Gap Cover from R190 – Adults | R18 – Children

Dis-Chem Health: Gap Plans

Base - price table

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

Summit - price table

 PrincipalAdultsChildren
< 18R25
18 - 39R235R95R35 (Child up to 25)
40 - 49R275R120
50 - 59R315R150
> 60R385R215

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 up to 500%: Shortfalls on Specialist AccountTariff Shortfalls up to 500%: Shortfalls on Specialist Account
Sub-limit:
Surgical Procedures or the shortfall of internal prosthesis
Sub-limit:
Surgical Procedures or the shortfall of internal prosthesis
Dental Reconstruction Benefit, limited to R45 700Dental Reconstruction Benefit, limited to R49 900
Hospital Booster: Daily lump sum benefit in the event of an accident or a premature birth limited to R25 760Hospital Booster: Daily lump sum benefit in the event of an accident or a premature birth limited to a maximum of R27 690
See Policy Docs for full listOncology shortfalls
Family Booster of R 15 000 for premature birth
Accidental Casualty up to R16 500
Co-payments: Upfront payments for certain procedures
Innovative Oncology Medicines
Child Casualty Illness
See Policy Docs for full list

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 five times (500%) that of the medical scheme tariff. 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

Other treatments include but not limited to:

Defined Medical Procedures
Conservative Back and Neck TreatmentIn-patient Basic Dentistry
MyringotomyEndometrial Ablation
TonsillectomyHernia Repair
AdenoidectomyVaricose Vein Surgery
Facet Joint InjectionsPercutaneous
Radiofrequency
Ablations
ArthroscopyRhizotomies
Functional Nasal
Procedures
Circumcision
Non-Malignant
Hysterectomy
Hymenotomy
LaparoscopyNissen
Fundoplication
ConfinementSpinal Fusion or Major Joint Replacement
Hysteroscopy
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

Request a call

If you would like a call back, click here and a dedicated broker will be in touch.