Introducing you to
Dis-Chem Health Gap Cover
When 100% is not enough?
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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
Base is our Standard Gap Cover plan that covers tariff shortfalls up to an additional 500%, sub-limits, dental reconstruction as well as Family and Hospital booster benefits. It starts from R141 per month.
Summit
Summit is our Comprehensive Gap Cover plan which has all the benefits of the Base Plan as well as cover for oncology, tariff shortfalls, sub-limits, co-payments and so much more. From R189 per month.
Base - price table
| Principal | Adults | Children | |
|---|---|---|---|
| < 18 | R20 | ||
| 18 - 39 | R141 | R72 | R29 (Child up to 25) |
| 40 - 49 | R176 | R96 | |
| 50 - 59 | R229 | R125 | |
| >= 60 | R272 | R177 |
Summit - price table
| Principal | Adults | Children | |
|---|---|---|---|
| < 18 | R29 | ||
| 18 - 39 | R189 | R106 | R39 (Child up to 25) |
| 40 - 49 | R237 | R135 | |
| 50 - 59 | R285 | R170 | |
| >= 60 | R370 | R246 |
Add Lifestyle Benefits: only R55 per month.
Compare our Gap Cover plans
The below outlines a sub-set of summarised benefits included in our Gap Cover plans. View the Policy Packs
| Base | Summit | |
|---|---|---|
| Tariff Shortfalls: Shortfalls on Specialist Account | Up to 500% | Up to 600% |
| Sub-limit: Surgical Procedures or the shortfall of internal prosthesis |  | |
| Dental Reconstruction Benefit | limited to R45,700 | limited to R49,900 |
| Hospital Booster: Daily lump sum benefit in the event of an accident or a premature birth | limited to a maximum of R28,500 | limited 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 list | See Policy Docs for full list |
Add Lifestyle Benefits including extra by Dis-Chem
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
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
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
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?
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:
*These are from previous claims that the insurer paid out in 2021
Examples of Gap Cover claims that the insurer has paid:
*These are from previous claims that the insurer paid out in 2021
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