+27 860 102 936 info@medgaponline.co.za
MedGap
For Families and Individuals

Gap cover is now a great deal easier to buy with the exclusive Medgap offer. Guard yourself against medical expense shortfalls during hospitalisation

For
Families and
Individuals
Many medical practitioners charge considerably more than medical schemes will pay. This creates a shortfall or gap between what the medical scheme has paid, and the actual cost incurred for the medical practitioner who treated you in hospital.
As a member you would be personally liable for the difference in cost, which for specialists and surgeons can add up to a sizeable amount. MedGap offers members and their loved ones a specially designed products that provides cover for medical expense shortfalls in the event of hospitalisation involving surgery or medical treatment, as well as for certain procedures performed out-of-hospital.

Our specially designed products will cater for families and individuals of all ages.

Individuals
Our Supreme and Primary Gap product offers cover for you and your loved ones registered as dependants on your medical scheme and that are eligible for cover at the date of your joining.
Pensioners
Our Supreme and Primary Pensioner Gap product offers cover only for the main policy holder over the age of 65 at the date of joining.
Millennial
This is exclusive cover for young individuals over 18 to under 30 years offering both the Primary and Supreme options at a competitive rate.

2022 RATES

MedGap Supreme and Primary Cover

These rates are applicable and guaranteed for 2022. Our MedGap products offers cover for you, your spouse, your children and your parents that are registered as dependents on your medical scheme and that are eligible for cover at the date of you joining. Millennial is a product for individuals over the age of 18 and under the age of 30. 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 offers cover for you only, if you are over the age of 65 at the date of joining.

Benefit highlights

Subject to a R178 000 Sublimit Per Annum

CO-PAYMENTS

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CO-PAYMENTS

Benefits
Co-Payments
Covers co-payments which a medical scheme levies for approved in-hospital or out-of-hospital procedures which members need to pay upfront and out of their own pockets.
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Internal Prosthesis

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Internal Prosthesis

Benefits

Internal Prosthesis 

Internal prosthesis costs can become quite expensive, especially if your medical scheme only pays up to a certain amount and you end up having to pay the difference yourself. 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 R30 000 per family per year. Stents and pacemakers are covered to a limit of R6 000 per claim event and this aggregates to the R30 000 annual limit
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Oncology

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Oncology

Benefits
Oncology
Benefit for Co-Payments on Oncology Treatment Programmes
Covers the co-payment (including biological drugs and specialised medication) of up to 20% that medical schemes impose on members once they have reached their oncology treatment benefit limit for the year.
Oncology Extender Benefit
Where a medical scheme's oncology benefit limit has been reached and no further benefits are available, we will pay 20% of the cost of each treatment (including biological drugs and specialised medication) paid by the insured person. Insured persons are required to register with the medical scheme's oncology treatment programme *Insured persons are eligible for only one of the above oncology treatment benefits, depending on their medical scheme's oncology benefit
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Casualty

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Q

Casualty

Benefits
Casualty
If you need to visit a casualty ward due to an emergency and accident, we will pay up to R20 000 of all the costs paid by you which you cannot claim back from your medical scheme. 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 5 years old or younger limited to R3000 per policy per year.
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Cancer Assist

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Q

Cancer Assist

Benefits
Cancer Assist
Pays a benefit of R5 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 2, 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.
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Accident Assist

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Q

Accident Assist

Benefits
Accident Assist
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.
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Trauma benefit

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Trauma and bereavement counselling benefit

Benefits
Trauma and bereavement counselling benefit
Pays R800 per counselling session up to R30 000 per family per year, for trauma counselling as a result of being a victim of, or witness to, an act of violence or a traumatic accident and bereavement counselling for an immediate family member.
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In Hospital Shortfall

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In Hospital Specialist Shortfall

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
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Baby Bump

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Q

BABY Bump

Benefits
Baby Bump
Pays a fixed amount of R2 000 upon diagnosis of pregnancy by a medical practitioner. to assist with the unplanned expenses.
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Premium Waiver Benefit

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Q

Premium Waiver Benefit

Benefits
Premium waiver benefit
Pays the equivalent of R6 000 per month for 6 months towards medical scheme contributions and gap cover premiums, if the premium payer covered on this policy dies or becomes permanently and totally disabled as a result of an accident. The full amount of R36 000 is paid upfront and not over the 6-month period
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Violent Crime Benefit

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Violent Crime Benefit

Benefits
Violent crime benefit
Doubles the accidental death or disability benefit paid if the death or disability is due to a violent crime to assist with the unexpected costs which may arise as a result of the violent nature of the incident.. The death benefit will be reduced if death relates to a minor.
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Robotic co-payment

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Robotic co-payment

Benefits
Robotic co-payment benefit
Should your condition require the use of Robot Assisted surgery and your medical scheme levies a co-payment, we will cover you up to R10 000 per policy per year
Robotic procedures shortfall benefits
Should your condition require the use of Robot Assisted surgery, our Robotic procedure shortfalls benefit will cover the shortfalls charged by medical practitioners. This cover is up to 3 times the amount paid by your medical scheme
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Non-DSP co-payment

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Q

Non-DSP co-payment benefit

Benefits
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, the scheme may impose an additional rand value co-payment. We cover this co -payment subject to a limit of R5000 per policy per annum.
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Sub-limit benefit

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Q

Sub-limit benefit

Benefits
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 R10 000 per policy per annum where your medical scheme limit has been exhausted.
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Breast reconstruction

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Q

Breast reconstruction benefit for non-affected breast

Benefits
Breast reconstruction benefit for non-affected breast
Provides assistance cover of R15 000 per policy per year should the insured be diagnosed with breast cancer and requires a cosmetic breast reconstruction for the non-affected breast due to a mastectomy. This can be used to recover the costs incurred or related to the treatment.
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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

I would like to start the claims process.
I would like to submit outstanding documentation on my existing claim

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.

Click to Amend your details now
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

I would like to start the claims process.
I would like to submit outstanding documentation on my existing claim
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.
Click to Amend your details now
Guarding yourself and your family against medical expense shortfalls
Apply for cover

Please click the button to complete the online application. Confirmation will be sent to you after activation of your policy.

Complete the online application

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

I would like to start the claims process.
I would like to submit outstanding documentation on my existing claim

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.

Click to Amend your details now
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

I would like to start the claims process.
I would like to submit outstanding documentation on my existing claim
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.
Click to Amend your details now
Click Here to see how easy it is to claim and update your details
See how easy it is to claim and also update your details
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

I would like to start the claims process.
I would like to submit outstanding documentation on my existing claim
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.
Click to Amend your details now