)

  • Childbirth
  • Dentistry (basic)
  • Tonsillectomy (Tonsil removal)
  • Broken bones

 

Examples of procedures covered out of hospital:

  • Gastroscopy, Cystoscopy or Hysteroscopy
  • Dialysis Treatment
  • Home Births
  • Circumcision, Root Canal

Read more – Policy Documents

 

Sub-Limits

Covers you for shortfalls from Medical Scheme Sub-Limits.

 

Sub-Limits

Medical Schemes often put limits on certain procedures. This means, they will only pay up to a defined rand value, however, your treatment may cost more. We will cover you up to R29,000 per event. This benefit is subject to the Core Benefit Limit.

 

Examples of such procedures:

  • Internal Prosthetics
  • Pacemakers
  • Implants
  • joint replacements

 

Read more – Policy Documents

 

Dental Reconstruction Benefit

Dental Reconstruction Surgery  required as a direct result of Accidental Harm or Oncology Treatment.

Dental Reconstruction Benefit

Dental Reconstruction Surgery required as a
direct result of either Accidental Harm or Oncology Treatment that occurred after the Inception of your Policy.

The benefit only covers the difference between what was charged by the specialist and paid by the medical aid . Limited to two of such events per Family per annum and a maximum of R45 700. Subject to the Core Benefit Limit of R177,800 per insured party

 

Read More: Policy Documents 

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Accidental Death & Disability Cover

Pays out a lump sum in the event of death or permanent disability due to an accident. Lump Sum payments &Contribution Waiver

Lump sum payments

In the event of Accidental death or permanent disability due to an accident, with these limits:

  • Principle Member: R35 500
  • Children below six years: R20 000
  • All other Insured Parties: R28 000
  • Contribution Waiver

    Contributions will be covered for 6 months up to a maximum of R35 500 where Policy Holder is the principal member of the Medical Scheme

     

  • Read More: Policy Documents

 

Hospital Booster

A lump sum payment for hospital admission related to an accident or premature birth.

 

Hospital Booster

Daily lump sum Benefits are payable where an Insured Party is admitted to a Hospital, as a direct result of either Accidental Harm or Premature Birth, as defined, in your Policy.

 

A maximum of two Hospital Episodes are covered under this Benefit, to a maximum amount of R25 760 Per Annum.

 

The Benefit is payable from day one of the Hospital Episode:

  • R400 per day from the 1st – 13th day (inclusive).
  • R780 per day from the 14th – 20th day (inclusive).
  • R1 510 per day from the 21st – 30th day (inclusive).

 

Read More: Policy Documents

 

Family Legal & Financial Counselling

Additional Value-added services to provide counselling and advice.

Family Legal & Financial Counselling Advice

 

Counselling from health professionals – unlimited telephonic, virtual or face-to-face appointments:

  • Children and teenager support
  • Life, parent, career coaching
  • Financial and legal advice
  • MyDoctor – portal and advice line
  • COVID-19 Support line
  • Road Accident Fund Cover Assistance
  • Workman’s Compensation Cover

 

Read More: Policy Documents

Compare our Plans – or see our Summit plan

 BaseSummit
Overall Annual LimitCore benefits - Limited to R177,800 per Insured Party: Policy Docs
In-Hospital (Core) Benefits
Tariff Shortfalls
Standard Co-Payments and Deductibles
Penalty Co-Payments and Deductibleslimited to R16 500 per event.
Sub-LimitsR29 000 per policyholder p.a.R57 500 per policyholder p.a.
Oncology (Cancer) Benefits
Dental Reconstruction Benefit2 events, R45,700 per policyholder p.a.2 events, R49,900 per policyholder p.a.
Out-of-Hospital (Core) Benefits
Co-payments on Listed Treatments
Out of Hospital Tariff Shortfalls
Extender Benefits
Casualty - Child Illness2 events, max of R2 500 per event
Accidental Casualty limited to R16 500 per event.
Maternity Extender (Family Booster)Limited to R15,000
Accident or Premature Birth Booster
Accidental Death & Disability: Lump Sum Payments
Accidental Death & Disability: Contribution Waiver
Road Accident Fund Cover Assistance
Family, Legal & Financial Counselling (Value Added Services)
Counselling from Health Professionals
Children & Teenager Support
Life, Parent, Career & Leadership Coaching
Financial & Legal Advice
MyDoctor – portal & advice line
Covid-19 Support line
Road Accident Fund Cover Assistance
Workman’s Compensation Cover
Note that Limits applySee the Value Added Services Brochure Brochure

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