CureMED Gap Cover

THE FOLLOWING BENEFITS ARE SUBJECT TO AN AGGREGATE ANNUAL LIMIT OF R150 000 PER INSURED PERSON


(This limit may be subject to regulatory amendment) (Sub-limits may apply)

THE FOLLOWING BENEFITS ARE NOT SUBJECT TO AN AGGREGATE ANNUAL LIMIT OF R150 000 PER INSURED PERSON


(Sub-limits may apply)
An additional fee of R65 may be charged for membership to CureClub. Ownership and control of the club membership resides with CureMED and the deduction is merely facilitated by Total Risk Administrators (Pty) Ltd on behalf of CureMED. The said club membership can therefore be freely transferred to CureMED at any stage. CureMED reserves the right that this facilitation might change in future without notice. The membership includes value added products. Please contact CureMED for further details.
Provide benefits for members and their dependants (spouse and/ or child/children) who are covered on one policy of a registered medical aid scheme. Members and their dependants can only be on two different medical aids and one Gap Cover Policy if they are legally married, or common law partners verified by submission of an affidavit confirming 12 months of co-habitation.
Are not medical aid schemes. The cover is not the same as that of a medical aid scheme. The cover is not a substitute for a medical scheme membership.
Have no entry age limit.
Are subject to the aggregate gap cover annual limit of R150 000 per insured person per annum. (This limit may change due to regulatory amendment).
May allow for immediate benefits for all policyholders except for a limited list of specific conditions and/or procedures. (There is no general 3 month waiting period!)
All of our 2019 product options offer the following TRA ASSIST (powered by ER24 ASSIST) benefits: - Home Drive (now includes a taxi service) - Panic Button - Medical Health Line
Cover Prescribed Minimum Benefits (PMBs) where a medical aid has failed to meet its obligations in this regard (for non-emergencies only).
NB: Refer to the policy document for the complete list of terms and conditions.

WHEN CAN YOU CLAIM?

GENERAL WAITING PERIOD

There is no general three (3) month waiting period. The following waiting periods commence from the Join Date of the Gap Cover Policy:

10 MONTH CONDITION SPECIFIC WAITING PERIOD

No claims may be submitted within the first 10 months of membership for any Gap Cover policy if they relate to any of the following conditions:
• Head, neck and spinal procedures (including stimulators) e.g. Laminectomy
• All types of hernia procedures
• Endoscopic procedures e.g. Colonoscopy, Gastroscopy
• Oesophagitis, Gastroenteritis and Gastro-Intestinal Disorders
• Pregnancy and childbirth (including caesarean delivery)
• Gynaecological conditions e.g. Hysterectomy
• Male genital system (including prostatectomy / robotic prostatectomy)
• All robotic type surgery
• Joint replacement (including Arthroplasty, Arthroscopy, Metatarsal
Osteotomy) but excluding treatment due to accidental trauma.
• Inability to walk / move without pain
• Any Ear, Nose and Throat procedures (including nasal, sinus, tonsil
and adenoid procedures)
• Cardiac (relating to the heart)
• Dentistry (unless due to accidental trauma)
• Cataracts and / or eye laser surgery (including all eye and lens procedures)
• Neurological conditions and procedures (including stimulators)
• Organ transplants (including cochlear implants)
• Renal Failure
• Reconstructive surgery as a result of an incident or condition that
occurred prior to membership (including skin grafts)
• Mental health or psychiatric conditions (including depression)
• Varicose veins
• Diabetes and related complications

All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.

CANCER DIAGNOSIS WAITING PERIOD

If a Policyholder is diagnosed with any form of cancer prior to membership, all related claims will be subject to a nine (9) month waiting period. If a Policyholder has previously been diagnosed with cancer and is currently in remission, the Policyholder needs to advise the insurer by way of medical evidence that the remission period has been for two (2) or more consecutive years.

PRE-EXISTING MEDICAL CONDITION/S WAITING PERIOD

NO claims relating to any pre-existing condition/s that may lead to hospitalisation (excluding cancer: see above) will be covered within the first six (6) months of membership. The insurer reserves the right to request any clinical information from a Policyholder’s doctor should a claim in this period indicate, and/or relate to, a pre-existing condition. All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.