Hi to all my valued Health Clients !!
Please find below a summary of the Discovery GAP cover for 2023 and Supplementary Illness Benefit which fits into their health plans seamlessly – when you submit your health claim it is handled as one claim together instead of 2 separate claims!!!
How does GAP cover work?
First of all you have to be a member of a Discovery Health Plan – Excluding Keycare and Primary care plans. Gap cover is designed to cover unexpected medical expenses for treatment related to hospital admissions were healthcare professionals charge more than what your medical scheme pays for.
Discovery GAP cover (comprehensive) pays up to an additional 500% of your medical scheme rate if your in hospital specialist account is higher than your what your medical scheme rate is.For eg: Classic core – pays at 200% MSR.Specialist charges 700% of MSR.Gap cover will pay out an additional 500% over and above the medical-aid payment of 200%.
Discovery GAP cover (core) pays an additional 250% of your medical scheme rate.
Hospital Admission Benefit Extender benefit
Gap cover is not designed for day to day out of hospital expenses except for shortfalls out of hospital that are related to treatment as a result of admission. This benefit pays up to R15 000 on Comprehensive Gap cover – per policy through the Hospital Admission Benefit Extender. Private ward cover is subject to an approved admission and hospital availability.
Gap Cover Core will pay up to R7 500 (No private ward cover here).
Scopes and Scans Benefit Extender Benefit.
In 2023 if you opt for the Discovery Gap Comprehensive option you will get cover for co-payments that apply to hospital accounts for endoscopic (gastroscopies, sigmoidoscopy, proctoscopy and colonoscopy) procedures and out of hospital MRI and CT scans when your medical-scheme pays for the rest of the account. This is paid out from the Scopes and Scans benefit extender benefit. This benefit is not available under the Gap cover core plan.
Travel Extender Benefit
In 2023 The Travel Benefit Extender benefit also provides cover for shortfalls on approved emergency international claims incurred while you travel outside South Africa.
This benefit is not available under the Gap cover core plan.
The Oncology Benefit Extender
This benefit assists with Oncology co-payments where the member has reached the oncology annual threshold and is liable for co-payments. For example:
– Classic Comprehensive – R500 000 annual oncology threshold with 20% co-payments thereafter
– Classic Saver – R250 000 annual oncology threshold with 20% co-payments thereafter
The Oncology Benefit Extender on the Comprehensive Gap Cover will provide additional coverage of up to R100 000 per person per annum.
The Gap Cover core plan provides up to R75 000 per person per annum.
Discovery Supplementary Illness Benefit
This benefit offers lump sum payments of up to R630 000 for main member, spouse or child on diagnosis of qualifying illnesses associated with high treatment costs; access to advanced genomic sequencing for certain cancers; premium waiver benefits and home support in addition to the normal GAP cover and must be added to the standard GAP cover plan. This benefit also provides a cash back benefit of up to 25% of premiums dependent on claims submitted. The Supplementary Illness Benefit is not automatically included with the standard Gap cover plans and must be selected.
Exclusions/Conditions
Not available to Keycare or Primary care plans
There is an overall limit of R185 000 per person per annum that can be claimed from this gap-cover policy
There is an automatic 3 month waiting period for any treatment except authorised emergency hospital admissions.
There is an automatic 12 month waiting period for certain conditions listed in the brochure.
You can find further information in the Discovery Gap Cover 2023 brochure here.
Please contact me for a comprehensive quote and any further advice you may need !!
Kind Regards
