EDGE 200

Our EDGE 200 option has been innovatively designed to give you the best start when insuring yourself against unforeseen medical shortfalls. We cover you, as the only individual insured on this option, when your medical scheme does not pay your private healthcare fees in full, remove the anxiety of unforeseen expenses for a casualty event and cover your gap cover policy premium when life happens.

GAP BENEFIT

WHY WE COVER YOU

Our GAP BENEFIT leaves you feeling assured that when an in- or out-of-hospital medical procedure is necessary and your service provider, such as your doctor or specialist, charges a rate more than what your medical scheme pays, the unexpected difference you are liable for won’t leave you out of pocket.

WHEN WE COVER YOU

  • You are covered when your service providers charge a rate more than what your medical scheme pays for medical procedures performed in hospital, doctors’ and specialists’ private rooms, day clinics and other registered facilities, provided your service providers’ accounts are paid from your medical scheme hospital benefit, also known as a risk or major medical benefit, and not from your medical scheme savings account or day-to-day benefit.
  • You are covered for Prescribed Minimum Benefit (PMB) medical procedures.

WHAT WE COVER YOU FOR

Our GAP BENEFIT provides an additional 200% cover, when you become liable for the difference between what your service providers charge, and what your medical scheme pays from your medical scheme hospital benefit for account shortfalls related to the following:

  • Doctors and specialists
  • Dentistry and related procedures limited to R 3 000 per year
  • Basic radiology
  • Specialised radiology limited to MRI, CT and PET scans up to
    R 2 000 per year
  • Pathology
  • Physiotherapy
  • Consumable items such as surgical gloves, bandages and gauze
  • Medication provided as part of your in- or out-of-hospital event

Where a claim under our GAP BENEFIT is received for a condition, procedure, surgery, treatment or an investigation and any related accounts in respect of Adenoidectomy, Tonsillectomy, Myringotomy/Grommets, Cardiovascular procedures, Cataract removal, Dentistry, Hysterectomy (unless due to cancer diagnosis), Hernia repair, Joint replacement, MRI, CT and PET scans, Nasal and sinus surgery, Pregnancy and childbirth, Spinal procedures and Scopes within the first 10 months of cover, and is not deemed as pre-existing or accidental, 20% of the medical expense shortfall amount will be payable.

GAP COVER FOR INDIVIDUALS WITH AN OVERALL POLICY LIMIT (OPL)
OF R 150 000 PER YEAR

ENTRY AGES MONTHLY PREMIUM
18 – 27 *
SingleR 100
28 – 64 *
SingleR 180
65+ *
SingleR 300

* Limited to one insured individual per policy

WE COVER
  • You, whether you are the main member or dependant on a medical scheme option.
  • You, as the only individual insured on this option.

CASUALTY BENEFIT

WHY WE COVER YOU

Our CASUALTY BENEFIT offers rich benefits to ensure that you not only receive the very best medical care, but also not having to worry about an unforeseen out of pocket expense for a casualty event.

WHEN WE COVER YOU

  • You are covered at a registered medical facility in the event of an accident, when immediate treatment is required for physical injury resulting from an external force outside your body due to impact with someone or something.
  • We will refund the cost of the casualty event to you when you become liable to pay out of your own pocket, or when your medical scheme pays the event from your medical scheme savings account.

WHAT WE COVER YOU FOR

Our CASUALTY BENEFIT covers the cost of your casualty event, including return visits for follow-up treatment that is required as a result of your initial casualty event, up to R 2 500 per year, for accounts related to the following:

  • Doctor or specialist consultations
  • Basic and specialised radiology
  • Pathology
  • Consumable items such as surgical gloves, bandages and gauze
  • Medication provided as part of your casualty event at the registered medical facility
  • Upfront casualty co-payments or facility fees

ADDITIONAL BENEFIT

GAP POLICY PREMIUM WAIVER BENEFIT

WHY WE COVER YOU

Our GAP POLICY PREMIUM WAIVER BENEFIT offers you the security of knowing that when you are faced with unexpected change resulting in financial difficulty, we have you covered.

WHEN AND WHAT WE COVER YOU FOR

  • Our GAP POLICY PREMIUM WAIVER BENEFIT covers your Stratum Benefits policy premium for 12 months in the event of death, permanent disability or forced retrenchment of the Stratum Benefits policy premium payer.
  • This benefit is not subject to the Overall Policy Limit (OPL).