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Gap Cover - Medical Aid Gap Cover Plans | Dis-Chem Health

Gap Cover from R141 – Adults | R20 – Children

When do you need Gap Cover?

●  Are you aware that medical aids may not cover all the extra expenses that occur during in-hospital procedures?

●  Can you afford a big payment Gap if that happens?

●  Did you know that if you are on a lower medical scheme, that you are more at risk?

Dis-Chem Health: Gap Plans

Base - price table

PrincipalAdultsChildren
< 18R20
18 - 39R141R72R29 (Child up to 25)
40 - 49R176R96
50 - 59R229R125
>= 60R272R177

Summit - price table

PrincipalAdultsChildren
< 18R29
18 - 39R189R106R39 (Child up to 25)
40 - 49R237R135
50 - 59R285R170
>= 60R370R246

Add Lifestyle Benefits: only R55 per month.

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Compare our Gap Cover plans

The below outlines a sub-set of summarised benefits included in our Gap Cover plans. View the Policy Packs

BaseSummit
Tariff Shortfalls: Shortfalls on Specialist AccountUp to 500%Up to 600%
Sub-limit:
Surgical Procedures or the shortfall of internal prosthesis
Dental Reconstruction Benefitlimited to R45,700limited to R49,900
Hospital Booster: Daily lump sum benefit in the event of an accident or a premature birth limited to a maximum of R28,500limited to a maximum of R29,300
Oncology (Cancer) shortfalls
Family Booster of R15,900 for premature birth
Accidental Casualty up to R18,450
Co-payments: Upfront payments for certain procedures
Innovative Oncology Medicines
Child Casualty Illness
Lifestyle Benefits: Family, Legal & Financial Counselling - brought at R55 | Month
Lifestyle Benefits: extra by Dis-Chem - 20% discounts on over 2,500 products - brought at R55 | month
See Policy Docs for full listSee Policy Docs for full list

Add Lifestyle Benefits including extraRewards

Extra Rewards with Dis-chem Health

Introducing extra, a rewards programme that gives Dis-Chem Health policyholders access to an immediate 20% discount on a variety of healthy and essential products, 365 days a year. This includes a basket of over 2500 health, home care, personal care, and baby products from leading brands, from all Dis-Chem stores and the Dis-Chem online store. Click here for more.

Gap Benefits

The below outlines a sub-set of summarised benefits included in our Gap Cover plans. To view the full Policy with detailed services and benefits as per your preferred plan, or to view the policy terms and conditions, please download the full policy document or contact us directly for more information.

In-Hospital Benefits

Tariff Shortfalls: Shortfalls on medical specialists while in hospital

Limited to an additional 500% (Base Plan) and 600% (Summit Plan) in tariff shortfall cover. Examples of in-hospital events:

  • Childbirth
  • Dentistry (basic)
  • Tonsillectomy (Tonsil removal)
  • Broken bones
  • Gynaecological procedures
  • Scopes: gastroscopies & colonoscopies
  • Orthopaedic surgery
  • Cardiac surgery

Sub-Limits *Summit Plan only:
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 a limited amount per year.
Examples of such procedures:

  • Internal Prosthetics
  • Pacemakers
  • Implants
  • Joint replacements

Co-payments on Listed Treatments: These are defined amounts that you need to pay upfront (as per your Medical Scheme) to the hospital, which you can claim back from Gap cover. This pertains to:

  • Scopes
  • Wisdom tooth extractions
  • Back and neck treatment
  • Reflux surgery

Penalties may be applied for using a hospital outside of your Medical Scheme network, we cover these penalty co-payments up to a rand limit per annum

For more information on the full policy benefits and limits for your preferred plan option – click here

Out-of-Hospital Treatment Benefits

Co-payments on Listed Treatments: These are defined amounts for procedures that you need to pay upfront (as per your Medical Scheme) to the service provider, which you can claim back from Gap cover. This pertains to:

Diagnostic radiology to find the problem:

  • MRI Scans
  • CT Scans
  • Arthroscopy

For more information on the full policy benefits and limits for your preferred plan option – click here

Oncology (Cancer) Benefits

*Summit Plan only

Oncology (Cancer Treatments): We cover a variety of cancer related treatments (when your treatment plan has been reviewed and approved by your Medical Scheme):

  • 20% Co-payment applied when you reach your cancer limit defined in your Medical Scheme plan
  • The difference between what your cancer specialist charges and what your Medical Scheme pays
  • A lump sum payment when you are first diagnosed with cancer and your treatment plan has been approved, up to the age of 66 years

For more information on the full policy benefits and limits for your preferred plan option – click here

Accidental Death & Disability Cover

  • Accidental Death and Disability: If you, or one of your dependants pass away or becomes permanently disabled as a result of an accident, we will pay R20,000 for children under 6 years old and between R28,000 and R30,000 for all other people covered on the policy.
  • Contribution Waiver: If the main member of your Medical Scheme passes away as a result of an accident, we will cover your Medical Scheme contributions for a limited period and amount. We will also waive your Gap Cover premium for 6 months.

For more information on the full policy benefits and limits for your preferred plan option – click here

What is Lifestyle Benefits?

Our Lifestyle Benefits is an additional set of benefits that you can get, at only R55 per month.

Family Counselling, as well as Legal and Financial advice: 

  • Counselling from Health Professionals
  • Children and Teenager Support 
  • Life, Parent, Career and Leadership Coaching
  • Financial & Legal Advice
  • Netcare 911 24hr medical advice line
  • Road Accident Fund claim assistance
  • Workman’s Compensation claim assistance

 

The Lifestyle Benefits also includes extra by Dis-Chem. 

With extra you get an exclusive and unlimited 20% discount on 2,500 products, when you shop at Dis-Chem.

Get up to R600 discounts per month, if you spend up to R3,000.

Examples of Gap Cover claims that the insurer has paid:

Gap Graph

*These are from previous claims that the insurer paid out in 2021

 

Examples of Gap Cover claims that the insurer has paid:

Gap Graph

*These are from previous claims that the insurer paid out in 2021

 

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