Benefits
In Hosptial Specialist Shortfall
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, Ischio-rectal 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, orchidopexy, prostate biopsy, vasectom
  • Prescribed Minimum Benefit (PMB) procedures are covered under this benefit
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.
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.