Benefits
Internal Prosthesis
Where an internal prosthesis was used, and the scheme’s limit has been exhausted, MedGap will pay the shortfall up to a limit of R30 000 per family per year. An internal prosthesis replaced a body part (e.g. hip replacement)
Internal prosthesis
SupremePrimary
Benefit for shortfalls in internal prosthesis costs
What is an internal prosthesis?
An internal prosthesis is a device that is placed inside the body during a procedure with the specific purpose of permanently replacing a body part. In other words, a body part is removed and permanently replaced with a prosthesis during surgery.
What will MedGap cover:
If you have an internal prosthesis fitted, your medical scheme may pay the full cost of the prosthesis or it may pay up to a fixed limit. If your medical scheme pays up to a fixed limit and there is a shortfall between the cost of the prosthesis and the fixed limit, we will cover this shortfall up to a maximum amount of R30 000 per policy per year.
MedGap will not cover benefits in the following circumstances
  • Devices that are placed inside a body to assist with the functioning of a body part (for example, a pacemaker, stents, etc.) are specifically excluded from cover
  • Any external prosthesis or dental implant.
  • We will also only cover you for any shortfall under this benefit if the medical scheme option that you have selected includes cover under your major medical benefit for the internal prosthesis that you are claiming for. If your medical scheme option does not include cover for this, we will not provide cover for any shortfall either
  • 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.