Gap Max

1. Overall annual limit (OAL) per insured person * R219,800
2. We cover medical specialists and oncologists for treatment or surgery provided in hospital
3. We cover medical specialists for out-patient procedures that would otherwise attract a co-payment if such procedure was
   performed in hospital
4. We cover gynaecologist and/or paediatrician consultations from the 2nd trimester to 90 days post-delivery; R730 per consultation,
   R2,900 per pregnancy

1. We cover the 20% co-payment after reaching the oncology threshold; 100% Cover

2. We cover co-payments on approved precision medicines and co-payments applied on ex-gratia benefits for precision medicines; R18,300 per claim

1. We cover the upfront payment applied as a fixed rand value to MRI/CT/PET scans, in-hospital endoscopes, in-hospital
basic dentistry and defined procedures; 100% Cover

2. We cover other upfront payments (including robotic surgery); R27,000 per event

3. We cover upfront payments for voluntary use of a non-network hospital or clinic; R21,000 per event | Max 2 pppa

1. We cover shortfalls when a sub-limit applies to an internal prosthetic device; R73,000 per event

2. We cover shortfalls when a sub-limit applies to MRI/CT/PET scans, endoscopes or intra-ocular lenses R8,600 per event

1. We cover emergency treatment at a casualty facility resulting from an accident; R20,000 per event, Max 2 pppa
We cover emergency after-hours illness treatment in a casualty ward for children under 12; R3,600 per event, Max 2 pppa

2. If the accident was a sports injury, we will also cover shortfalls on rehabilitation consultations at a physiotherapist/biokineticist/
chiropractor; R820 per consult, Max 6 per event

1. We cover the excess on your international travel insurance for medical emergencies; R4,200 per departure

1. We will pay a once-off lump sum on a first lifetime diagnosis that is made after policy inception and the expiry of all
waiting periods ‡
Stage 1 – R7,000
Stage 2 – R20,000
Stage 3 – R30,000
Stage 4 – R50,000

2. If after diagnosis you upgrade your medical scheme benefit option at the first opportunity, we will provide a waiver for
the additional medical scheme contributions * R5,200 pm for 12 Months

1. For an admission resulting from an accident and the admission is 3 days or longer; Tier 1 = R180 per day
We will pay a daily lump sum: Tier 1 from day 1 to 7 and Tier 2 from day 8 to 28; Tier 2 = R1,800 per day

2. We pay a lump sum for a birth that is 42 days or more premature; R22,000 per event

1. In the event of accidental death or permanent disability caused by an accident; R24,000

2. If the event is a direct result of a proven crime, this benefit doubles ¥

1. In the event of accidental death or permanent disability of the principal member or spouse, we will cover the medical
scheme contributions and gap cover premiums for 6 months
R8,600 pm – medical aid
100% on policy

1. If an insured is a witness to or a victim of a violent crime, we will cover sessions
with a counselling therapist; R1,000 per session, Max R11,000 pppa