Benefits
Casualty
If you need to visit an emergency casualty ward due to an accident and emergency, we will pay you up to R10 000 of the costs paid by you which you cannot claim back from your medical scheme.
  • This benefit is limited to 3 casualty visits per family per year.
  • One visit may be for an emergency trauma visit for a minor child under 6 years of which we will pay up to R2 000.
  • This benefit is aggregated to either 3 visits or up to the limit of R10 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.
    Accidental Emergency casualty benefit
    SupremePrimary
    Accidental and Emergency casualty benefit
    The purpose of this benefit is to provide financial assistance in an emergency where an insured person requires immediate medical attention and does not have enough cover through their medical aid. It is not intended to be used to cover day-to-day medical expenses such as doctor visits, medication, etc. when an insured’s daily benefits through their medical scheme are depleted.
    What will this benefit pay?
    This benefit will pay up to 3 casualty visits or R10 000 per family per year, of the costs paid by an insured for a visit to the emergency casualty ward, as a result of an accident.
    What does “accident” 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 visit to the causality ward is as a result of an event that meets all the above requirements, the benefit will not be payable
    What does “emergency” mean?
    “Emergency” means the necessity to immediately visit a casualty facility due to a bodily injury caused by an accident as defined in the policy, and when failure to do so, may result in loss of life, limb or significant complications.
    What are the conditions of cover for this benefit?
  • This benefit is payable for three casualty visits per policy per year up to a maximum of R10 000.
  • Your medical scheme must have paid the first portion of the claim for you to be eligible for cover under this benefit.
  • Eligibility to claim for this benefit is subject to verification that the event was an emergency and due to an accident.
  • Any portion of the total charges paid by your medical scheme will be deducted from the amount payable to you.
  • 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.

    If you are interested in joining Medgap please sms “Medgap” to 43366 we will phone you back with accredited advice.