Benefits
Accidental Lumpsum
The benefit is available at no additional cost to all MedGap Supreme policy holders. If you or a dependant dies or becomes permanently and totally disabled as a result of an accident while you are covered under this policy, we will pay your estate (on death) or you (on permanent disability), a fixed amount of R50 000.

Any Accidental death benefit payable for a minor child under the age of 6 years will be capped at R10 000 and a minor child between ages 6 and 13 years, will be capped at R30 000.

Claiming made easy

If you have given consent for claims data sharing with Guardrisk insurance company the claim will be automatically processed and paid to the member. MedGap wants to make claiming as easy as possible for our clients. It is important to follow the steps below to ensure that your claim is processed within the correct timeframes. You have 4 months from the date of treatment to provide us with written notice of your claim. If any details are missing, or we need more information or documents, we will contact you. If we do this, please send us the outstanding documents within 28 days of our request or we will close your claim until you provide us with the documents we need. If you do not send us these documents within 12 months of your claim event, your claim will prescribe and we will close it permanently.

Steps to follow to submit your claim

1

Complete the applicable section in the online form below, and submit OR download the PDF version of the form, complete and send, with all required documents, to medgapclaims@guardrisk.co.za

2

Ensure that each section that is relevant to your claim is completed clearly, accurately and completely

3

A copy of the claim form will automatically be sent to medgapclaims@guardrisk.co.za

4

If you are not able to email your claim to us, print your completed claim form and posit it, with all required documents to: The MedGap Claims Team, Guardrisk Insurance Company Limited, PO Box 786015, Sandton, 2146

Update your details
If you need to update any personal information you can complete the relevant section in the online amendment form. You will receive confirmation of the change once updated on our systems.
Claiming made easy

If you have given consent for claims data sharing with Guardrisk insurance company the claim will be automatically processed and paid to the member. MedGap wants to make claiming as easy as possible for our clients. It is important to follow the steps below to ensure that your claim is processed within the correct timeframes. You have 4 months from the date of treatment to provide us with written notice of your claim. If any details are missing, or we need more information or documents, we will contact you. If we do this, please send us the outstanding documents within 28 days of our request or we will close your claim until you provide us with the documents we need. If you do not send us these documents within 12 months of your claim event, your claim will prescribe and we will close it permanently.

Steps to follow to submit your claim

1

Complete the applicable section in the online form below, and submit OR download the PDF version of the form, complete and send, with all required documents, to medgapclaims@guardrisk.co.za

2

Ensure that each section that is relevant to your claim is completed clearly, accurately and completely

3

A copy of the claim form will automatically be sent to medgapclaims@guardrisk.co.za

4

If you are not able to email your claim to us, print your completed claim form and posit it, with all required documents to: The MedGap Claims Team, Guardrisk Insurance Company Limited, PO Box 786015, Sandton, 2146

Update your details
If you need to update any personal information you can complete the relevant section in the online amendment form. You will receive confirmation of the change once updated on our systems.
DISABILITY
SupremePrimary
Lump sum benefit for personal Accidental Death and Permanent and Total Disability
For accidental death this benefit will pay R50 000 for insured persons over the age of 14 (including the principal member, the spouse, adult dependants and child dependants over the age of 14 years), R30 000 for child dependants between the age of 6 and 13 years and R10 000 for child dependants under the age of 6 years, at date of death. For accidental disability this benefit will pay R50 000 for all insured persons.
This benefit (either death or disability) will only pay once per person per lifetime.
What does “accidental” mean?
The policy wording defines an “Accident” as a sudden, unexpected, violent and visible external event, which is inflicted on you by something other than yourself at an identifiable time and place and that independently of any other cause, directly results in Bodily Injury. This means that unless the death or disability is as a result of an event that meets all of the above requirements, the benefit will not be payable
What does permanent, and total disablement mean?
Permanent and Total Disablement means being completely unable to perform any occupation whatsoever, unable to perform any normal daily living tasks (such as eating, dressing, bathing, walking, etc.) yourself and in the opinion of a Medical Practitioner, unlikely to ever recover from disability.
This also means that permanent and total disability of a specific body part (for example a leg or arm) does not meet these criteria. The disability must also be diagnosed as totally and permanently disabled within 4 months of the accident.
MedGap will not cover benefits in the following circumstances
  • Death or disability that is not due to an accident as defined in the policy
  • Disability that is not permanent and total as defined in the policy.
  • Disability that is not diagnosed within 4 months of the accident.
  • The waiting periods that could apply to you and your dependants from your 1st day of cover include:
    A 3-month general waiting period. During this period, you will not be able to make any claims.
    A 12-month waiting period for any cancer, birth and pregnancy related medical conditions.
    A 9-month waiting period for any other pre-existing medical condition including a physical defect, injury, disease or illness that you or any of your dependants have already been diagnosed for or for which care or treatment was recommended or received within 12 months before the 1st day of cover and which would have caused a reasonable person to seek medical advice and/or treatment.
    Claiming made easy

    If you have given consent for claims data sharing with Guardrisk insurance company the claim will be automatically processed and paid to the member. MedGap wants to make claiming as easy as possible for our clients. It is important to follow the steps below to ensure that your claim is processed within the correct timeframes. You have 4 months from the date of treatment to provide us with written notice of your claim. If any details are missing, or we need more information or documents, we will contact you. If we do this, please send us the outstanding documents within 28 days of our request or we will close your claim until you provide us with the documents we need. If you do not send us these documents within 12 months of your claim event, your claim will prescribe and we will close it permanently.

    Steps to follow to submit your claim

    1

    Complete the applicable section in the online form below, and submit OR download the PDF version of the form, complete and send, with all required documents, to medgapclaims@guardrisk.co.za

    2

    Ensure that each section that is relevant to your claim is completed clearly, accurately and completely

    3

    A copy of the claim form will automatically be sent to medgapclaims@guardrisk.co.za

    4

    If you are not able to email your claim to us, print your completed claim form and posit it, with all required documents to: The MedGap Claims Team, Guardrisk Insurance Company Limited, PO Box 786015, Sandton, 2146

    Update your details
    If you need to update any personal information you can complete the relevant section in the online amendment form. You will receive confirmation of the change once updated on our systems.