MediGap Primary

This option assists with covering the medical expense shortfalls between what your Medical Scheme covers versus the private in-hospital rates, especially for the costs of Specialists and Anaesthetists.

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  • Increases the Medical Aid rate up to 350% for in-hospital treatments.
  • Casualty Benefit
  • Overall Annual Limit (OAL) – R150 000 per insured per annum and an excess of R350 per event

How Does Medical Expense Shortfall Cover Work?

A Medical Expense Shortfall is the difference between what medical service providers (e.g. Doctors, basic and specialised Radiology, Pathology, Specialists) charge and what Medical Schemes pay for the treatment performed in hospitals and day clinics, provided that it is paid from the Hospital Benefit of your Medical Scheme.

Medical Expense Shortfall Cover will boost your Medical Aid rate, helping you with this shortfall!

Below is an example of a claim for a Hip replacement

MEDICAL SERVICE PROVIDER AMOUNT CHARGED BY THE MEDICAL SERVICE PROVIDER AMOUNT PAID BY MEDICAL SCHEME AMOUNT PAID BY TURNBERRY
Surgeon R17 053 R6 021 R11 032
Anaesthetist R8 256 R2 402 R5 854
Total paid by Turnberry R16 886

In-hospital benefits

Medical expense shortfall expense

  • Increases the medical aid rate up to 350% for example specialist, gps, anaesthetist, radiology, pathology etc
  • Subject to the overall annual limit and an excess of r350 per event

Out-of-hospital benefits

Casualty benefit (accidents only)

  • R3 000 per event per insured. Subject to the overall annual limit and an excess of r350 per event

Added benefits

Medical scheme contribution waiver

  • Up to r5 500 per month for 6 months, in the event of death or permanent and total disability as a result of an accident, of the medical scheme contribution payer

Gap premium waiver

  • Pays the premium for your launch policy for 6 months, in the event of death or permanent and total disability as a result of an accident,of the contribution payer

International travel cover

  • R5 000 000 per insured

Waiting Periods

  • A 3-month general waiting period applys to all benefits, with exception of benefits providing cover up to 600% should the commencement of the Policy be in line with the commencement date of the Medical Scheme. Accidents will be covered with in the 3 month general waiting period.
  • A 10-month waiting period on pregnancy/childbirth
  • A 12-month waiting period on/investment, treatment or surgery for: hysterectomy (except where malignancy can be proven) , hysteroscopies, endometriosis, ovarian cysts and fibroids ( myomectomy), muscular-skeletal, tonsillectomy, myringotomy, grommets, adenoids, wisdom teeth, hernia, cataracts, gastroscopies, colonoscopies, cancer, nasal and sinus

Childbirth Limits

  • Treatment date of the claims is within: Benefits for childbirth will be capped at :
    First 12 months of the Policy R8 000 per event
    13-24 months of the Policy R12 000 per event
    25+ months of the Policy Subject to the Overall Annual Limit of the Policy

Exclusions

You can download our Exclusion document here.