Gap Cover - Base Plan
Additional cover that is simple and rewarding from R141 for Adults & R20 for Children
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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
| 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 |
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
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
extraRewards
20% OFF over 2,500 products for policyholders
extraRewards
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
Compare our Plans – or see our Summit plan
| Base | Summit | |
|---|---|---|
| Overall Annual Limit | Core benefits - Limited to R198,660 per Insured Party: Policy Docs | |
| In-Hospital (Core) Benefits | ||
| Tariff Shortfalls | Up to 500% | Up to 600% |
| Standard Co-Payments and Deductibles |  |  |
| Penalty Co-Payments and Deductibles | | limited to R18,550 per event. |
| Shortfalls from Sub-Limits | R32,500 per policy per annum | R64,500 per policy per annum |
| Oncology (Cancer) Benefits | | |
| Dental Reconstruction Benefit | 2 events, R45,700 per policy per annum | 2 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 Illness | | 2 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 apply | See the Lifestyle Benefits Brochure | |
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