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Gap Cover & Health Insurance for Real People

STRATUM

GAP COVER COMPARE

Find the gap cover that’s right for you.

2019 Individual Gap Cover Product Range Overview

GAP COVER RANGE

OUR PRODUCTS

  • GAP BENEFIT
  • OVERALL POLICY LIMIT (OPL)
    All benefits accummulate to an OVERALL POLICY LIMIT per person or per policy per year, as indicated.
  • GAP BENEFIT
    Provides 200% or 500% cover, over and above the rate your medical aid pays when your healthcare providers charge more than what your medical aid pays from your medical aid hospital or risk benefit for:

    • Medical procedures;
    • Dental related procedures;
    • Basic and specialised radiology;
    • Pathology;
    • Physiotherapy;
    • Consumable items;
    • Medication; and
    • Prescribed Minimum Benefit (PMB) medical procedures.
  • CO-PAYMENT BENEFIT
    Covers upfront co-payments, deductibles and hospital admission fees paid by you or deducted from your medical savings account.
  • CANCER DIAGNOSIS BENEFIT
    (Not subject to the OPL)
    Pays a once-off benefit amount on first-time cancer diagnosis before age 65, and subject to specific qualifying criteria.
  • ONCOLOGY SHORTFALL BENEFIT
    Covers the difference between what your healthcare providers charge and the rate your medical aid pays from your oncology benefit for healthcare services approved under your treatment plan, such as:

    • Specialists’ consultations;
    • Radiotherapy and chemotherapy;
    • Specialised radiology; and
    • Oncology medication.
  • ONCOLOGY OPTIMISER BENEFIT
    Covers the cost of your ongoing oncology treatment, when the rand amount provided by your medical aid option's oncology benefit has been reached.
  • SUB-LIMIT BENEFIT
    Covers the difference in cost when your medical aid pays a portion of your healthcare provider's account from a sub-limit or annual limit relating to:

    • Internal prosthetic devices;
    • Renal dialysis treatment;
    • Colonoscopies, gastroscopies; and
    • MRI or CT scans.
  • CASUALTY BENEFIT
    Covers the cost of your casualty event at any registered medical facility paid by you or from your medical aid day-to-day benefit or medical savings account for:

    • Doctors’ and specialists’
    consultations;
    • Basic and specialised radiology;
    • Pathology;
    • Consumable items;
    • Medication;
    • External medical items;
    • Return visits follow-up treatment;
    • Upfront casualty co-payments or facility fees; and
    • Children younger than 5 at a registered casualty facility when after-hours medical treatment is required due to illness.
  • TRAUMA COUNSELLING BENEFIT
    Covers the cost of your registered counsellor's, clinical psychologist's or psychiatrist's consultation fees paid by you or paid from your medical aid day-to-day benefit or medical savings account.
  • REHABILITATION OPTIMISER BENEFIT
    Covers the cost of your stay at a registered sub-acute or step-down facility and treatment provided by on-site therapists required due to an accident, when the physical rehabilitation benefit provided by your medical aid has been reached.
  • PREVENTATIVE CARE BENEFIT
    Covers the cost of your healthcare provider's consultation fee and the cost of a contraceptive device implant, full blood count (FBC test), mammogram, pap smear or prostate screening (PSA test) paid by you or paid from your medical savings account.
  • OUT-PATIENT SPECIALIST CONSULTATION BENEFIT
    (Launching 1st Jan 2019)
    Covers the cost of your specialist's consultation fee when referred by your GP and a portion of the consultation fee for a visit to your specialist's private room is paid from your medical aid hospital, risk, day-to-day benefit or medical savings account.
  • ADDITIONAL BENEFITS
  • GAP POLICY PREMIUM WAIVER BENEFIT
    covers your Gap Cover policy premium when the person paying your premium no longer can.
  • MEDICAL AID CONTRIBUTION WAIVER BENEFIT
    covers your medical aid contribution when the person paying your contribution no longer can.
  • ACCIDENTAL DISABILITY AND DEATH BENEFIT
    pays a lump-sum benefit amount in the event of total and permanent disability or death due to an accident.
  • FUNERAL CARE BENEFIT
    pays a lump-sum benefit amount in the event of death.
  • LIFESTYLE BENEFITS
  • STRATUM FUEL REWARDS
    (Launching 1st Dec 2018)
    STRATUM FUEL REWARDS gives you more bang for your buck when you fill up with diesel at any SHELL service station.
    Launching 1 December 2018.
  • INTERNATIONAL TRAVEL INSURANCE
    (Launching 1st Jan 2019)
    INTERNATIONAL TRAVEL INSURANCE provides medical cover while travelling abroad for leisure - from the moment you need medical assistance to the time your healthcare providers' accounts are paid.

