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Gap Cover Base Plan - Affordable Gap Cover | Dis-Chem Health

Covers shortfall payments up to an additional 500% 

Base

Dis-Chem Health Gap – Base, covers you for certain shortfall costs of Hospital treatments and procedures. For an additional R55 a month, include Lifestyle Benefits like Family, Legal & Financial Counselling as well as extra by Dis-Chem.

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

Base Plan Pricing

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

Your Benefits

 

Tariff Shortfalls

Cover for certain in and out of hospital specialist shortfalls.

Tariff Shortfalls

Covers the difference between the specialist fee and what the medical scheme pays. Limited to an additional (500%) 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. But, your treatment may cost more. Get cover of up to R32,500 per event. The 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

The benefit is for dental reconstruction surgery that is required as a direct result of either accidental harm or oncology treatment. It covers the difference between what the specialist charged and the medical aid paid.

 

Limited to 2 events per family annually and a maximum of R45 700. Subject to the Core benefit limit.

 

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 case of accidental death or permanent disability due to an accident, with these limits:

  • Children below six years: R20,000
  • All other Insured Parties: R30,000

Contribution Waiver

Your medical scheme contributions will be covered for 6 months up to a maximum of R35 500 where the policyholder 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

Lump-Sum payments & Contribution Waiver

 

Daily lump sum benefits are payable when an insured party is admitted to a hospital, because of Accidental Harm or Premature Birth.

 

A maximum of two hospital episodes are covered under this benefit R28 500 per family per annum.

 

The benefit is payable from day one of the hospital episode:

  • R412 per day from the 1st – 13th day (inclusive).
  • R803 per day from the 14th – 20th day (inclusive).
  • R1 555 per day from the 21st – 30th day (inclusive).

 

Read More: Policy Documents

 

Lifestyle Benefits

Access to family counselling, legal or financial advice and more​

Lifestyle Benefits

Part of the Lifestyle Benefits at R55 | month 

 

  • Counselling from health professionals – unlimited telephonic, virtual or face-to-face appointments
  • Children and teenager support
  • Life, parent, career coaching
  • Financial and legal advice
  • Health-on-line 24hr advice line

 

*These are non-insurance services offered by Kaelo

*Learn more

 

extra by Dis-Chem

20% OFF over 2,500 products for policyholders

extra

Part of the Lifestyle Benefits bought at R55 | month

 

A rewards programme that gives policyholders access to an immediate 20% discount on a basket of over 2,500 health, home care, personal care, and baby products from leading brands.

 

Available at Dis-Chem stores and Dis-Chem online.

 

*These are non-insurance services offered by Kaelo

 

*See more detail

*Learn more

Compare our Plans – or see our Summit plan

BaseSummit
Overall Annual LimitCore benefits - Limited to R198,660 per Insured Party: Policy Docs
In-Hospital (Core) Benefits
Tariff ShortfallsUp to 500%Up to 600%
Standard Co-Payments and Deductibles
Penalty Co-Payments and Deductibleslimited to R18,550 per event.
Shortfalls from Sub-LimitsR32,500 per policy per annumR64,500 per policy per annum
Oncology (Cancer) Benefits
Dental Reconstruction Benefit2 events, R45,700 per policy per annum2 events, R49,900 per policy per annum
Out-of-Hospital (Core) Benefits
Co-payments on Listed Treatments
Out of Hospital Tariff Shortfalls: (500%)
Extender Benefits
Casualty - Child Illness2 events, max of R2,860 per event
Accidental Casualty limited to R18,450 per event.
Maternity Extender (Family Booster)Limited to R15,900
Accident or Premature Birth Booster
Accidental Death & Disability: Lump Sum Payments
Accidental Death & Disability: Contribution Waiver
Road Accident Fund Cover Assistance
Lifestyle Benefits: Family, Legal & Financial Counselling
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
Lifestyle Benefits: extra by Dis-Chem
extra: 20% OFF over 2,500 products for policyholders
Note that Limits applySee the Lifestyle Benefits Brochure
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