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Discounted rates up to 28% to Bonitas Member
From 2025, members who do not have dependants can now enjoy a lower rate by paying a single rate.
**This will only be applicable to our individual products not employer groups
From 2025, members who do not have dependants can now enjoy a lower rate by paying a single rate.
**This will only be applicable to our individual products not employer groups
2024 RATES
Millennial is a product for individuals over the age of 18 and under the age of 30 (no dependents may be covered). New members cannot join if they are already 30. When a member turns 30 during the year, we will automatically move them to the individual family cover with their renewal in January the following year.
Our MedGap Pensioner products offer cover for you only, if you are over the age of 65 at the date of joining.
The Student Gap product is only available for full-time students between the ages of 18 and 28, registered at a recognised Tertiary Educational facility and provides cover for the principal member only (no dependents may be covered)
2025 Shortfall Benefits
Subject to a R200 000 Sublimit Per Annum
Medical practitioner shortfall benefit
Medical practitioner shortfall benefit
Covers the shortfall between what the medical practitioner charges and the medical scheme pays, up to 3 times the amount paid by the medical scheme for in-hospital and certain out-of-hospital procedures.
Prescribed minimum benefits (PMB) procedures are covered under this benefit
We will also cover you up to the above multiples of what your scheme has paid, for certain authorised out-of-hospital procedures. The list of procedures which we will cover you for include:
- Cardiovascular - Coronary angioplasty and angiogram
- Ear, nose, throat - Adenoidectomy, direct laryngoscopy, grommets, myringotomy, sinus surgery and tonsillectomy
- Dermatologic - Skin grafts
- Gastro – intestinal – Closure of colostomy, colonoscopy, endoscopy, gastroscopy, laparoscopy, oesophagoscopy, haemorrhoidectomy, Ischiorectal abscess drainage
- Gynaecology – Cervical laser ablation, dilatation and curettage, hysteroscopy, tubal ligation, Incision and drainage or marsupilisation of Bartholin’s cyst, laparoscopy
- Obstetrics – Childbirth in a non – hospital setting
- Oncology – Chemotherapy and radiotherapy
- Ophthalmology – Cataract removal, pterygium removal, trabeculectomy, laser eye surgery
- Radiology - CAT, MRI, PET scans, nuclear radiology, varicose vein removal
- Renal - Kidney dialysis
- Respiratory - Bronchoscopy
- Urology - Circumcision (due to medical necessity), cystoscopy, prostate biopsy, vasectomy
- Prescribed Minimum Benefit (PMB) procedures are covered under this benefit
Allied professional’s shortfall cover
Allied professional’s shortfall cover
We cover the shortfall between what the allied professional has charged and what your medical scheme has paid. This is paid up to 3 times the amount paid by your medical scheme towards in-hospital shortfalls and is limited to R2 500 per policy per year.
Robotic procedures shortfall benefits
Robotic procedures shortfall benefits
Co-payment benefit
Co-payment benefit
Robotic procedure co-payment benefit
Robotic procedure co-payment benefit
Non-DSP co-payment benefit
Non-DSP co-payment benefit
Certain medical scheme options stipulate the use of their preferred network hospitals for elective procedures. Should you need to use a non-network hospital and your medical scheme imposes an additional co-payment, we cover this co-payment subject to a limit of R12 000 up to two claims per policy per year (rand and percentage-based co-payments).
Oncology co-payment benefit *
Oncology co-payment benefit *
Oncology extender benefit *
Oncology extender benefit *
Internal prosthesis benefit
Internal prosthesis shortfall benefit
If you undergo a medical procedure that requires the use of an internal prosthesis to replace a body part and you reach your medical scheme limit for the year, we will pay the shortfall up to a limit of R35 000 per family per year. Stents and pacemakers are covered up to R8 000 per claim event and this aggregates to the R35 000 annual limit.
Casualty Benefit
Casualty Benefit
In the event of an emergency caused by an accident and you need to visit an emergency casualty ward within 24 hours of the event, we will pay up to R24 000 of all costs incurred. This benefit is limited to five casualty visits per family per year. Three of these visits may be for an emergency only, for a child that is 8 years old or younger limited to R5 000 per policy per year, this aggregates to the R24 000 annual limit.
Sub-limit benefit
Sub-limit benefit
Certain medical schemes will only cover MRI/CT scans and scopes up to a specific limit. Our Sub-Limit benefit will pay up to R16 000 per policy per year where your medical scheme limit has been exhausted.
2025 Assist Benefits
Cancer Assist benefit
Cancer assist benefit
Pays a benefit of R8 000 if an insured is diagnosed with minimum stage II, local and malignant cancer for the first time while covered on the policy
OR
Pays R20 000 for first-time diagnosis of at least stage II, regional and malignant cancer. Pays an additional R15 000 if the medical scheme oncology benefit limit is reached in the same year. Benefit is payable once per insured per lifetime. This benefit assists in covering unexpected costs which may arise as a result of the diagnosis.
Accidental death/disability assist benefit
Accidental death/disability assist benefit
An amount of R55 000 will be paid if an insured dies or becomes permanently and totally disabled as a result of an accident while covered on the policy. The death benefit will be reduced if death relates to a minor. Subject to one claim per insured per lifetime. This benefit assists in covering unexpected costs which may arise as a result of the diagnosis.
Violent crime benefit
Violent crime benefit
Breast reconstruction benefit for non-affected breast
Breast reconstruction benefit for non-affected breast
Premium waiver benefit
Premium waiver benefit
If you become permanently and totally disabled or die as a result of an accident or violent crime, we will pay an amount of R36 000 upfront which can be used to cover the cost of your dependents’ medical scheme and gap cover premiums.
Trauma and bereavement counselling benefit
Trauma and bereavement counselling benefit
Baby bump benefit
Baby bump benefit
Pays a fixed amount of R2 500 upon diagnosis of pregnancy by a medical practitioner. to assist with the unplanned expenses.
Please click the button for detailed brochure of benefits
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.