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
Call me
Get a quote
download plan brochure
R210 000 Per Insured
EXECUTIVE PLAN
from
R285
Call me
Get a quote
download plan brochure
R210 000 Per Insured

OUTPATIENT COVER

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.

Cover per policy*

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

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

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 quadruple (QDL) the Scheme approved settlement for all IN-HOSPITAL treatment and procedures which are above the scheme payout quadrupling what your Scheme pays.

Cover*

Up to 200% of Scheme paid amount
(we double the Scheme settled amount)
Up to 400% of Scheme paid amount
(we quadruple the Scheme settled amount)

Cancer Co-payment Benefit

6-month waiting period

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 including co-payments, internal prosthetic devices and cancer treatment.

We quadruple (QDL) 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 including copayments, internal prosthetic devices and cancer treatment.

Cover*

Up to 200% of Scheme paid amount
(we double the Scheme settled amount)
Up to 400% of Scheme paid amount
(we quadruple the Scheme settled amount)

Casualty Accident/Illness

Immediately available for Accident
3-month waiting period for Illness

We pay any shortfalls or co-payments up to double what the scheme pays 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.

We pay any shortfalls or co-payments up to quadruple what the scheme pays 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.

Cover*

R5 000
per event per policy
(limited to 2 events per annum)
R7 000
per event per policy (limited to 2 events per annum)

Scans & Scopes (Specialised Radiology)

3-month waiting period for Illness

We pay any shortfalls or co-payments up to double what the scheme pays, 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.

We pay any shortfalls or co-payments up to quadruple what the scheme pays, 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.

Cover*

R5 000
per event per policy (limited to 2 events per annum)
R7 500
per event per policy (limited to 2 events per annum)

Post Pregnancy Cover

12-month waiting period

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

Cover*

R3 000
per annum per policy
R5 000
per annum per policy

Accidental HIV Infection & Treatment

Testing
Immediately Available

HIV Testing

Treatment
Immediately available
Treatment after Positive diagnosis. Must be reported within 48 hours.

Cover*

R5 000 per policy
R10 000 per policy
R5 000 per policy
R10 000 per policy

Value Added Products

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.

Cover per insured*

  • 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 000
  • 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.

Cover per insured*

R5 000 per policy
R5 000 per policy
CORE PLAN
from
R220
per month
Call me
Get a quote
download plan brochure
R210 000 Per Insured
OUTPATIENT 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.
Cover per policy*
R2 000
per annum per policy
(limited to R500 per event)
IN-HOSPITAL & SPECIALISED TREATMENT
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.
Cover*
Up to 200% of Scheme paid amount
(we double the Scheme settled amount)
6-month waiting period

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 including co-payments, internal prosthetic devices and cancer treatment.
Cover*
Up to 200% of Scheme paid amount
(we double the Scheme settled amount)
Immediately available for Accident
3-month waiting period for Illness

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.
Cover*
R5 000
per event per policy
(limited to 2 events per annum)
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.
Cover*
R5 000
per event per policy
(limited to 2 events per annum)
12-month waiting period

Any shortfalls that your scheme paid from your MSA for procedures such as pap smears, routine bloods, immunisation and IUDs.
Cover*
R3 000
per annum per policy
Testing

Immediately available

HIV Testing
Cover*
R5 000 per policy
Treatment

Immediately available

Treatment after Positive diagnosis. Must be reported within 48 hours.
Cover*
R10 000 per policy
VALUE ADDED PRODUCTS
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.
Cover per insured*
  • 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

Assistance with costs related to treatment for trauma, assault & counselling where accidental exposure to HIV or any other trauma occurs.
Cover per insured*
R5 000 per policy
EXECUTIVE PLAN
from
R285
per month
Call me
Get a quote
download plan brochure
R210 000 Per Insured
OUTPATIENT 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.
Cover per policy*
R4 000
per annum per policy
(limited to R750 per event)
IN-HOSPITAL & SPECIALISED TREATMENT
Excluding penalties imposed by your Scheme

Immediately available for Accident
3-month waiting period for Illness

We quadruple (QDL) the Scheme approved settlement for all IN-HOSPITAL treatment and procedures which are above the scheme payout quadrupling what your Scheme pays.

We will cover all specialists In-Hospital that would have been covered by the scheme.
Cover*
Up to 400% of Scheme paid amount
(we quadruple the Scheme settled amount)
6-month waiting period

We quadruple (QDL) 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 including co-payments, internal prosthetic devices and cancer treatment.
Cover*
Up to 400% of Scheme paid amount
(we quadruple the Scheme settled amount)
Immediately available for Accident
3-month waiting period for Illness

We pay any shortfalls or co-payments up to quadruple what the scheme pays 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. Assessment will be based on the Triage Scale.
Cover*
R7 000
per event per policy
(limited to 2 events per annum)
3-month waiting period for Illness

We pay any shortfalls or co-payments up to quadruple what the scheme pays, 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.
Cover*
R7 500
per event per policy
(limited to 2 events per annum)
12-month waiting period

Any shortfalls that your scheme paid from your MSA for procedures such as pap smears, routine bloods, immunisation and IUDs.
Cover*
R5 000
per annum per policy
Testing

Immediately available

HIV Testing
Cover*
R5 000 per policy
Treatment

Immediately available

Treatment after Positive diagnosis. Must be reported within 48 hours.
Cover*
R10 000 per policy
VALUE ADDED PRODUCTS
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.
Cover per insured*
  • 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

Assistance with costs related to treatment for trauma, assault & counselling where accidental exposure to HIV or any other trauma occurs.
Cover per insured*
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.

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