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Cover for Tariff Shortfalls, Oncology Benefits, Accident Cover & More

Summit

Dis-Chem Health Gap – Summit, covers you for certain shortfall costs of Hospital treatments, Oncology (Cancer) Benefits, & Accident Cover.

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

Summit Plan Pricing

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

Your Benefits

 

Tariff Shortfalls

Cover for certain in-hospital specialist shortfalls.

*In-Hospital Tariff Shortfalls.

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 & Deductibles

Cover for defined up-front payments to the Hospital.

 

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

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 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

Cover for Tariff Shortfalls, Sub-Limits and Co-payments related to approved cancer treatments.

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 Oncology Treatment.

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

When your medical Scheme doesn’t cover Services provided in Casualty for Accidents, or Illness for children under 12

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

 

Accidental Death & Disability Cover:

Lump Sum payments & Contribution Waiver

 

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

Covers you for pre-estimated expenses related to a premature birth.

 

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

A lump sum payment for hospital admission related to an accident

 

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

Additional Value-added services to provide counselling and advice.

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

Compare our Plans – or see our Base plan

 BaseSummit
Overall Annual LimitCore benefits - Limited to R177,800 per Insured Party: Policy Docs
In-Hospital (Core) Benefits
Tariff Shortfalls
Standard Co-Payments and Deductibles
Penalty Co-Payments and Deductibleslimited to R16 500 per event.
Sub-LimitsR29 000 per policyholder p.a.R57 500 per policyholder p.a.
Oncology (Cancer) Benefits
Dental Reconstruction Benefit2 events, R45,700 per policyholder p.a.2 events, R49,900 per policyholder p.a.
Out-of-Hospital (Core) Benefits
Co-payments on Listed Treatments
Out of Hospital Tariff Shortfalls
Extender Benefits
Casualty - Child Illness2 events, max of R2 500 per event
Accidental Casualty limited to R16 500 per event.
Maternity Extender (Family Booster)Limited to R15,000
Accident or Premature Birth Booster
Accidental Death & Disability: Lump Sum Payments
Accidental Death & Disability: Contribution Waiver
Road Accident Fund Cover Assistance
Family, Legal & Financial Counselling (Value Added Services)
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
Note that Limits applySee the Value Added Services Brochure Brochure

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