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Gap Cover – FAQs | Dis-Chem Health

Gap Cover: Frequently Asked Questions

General

What are Dis-Chem Health Gap Cover products all about?

Gap Cover provides short-term insurance products that help you cover certain cost shortfalls between what your medical provider charges and what your medical aid pays.

How do I join Dis-Chem Health Gap Cover?

Fill in your details on this page indicating that you would like Gap Cover. A broker will call you back, run you through a quote and talk you through the 2 Gap options. Policies are bought over the phone, and your policy documents will be mailed to you.

Are my dependants covered?

Your spouse and children (up to age 26) may be added as dependants onto your policy.

If I would like to cancel, what is the notice period?

A minimum of 31 days’ notice is required in order to cancel your policy.

Will I have any waiting periods?

The waiting periods for Dis-Chem Health Gap Cover are as follows:

  • 3-month general waiting period, excludes claims as a result of an accident.
  • 12 Month Condition Specific waiting period – Applies to any pre-existing conditions.
  • If you are transferring your Gap cover from another provider, your waiting periods will be reviewed and possibly waived. Proof of previous cover is required.

Benefits

How do these shortfalls occur?

They occur when your surgeon or anaesthetist charges more than what your medical aid pays for a procedure or specific code. This is called a ‘tariff’ shortfall.

Do all specialists charge more than the medical aid tariff?

A lot of them do and the charges vary from 1.5 times above what the medical scheme covers up to as much as 5 times more than the medical aid tariff.

How much is a tariff shortfall?

Tariff shortfalls vary according to the fees charged by your medical specialist and also the severity of the procedure. Typically, the shortfalls on minor procedures are several thousand rands and can be anywhere between twenty and forty thousand rands on large procedures.

Can shortfalls occur in any other way?

Yes, they can also occur if your medical scheme imposes co-payments or deductibles on certain procedures, e.g. MRI/CT scans or diagnostic scopes while in hospital.

How much is a co-payment or a deductible?

It all depends on your medical plan and on the type of procedure, but they range from around R2,000 up to as much as R15 000 per case.

Will all my shortfalls be covered by Dis-Chem Health Gap?

The policy does contain some exclusions, please refer to your policy document for the detailed list.

What are Lifestyle benefits?

These are optional benefits that you can include in your Gap Cover plan for an additional R75. Lifestyle Benefits unlock extra by Dis-Chem: A 20% discount on over 2,500 products, when you shop at Dis-Chem.

 

Other benefits focus on improving mental wellness such as family counselling, children and teenager support as well as financial and legal advice.

 

For more information on Lifestyle Benefits, click here.

Claims

How often does Gap Cover pay claims?

Dis-Chem Health Gap Cover processes claims daily and payable benefit payments to members also made daily. Claims take 7 – 14 working days to finalise once all required documents are received by Dis-Chem Health.

How do I claim from Gap Cover?

You can visit the website https://dischemhealth.co.za/self-support/ and either download a claim form or complete the online claim form.

What supporting documents are required in order to claim from Dis-Chem Health Gap?

Minimum documents required are: fully completed claim form, copy of the Doctors invoice, copy of the hospital account and a copy of your medical scheme statement showing the shortfall.

What are Dis-Chem Health Gap Cover products all about?

Gap Cover provides short-term insurance products that help you cover certain cost shortfalls between what your medical provider charges and what your medical aid pays.

How do these shortfalls occur?

They occur when your surgeon or anaesthetist charges more than what your medical aid pays for a procedure or specific code. This is called a ‘tariff’ shortfall.

Do all specialists charge more than the medical aid tariff?

A lot of them do and the charges vary from 1.5 times above what the medical scheme covers up to as much as 5 times more than the medical aid tariff.

How much is a tariff shortfall?

Tariff shortfalls vary according to the fees charged by your medical specialist and also the severity of the procedure. Typically, the shortfalls on minor procedures are several thousand rands and can be anywhere between twenty and forty thousand rands on large procedures.

Can shortfalls occur in any other way?

Yes, they can also occur if your medical scheme imposes co-payments or deductibles on certain procedures, e.g. MRI/CT scans or diagnostic scopes while in hospital.

How much is a co-payment or a deductible?

It all depends on your medical plan and on the type of procedure, but they range from around R2,000 up to as much as R15 000 per case.

How often does Gap Cover pay claims?

Dis-Chem Health Gap Cover processes claims daily and payable benefit payments to members also made daily. Claims take 7 – 14 working days to finalise once all required documents are received by Dis-Chem Health.

How do I join Dis-Chem Health Gap Cover?

Fill in your details on this page indicating that you would like Gap Cover. A broker will call you back, run you through a quote and talk you through the 2 Gap options. Policies are bought over the phone, and your policy documents will be mailed to you.

How do I claim from Gap Cover?

You can visit the website https://dischemhealth.co.za/customer-support/ and either download a claim form or complete the online claim form.

What supporting documents are required in order to claim from Dis-Chem Health Gap?

Minimum documents required are: fully completed claim form, copy of the Doctors invoice, copy of the hospital account and a copy of your medical scheme statement showing the shortfall.

Will all my shortfalls be covered by Dis-Chem Health Gap?

The policy does contain some exclusions, please refer to your policy document for the detailed list.

Are my dependants covered?

Your spouse and children (up to age 26) may be added as dependants onto your policy.

If I would like to cancel, what is the notice period?

A minimum of 31 days’ notice is required in order to cancel your policy.

Will I have any waiting periods?

The waiting periods for Dis-Chem Health Gap Cover are as follows:

  • 3-month general waiting period, excludes claims as a result of an accident.
  • 12 Month Condition Specific waiting period – Applies to any pre-existing conditions.
  • If you are transferring your Gap cover from another provider, your waiting periods will be reviewed and possibly waived. Proof of previous cover is required.

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