OnePlan GAP Cover

ONEPLAN GAP COVER

FOR WHEN YOUR MEDICAL AID COVER FALLS SHORT

With Oneplan Gap Cover, you know exactly what you're covered for. There is no complicated jargon, confusing benefits, long claims processes or high monthly premiums.
Just the GAP in health bills filled.

No Sub-Limits

Double or quadruple scheme payout

Added Cancer Cover

Cover for all cancers, no questions asked

Shortfalls & Co-payments Covered

Even within your MSA Savings Threshold

Accidental Death Cover & HIV Treatments

At no extra premium

TWO AFFORDABLE GAP COVER PLANS TO CHOOSE FROM

Plus add your child as a dependant from only R70pm.

Core Plan From R220
download plan brochure
Executive Plan From R285
download plan brochure
x x

R198 000 Per Insured

R198 000 Per Insured
Outpatient Cover Cover Description Cover Per Policy*
SAVINGS GAP COVER
The Savings Benefit will not be covered if insured belongs to a scheme Hospital Plan Only
30 days waiting period 		Once you have run out of your Scheme savings or if you have reached your day-to-day benefit sub-limit, we cover the shortfall for:
  • General Practitioner visits
  • Basic Dentistry
  • Basic radiology or pathology that is deemed necessary by your General Practitioner or medical specialist for treatment and diagnosis purposes.
  • Prescription Medication covers the shortfall between what the dispensing practitioner charged and what the Scheme paid.
R2 000
per annum per policy
(limited to R500 per event) 		R4 000
per annum per policy
(limited to R750 per event)
In hospital & specialised treatment Cover description Cover*
SHORTFALLS & CO-PAYMENTS FOR ALL IN-HOSPITAL TREATMENT AND PROCEDURES
Excluding penalties imposed by your Scheme
Immediately available for Accident
3-month waiting period for Illness 		We double (DBL) the Scheme approved settlement for all IN-HOSPITAL treatment and procedures which are above the scheme payout doubling what your Scheme pays.

We will cover all specialists In-Hospital that would have been covered by the scheme.

We double (DBL) the Scheme approved settlement for cancer related claims once the Medical Scheme’s oncology threshold has been reached. Your cover depends on the option you choose icluding co-payments, internal prosthetic devices and cancer treatment.

We pay any shortfalls or co-payments up to double the Scheme rate for a medical or surgical procedure following an emergency incurred in the casualty unit of a hospital where such costs were not met by the Scheme. Assesment will be based on the Triage Scale. 		Up to 200% of Scheme Rate
(we double the Scheme Rate) 		Up to 400% of Scheme Rate
(we quadruple the Scheme Rate)
CANCER CO-PAYMENT BENEFIT
6-month waiting period 		Up to 200% of Scheme Rate
(we double the Scheme Rate) 		Up to 400% of Scheme Rate
(we quadruple the Scheme Rate)
CASUALTY ACCIDENT/ILLNESS
Immediately available for Accident
3-month waiting period for Illness 		R5 000
per event per policy
(limited to 2 events) 		R7 000
per event per policy
(limited to 2 events)
SCANS & SCOPES
(SPECIALISED RADIOLOGY)
3-month waiting period for Illness 		We pay any shortfalls or co-payments up to double the Scheme rate, subject to Cover Limit for diagnostic procedures authorised by your Scheme that is deemed necessary for treatment and diagnosis purposes performed in-hospital or a day clinic. Only 2 events per policy.

Any shortfalls that your scheme paid from your MSA for procedures such as pap smears, routine bloods, immunisation and IUDs.

HIV Testing

Treatment after Positive diagnosis. Must be reported within 48 hours 		R5 000
per event per policy
(limited to 2 events) 		R7 500
per event per policy
(limited to 2 events)
POST PREGNANCY COVER
12-month waiting period 		R3 000
per annum per policy 		R5 000
per annum per policy
ACCIDENTAL HIV INFECTION & TREATMENT
Testing Immediately available
Treatment Immediately available 		R5 000 per policy

R10 000 per policy 		R5 000 per policy

R10 000 per policy
Value Added Products Cover Description Cover Per Insured*
ACCIDENTAL DEATH
In the event that any Insured Person under this policy dies due to an unforeseen accident event Immediately available 		We pay a lump sum cash amount in the unfortunate event of accidental death. Principal: R10 000
Spouse / Partner: R10 000
Children 14 - 21 yrs: R10 000
Children 6 - 13 yrs: R7 500
Children 1 - 5 yrs: R5 000 		Principal: R25 000
Spouse / Partner: R25 000
Children 14 - 21 yrs: R25 000
Children 6 - 13 yrs: R15 500
Children 1 - 5 yrs: R10 000
TRAUMA, ASSAULT & COUNSELLING
Immediately available 		Assistance with costs related to treatment for trauma, Assault & counselling where accidental exposure to HIV or any other trauma occurs. R5 000
per policy 		R5 000
per policy