    Launching 1 January 2019.
  • OPTIMISER BENEFITS
  • HOSPITAL OPTIMISER BENEFIT
    Covers your stay in hospital and all related healthcare providers’ accounts when your medical aid’s overall annual hospital limit has been reached.
  • ACCESS OPTIMISER BENEFIT
    covers specific medical procedures and treatments that your medical aid excludes.
  • MONTHLY PREMIUM
  • ENTRY AGES AND MONTHLY PREMIUM

GAP 200

EDGE 200

  • 200%
  • OPL of R 157 000 per year.
  • Additional 200% cover. Dental related procedures - R 3 000 per year. Dental procedures related to accidental injury or cancer - R 6 000 per year. MRI, CT, PET scans and ultrasounds - R 2 000 per year.
  • R 3 500 per year.

    This option does not cover dependants.
  • Edge 200
  • 12 Months in the event of forced retrenchment, total and permanent disability or death.
  • Edge 200
  • 22 Cents cash back for every litre.
  • EDGE 200
  • EDGE 200
  • 18 - 27
    Single R110
    28 - 64
    Single R199
    65+
    Single R332

GAP 200

COMPACT 200

  • 200%
  • OPL of R 157 000 per person per year.
  • Additional 200% cover. Dental related procedures - R 3 000 per policy per year. Dental procedures related to accidental injury or cancer - R 6 000 per policy per year. MRI, CT, PET scans and ultrasounds - R 2 000 per policy per year.
  • R 15 000 per policy per year.
  • R 15 000 per person.
    Not subject to the OPL
  • No benefit limit but subject to the OPL.
  • R 50 000 per person per year.
    Subject to the OPL.
  • R 15 000 per person per event for an internal prosthetic device.
  • R 6 000 per policy per year.
  • R 5 000 per policy per year.
    Subject to the OPL.
  • Compact 200
  • Principal Insured and Spouse - R 15 000 limited to 1 event per person per year.

    Dependant - R 5 000 limited to 1 event per dependant per year.
  • Compact 200
  • 22 Cents cash back for every litre.
  • COMPACT 200
  • COMPACT 200
  • 64 OR YOUNGER
    Single R199
    Family R232
    65+
    Single or Family R387

GAP 500

BASE

  • 500%
  • OPL of R 157 000 per person per year.
  • Additional 500% cover. Dental related procedures - R 3 000 per policy per year. Dental procedures related to accidental injury or cancer - R 6 000 per policy per year. MRI, CT, PET scans and ultrasounds - R 2 000 per policy per year.
  • R 5 000 per person.
    Not subject to the OPL
  • R 7 000 per policy per year.
  • R 6 000 per policy per year.
    Subject to the OPL.
  • Base
  • Principal Insured and Spouse - R 6 000 limited to 1 event per person per year.
  • Base
  • 22 Cents cash back for every litre.
  • 1 Event per policy per year.
  • BASE
  • BASE
  • 64 OR YOUNGER
    Single R199
    Family R230
    65+
    Single or Family R387

GAP 500

CO-EVOLUTION

  • 500%
  • OPL of R 157 000 per person per year.
  • Additional 500% cover. Dental related procedures - R 3 000 per policy per year. Dental procedures related to accidental injury or cancer - R 6 000 per policy per year. MRI, CT, PET scans and ultrasounds - R 2 000 per policy per year.
  • R 50 000 per policy per year.
  • R 5 000 per person.
    Not subject to the OPL
  • R 8 000 per policy per year.
  • R 7 000 per policy per year.
    Subject to the OPL.
  • Co-evolution
  • Principal Insured and Spouse - R 7 000 limited to 1 event per person per year.
  • Co-evolution
  • 22 Cents cash back for every litre.
  • 1 Event per policy per year.
  • CO-EVOLUTION
  • CO-EVOLUTION
  • 64 OR YOUNGER
    Single R221
    Family R279
    65+
    Single or Family R442

GAP 500

ELITE

  • 500%
  • OPL of R 157 000 per person per year.
  • Additional 500% cover.

