Your FAQ’s

Explaining your frequently asked questions in a simple, clear and concise manner so that you don’t have to read between the lines.

Why is it important to have gap cover?

Gap cover products are designed to cover medical expense shortfalls that exist between the fees charged for private healthcare and what your medical scheme pays. Being covered by Stratum Benefits leaves you feeling assured that when you become liable to pay a portion of your service providers’ accounts, the unexpected difference won’t leave you out of pocket.

Our product offering boasts an array of additional benefits that cover you when you are required to settle an upfront co-payment, or when having to pay a portion towards your service providers’ account for your oncology treatment, internal prosthesis, MRI or CT scans, casualty events or trauma counselling to name but a few.

Who qualifies for gap cover?

Gap cover is a short-term insurance product that covers you when belonging to a registered South African medical scheme. Our products are compatible with all medical schemes; providing cover to individuals and families as well as corporate employer groups.

Who is covered on a gap cover policy?

We cover individuals of all ages. Different premiums apply to individuals 64 and younger applying for cover as either single applicants or families. We cover you and your spouse on one policy, even if you belong to different medical schemes or medical scheme options, including all dependants registered on your or your spouse’s medical scheme option.

Individuals 65 and older applying for cover may join as either a single individual or a family. Cover for a family is limited to two insured individuals per policy.

Does Stratum Benefits offer alternative short-term insurance solutions other than gap cover?

Besides our comprehensive Gap Cover Product Range, we also provide an essential Health Insurance Product Range for individuals from all walks of life. Individuals and corporate employer groups can choose between Day-To-Day BenefitsEmergency & Accidental Benefits or a combination option.

Will a guarantee of payment be issued to my service provider prior to my medical procedure or treatment?

Certain queries cannot be resolved without following an appropriate process or receiving necessary supporting documentation and therefore we are unable to issue guarantees of payment. Several factors influence the outcome of a claim, such as your waiting periods, general exclusions, was the medical procedure paid as an in- or out-of-hospital event and the portion your medical scheme paid towards your service providers’ accounts.