Medical Gap Covers: Sub-limits

[jeansmithh]

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]

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]

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]

How did you find ambledown? I'm with them and will be using them soon.

 

[craiglotter]

I'm using Stratum for my gap cover. So far they've been great!

 

[Kosmik]

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.