    Dental related procedures - R 5 000 per policy per year.

    Dental procedures related to accidental injury or cancer - R 10 000 per policy per year.

    MRI, CT, PET scans and ultrasounds - R 2 000 per policy per year.
  • No benefit limit but subject to the OPL. + 1 Co-payment up to R 8 500 per policy per year for the voluntary use of a hospital or day clinic outside your medical aid's network, subject to the OPL.
  • R 30 000 per person.
    Not subject to the OPL
  • No benefit limit but subject to the OPL.
  • No benefit limit but subject to the OPL.
  • R 30 000 per person per event for an internal prosthetic device or renal dialysis treatment.

    R 1 500 per person per event for a colonoscopy or gastroscopy.

    R 3 000 per MRI or CT scan per policy per year, limited to 2 scans when you are liable to pay a portion or the full amount when a benefit limit has been reached.
  • R 7 000 per policy per year.
  • R 10 000 per policy per year.
    Subject to the OPL.
  • R 10 000 per person per year.
  • R 800 per policy per year.
  • R 1 000 per consultation, maximum 3 consultations per person limited to R 6 000 per policy per year.
  • Elite
  • 12 Months in the event of forced retrenchment, total and permanent disability or death.
  • R 4 500 per month, limited to 6 months in the event of total and permanent disability or death.
  • Principal Insured and Spouse - R 25 000 limited to 1 event per person per year.

    Dependant - R 5 000 limited to 1 event per dependant per year.
  • Elite
  • 22 Cents cash back for every litre.
  • 1 Event per policy per year.
  • ELITE
  • ELITE
  • 64 OR YOUNGER
    Single R326
    Family R392
    65+
    Single R519
    Family R635

OPTIMISER

ACCESS OPTIMISER

  • 200% OR 500%
  • OPL of R 100 000 per policy per year or when adding our 200% or 500% GAP BENEFIT increases to R 157 000 per policy per year.
  • Additional 200% or 500% cover when added voluntarily at an additional monthly premium. Dental related procedures - R 3 000 per policy per year. Dental procedures related to accidental injury or cancer - R 6 000 per policy per year. MRI, CT, PET scans and ultrasounds - R 2 000 per policy per year.
  • This benefit is automatically included when you add our GAP BENEFIT to your ACCESS OPTIMISER OPTION.

    R 1 000 per policy per year.
  • ACCESS OPTIMISER
  • Principal Insured and Spouse - R 5 000 limited to 1 event per person per year.
  • ACCESS OPTIMISER
  • 22 Cents cash back for every litre.
  • ACCESS OPTIMISER
  • R 14 000
    • Bunion surgery
    • Dental procedures - impacted teeth (children 18 or younger)
    R 20 000
    • Removal of varicose veins
    • Skin disorders (incl. benign growths & lipomas)
    • Non-cancerous breast conditions
    R 23 000
    • Functional nasal surgery
    R 25 000
    • Knee or shoulder surgery
    R 50 000
    • Arthroscopic surgery
    • Back or neck surgery
    • Joint replacement surgery
    R 55 000
    • Oesophageal reflux & hiatus hernia surgery
    R 80 000
    • Cochlear implant, auditory brain implant & internal nerve stimulator surgery (procedure, device, processor & hearing aids incl.)
    • Dental procedures for reconstructive surgery (due to an accidental event)
  • ACCESS OPTIMISER
  • 64 OR YOUNGER
    Single or Family R252
    Incl 200% GAP Benefit R279
    Incl 500% GAP Benefit R322
    65+
    Single or FamilyR311
    Incl 200% GAP Benefit R358
    Incl 500% GAP Benefit R436

OPTIMISER

HOSPITAL OPTIMISER

  • N/A
  • OPL of R 157 000 per person per year.
  • HOSPITAL OPTIMISER
  • Principal Insured - R 10 000 in the event of death.
  • HOSPITAL OPTIMISER
  • 22 Cents cash back for every litre.
  • HOSPITAL OPTIMISER
  • Subject to the OPL.
  • HOSPITAL OPTIMISER
  • ALL AGES
    Single or Family R90