Frequently asked questions

  • Who would need Gap Cover?

    Anyone belonging to a registered South African Medical Scheme, as medical scheme options have varying rates of reimbursement often resulting in members experiencing large unforeseen shortfalls they did not bank on.

  • Why do I need Gap Cover?

    Members on a medical scheme are increasingly taking on the risk of rising healthcare costs, resulting in patients and their families footing the shortfalls that their medical aid doesn’t pay.

  • How do I use my Gap Cover?

    By simply completing and signing the Gap Cover claim form and submitting the required documents as per the below to claims@ambledown.co.za

    • Signed Claim Form
    • Specialists’ Accounts
    • Full Hospital Account – Not a Statement
    • Detailed Medical Aid Statement reflecting the above accounts
    • Confirmation of Banking Details.

     

  • Will I have to wait before I can claim?

    General waiting periods and pre-existing medical condition waiting periods may Apply:

    • 3-month general waiting period
    • 12 month pre-existing condition waiting period where a member has received treatment or advice, member may not claim against this for the first 12-momths of the policy.

  • Restrictions and pre-requisites?

    • The minimum entry age for the principal insured person is 18 and the maximum entry age is 65. Applicants 66 and older have the option of selecting products for seniors.
    • Gap Cover will not cover shortfalls for mental depression and stress-related conditions, suicide and/or death due to self-inflicted injuries, drug and/or alcohol abuse, criminal activity, and war, etc. Please refer to the general exceptions in the policy document for detailed information.
    • Gap Cover will not cover you for any condition that is an exclusion on your medical aid option. Nor will it provide cover for a procedure that is not authorised by your medical aid.

     

  • Important questions to ask yourself before you get Gap Cover

    • Is your medical aid the only financial plan in place to cover the costs for you and your family when hospitalised due to illness or an accident?
    • Are you unable to secure funds at short notice with which to pay medical aid shortfalls when hospitalised due to illness or an accident?
    • Do you want peace of mind knowing that in the event of being hospitalised due to illness or an accident you can guarantee payment for the best care and service up to 500% of the medical scheme rate?

      Any Yes response means that you should be talking to an industry professional who can help guide you in making an informed Gap Cover choice over and above your current medical aid cover, and more importantly, avoid the stress of experiencing post-operative expense shock.
Need more help?

For claims or any queries.

Call us on:
087 820 8247

Email us at

absagapcover@optivest.co.za

This is not a medical scheme and the cover is not the same as that of the medical scheme. This policy is not a substitute for medical scheme membership. The master policy issued is the source of all benefits, rights, and obligations and exclusions.

Absa Insurance Company Limited, an insurer licensed to conduct non-life insurance business and an Authorised Financial Services Provider (FSP 8030). Registration number 2000/025898/06. Terms and conditions apply.