*Subject to Combined Annual Limit and Claim Limit. Terms and Conditions Apply. Pre-Existing Conditions are excluded for a maximum of 12 Months if no previous Gap Cover. Late Joiner Fees may be applied. Premiums are Risk Profile Age dependent. Event incl multiple treatments or procedures, claimed 14days apart. Post-pregnancy benefit available for 6 months after delivery.

Download Comparison Brochure

Core Plan
From
R220

Overall annual limit
R198 000
Per Insured

OUT-PATIENT COVER

SAVINGS GAP COVER
R2 000
per annum per policy
(limited to R500 per event)
30 days waiting period

IN-HOSPITAL & SPECIALISED TREATMENT

SHORTFALLS & CO-PAYMENTS FOR ALL IN-HOSPITAL TREATMENT AND PROCEDURES
Up to 200% of Scheme Rate
(we double the Scheme Rate)
Excluding Penalties Imposed By Your Scheme
Immediately Available For Accident
3-Month Waiting Period For Illness

CANCER CO-PAYMENT BENEFIT
Up to 200% of Scheme Rate
(we double the Scheme Rate)
6-month waiting period

CASUALTY ACCIDENT/ILLNESS
R5 000
per event per policy
(limited to 2 events)
Immediately available for Accident
3-month waiting period for Illness

SCANS & SCOPES
(SPECIALISED RADIOLOGY)
R5 000
per event per policy
(limited to 2 events)
3-month waiting period for Illness

POST PREGNANCY COVER
R3 000
per annum per policy
12-month waiting period

ACCIDENTAL HIV INFECTION & TREATMENT
R5 000 per policy
Testing Immediately available
R10 000 per policy
Treatment Immediately available

VALUE-ADDED PRODUCTS

ACCIDENTAL DEATH
Principal: R10 000
Spouse / Partner: R10 000
Children 14 - 21 yrs: R10 000
Children 6 - 13 yrs: R7 500
Children 1 - 5 yrs: R5 000

Immediately Available

TRAUMA, ASSAULT & COUNSELLING
R5 000
per policy
Immediately Available

download plan brochure


Executive Plan
From
R285

Overall annual limit
R198 000
Per Insured

OUT-PATIENT COVER

SAVINGS GAP COVER
R4 000
per annum per policy
(limited to R750 per event)
30 days waiting period

IN-HOSPITAL & SPECIALISED TREATMENT

SHORTFALLS & CO-PAYMENTS FOR ALL IN-HOSPITAL TREATMENT AND PROCEDURES
Up to 400% of Scheme Rate
(we quadruple the Scheme Rate)
Excluding Penalties Imposed By Your Scheme
Immediately Available For Accident
3-Month Waiting Period For Illness

CANCER CO-PAYMENT BENEFIT
Up to 400% of Scheme Rate
(we quadruple the Scheme Rate)
6-month waiting period

CASUALTY ACCIDENT/ILLNESS
R7 000
per event per policy
(limited to 2 events)
Immediately available for Accident
3-month waiting period for Illness

SCANS & SCOPES
(SPECIALISED RADIOLOGY)
R7 500
per event per policy
(limited to 2 events)
Immediately available for Accident
3-month waiting period for Illness

POST PREGNANCY COVER
R5 000
per annum per policy
12-month waiting period

ACCIDENTAL HIV INFECTION & TREATMENT
R5 000 per policy
Testing Immediately available
R10 000 per policy
Treatment Immediately available

VALUE-ADDED PRODUCTS

ACCIDENTAL DEATH
Principal: R25 000
Spouse / Partner: R25 000
Children 14 - 21 yrs: R25 000
Children 6 - 13 yrs: R15 000
Children 1 - 5 yrs: R10 000

Immediately Available

TRAUMA, ASSAULT & COUNSELLING
R5 000
per policy
Immediately Available

download plan brochure

*Subject to Combined Annual Limit and Claim Limit. Terms and Conditions Apply. Pre-Existing Conditions are excluded for a maximum of 12 Months if no previous Gap Cover. Late Joiner Fees may be applied. Premiums are Risk Profile Age dependent. Event incl multiple treatments or procedures, claimed 14days apart. Post-pregnancy benefit available for 6 months after delivery.






© All Rights Reserved, Oneplan. Terms of use