Dis-Chem Health Gap Cover

Tariff Shortfalls

Cover the difference between what your specialist charges and what the Medical Scheme pays according to their rate. Limited to an additional (500%) that 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

Standard Co-Payments and Deductibles

These are defined amounts that you need to pay upfront (as per your Medical Scheme) to the hospital, which you can claim back.

Out-of-Hospital Examples include:

• Scopes
• Pacemakers
• Implants

In-Hospital Examples include:

• MRI Scans
• CT Scans
• PET Scans
• Scopes

Benefits limited to the Core Benefit Limit.

Read More: Policy Documents

Sub-Limits

Medical Schemes often put limits on certain procedures. This means they will only pay up to a defined value, however, your treatment may cost more. We will cover you up to R57 500 per event. This benefit is subject to Core Benefit Limit.

Examples of such procedures:

• Internal Prosthetics
• Pacemakers
• Implants
• joint replacements

Read More: Policy Documents

Oncology (Cancer) Benefits

Oncology Tariff Shortfalls: Covers you for shortfalls in respect of cancer related Treatment, approved by the Medical Scheme, limited to an additional 500%.

Oncology Sub-Limits: Cover for when the charges relating to the services supplied, have exceeded the benefit sub-limit that applies to cancer treatment of the Medical Scheme plan type you are on.

Oncology Co-payments: Cover for the co-payment applied once your cancer related costs have exceeded the specific threshold defined by your Medical Scheme. Limited to 20% of your co-payment amount.

Innovative Oncology Medicines: Cover for defined Innovative Oncology Medicines which have been approved by your Medical Scheme. Limited to the lesser of 25% of the total drug cost or R12 000.

Read More: Policy Documents

Dental Reconstruction Benefit

Dental Reconstruction Surgery required as a direct result of Accidental Harm or from Oncology Treatment that occurred after the Inception of your policy.

The benefit only covers the difference between what was charged by the specialist and paid by the Medical Scheme. Limited to two of such events per family per annum and up to  R49 900. Subject to the Core Benefit Limit of R177 800 per industry per annum.

Read More: Policy Documents

Accidental Casualty & Child Casualty

Covers you and your family in an accidental emergency or for children under 12 for illness relate emergencies. If payment is made from your available Medical Savings Account, or from your own pocket, we will reimburse that too.

Examples of Accidental Harm are:

• Broken Bones
• Falls
• Cuts

Cover is limited to R16 500 per event

Limits apply: Policy Documents

Lump sum payments: 

In the event 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:

Contributions will be covered for 6 months up to a maximum of R35 500 where policyholder is the principal member of the Medical Scheme.

Read More: Policy Documents

Maternity Extender – Family booster

A lump sum benefit is payable when a Premature Birth occurs.

The Lump Sum payable is R15 000.

Read more: Policy Documents

Hospital Booster

Lump-Sum payments & Contribution Waiver

Daily lump sum Benefits are payable where an Insured Party is admitted to a hospital, as a direct result of either Accidental Harm or Premature Birth, as defined, in your Policy.

A maximum of two Hospital Episodes are covered under this benefit, to a maximum amount of R27 690 Per Annum.

The benefit is payable from day one of the Hospital Episode:

R450 per day from the 1st – 13th day (inclusive).

R820 per day from the 14th – 20th day (inclusive).

R1 610 per day from the 21st – 30th day (inclusive).

Read More: Policy Documents

Family Legal & Financial Counselling Advice

Counselling from health professionals – unlimited telephonic, virtual or face-to-face appointments:

• Children and teenager support
• Life, parent, career coaching
• Financial and legal advice
• MyDoctor – portal and advice line
• COVID-19 Support line
• Road Accident Fund Cover Assistance
• Workman’s Compensation Cover

Read More: Policy Documents