Benefits
Oncology
Some medical schemes impose a co-payment of up to 20% once you reach the oncology treatment benefit limit for the year. If you reach your benefit limit for the year, we will cover the co-payments up to 20% that is imposed on you by your medical scheme.
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.
Benefits for Co-Payments: Oncology
SupremePrimary
Benefit for co-payments on oncology Treatment programmes
If you have been diagnosed with cancer you will be required by your medical scheme to register for oncology benefits through an oncology treatment programme with them and the cost for your cancer treatment will be subject to an annual limit. Once you have reached your medical scheme limit, your medical scheme will levy a 20% co-payment on all cancer treatment costs for the remainder of that year. We will cover this 20% co-payment but please remember that by law, your overall limit for shortfalls and co-payments is limited to R 165 000 per Insured Person per policy year.
MedGap will not cover benefits in the following circumstances
  • Co-payments applied before you reach your oncology treatment benefit limit;
  • Co-payments applied if you choose to be treated by a service provider that is not contracted with your medical scheme – this is called a non-designated service provider or a non-DSP.
  • Oncology extender Benefit
    SupremePrimary
    Benefit for shortfalls in internal prosthesis costs
    The oncology extender benefit will operate on a similar basis as the oncology co-payment benefit, in that if an insured reaches their medical scheme’s annual oncology treatment limit and the medical scheme offers no further cover for treatment for that year, MedGap will pay the first 20% of treatment costs for the remainder of that year. The remaining 80% of treatment costs will remain for the account of the insured and this cost must have been paid before the 20% benefit will be paid by Medgap. Once again, your overall limit for shortfalls and co-payments is capped at R165 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.

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