Medical Gap Covers: Sub-limits

jeansmithh

New Member
Joined
Feb 27, 2018
Messages
2
Hi everyone

I have been looking for a Gap Cover for my Medical Aid and they all seem similar to me, but I am thinking of going with Sanlan Gap Cover, which offers additional 500% of scheme rate, and the monthly premium is at R250 (families / individuals)!

I am, however, struggling to understand what is meant by "sub-limit"s?
For example, Sanlam Gap Cover has a "sub-limit" of R44,000 per event/condition.

So in other words, for example: if a procedure costs R90 000 and my medical aid's limit is at R30 000; I can claim R44 000 from Sanlam Gap Cover, but will have to pay for the remaining R16 000?

Would this apply to ALL procedures/treatments?
I noticed that "sub-limit" benefits provided by other Gap Covers are usually only for internal prostheses.

I would appreciate any inputs! :)

I am including the link for Sanlam Gap cover:
https://www.sanlam.co.za/personal/i...-medical-gap-cover-insurance.aspx#PlanDetails
 

Kosmik

Honorary Master
Joined
Sep 21, 2007
Messages
22,209
I've used complimed before and ambledown. Sublimits normally applied to certain procedures ie: MRI scans, cancer etc, for those "self-payment gaps". General gap used to have a very high ceiling ( 1.5 to 2 Million ) until a law was passed last year restricting gap cover to a max of R150k per family per year.

As per your link

Limit on Gap Cover Insurance Benefits
New regulations for gap cover stipulate that:

Policyholders will only be able to claim R 150 000 per year, for every insured individual on the policy
Hospital cash-back plans will be limited to paying their clients a maximum of R3 000 per day, or a total lump sum of R20 000 per year

The R44k is for sublimits, ask for a list of those, I don't see them stated anywhere.
 

jeansmithh

New Member
Joined
Feb 27, 2018
Messages
2
Kosmik, thank you for your advice - much appreciated! I have followed up with Sanlam to provide me with the list of procedures that have sub-limits.

On another note, how was your experience with Complimed / Ambledown?
Who are you with now?
 

xrapidx

Honorary Master
Joined
Feb 16, 2007
Messages
39,404
How did you find ambledown? I'm with them and will be using them soon.
 

Kosmik

Honorary Master
Joined
Sep 21, 2007
Messages
22,209
Kosmik, thank you for your advice - much appreciated! I have followed up with Sanlam to provide me with the list of procedures that have sub-limits.

On another note, how was your experience with Complimed / Ambledown?
Who are you with now?

Our company is the signer of gap, we pay quite low. I think it's still Ambledown, have had no issues with them and they covered a bill in excess of R300k prior to the new legislation, no issues, even went out of their way to assist.
 
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