In certain cases the cost for in-hospital procedures or outpatient treatment may exceed the base medical aid rate by an additional 5-times. By taking out Sanlam Medical Gap Cover Insurance, you ensure that you and your family aren’t left with a large excess amount to settle.
How medical gap cover insurance works.
View the Frequently Asked Questions.
Find out more about Sanlam Comprehensive Gap Cover Plan.
From R219 for individuals, and R385 for families.
Note: Graph values show actual payments made by medical aid schemesand gap cover amounts paid out by Kaelo Risk (Pty) Ltd (FSP:36931),the administrator for Sanlam Gap Cover.
In certain cases the cost for in-hospital procedures or outpatient treatment may exceed the base medical aid rate by 5-times. By taking out Sanlam Medical Gap Cover Insurance, you ensure that you and your family aren’t left with a large excess amount to settle.
Yes, the following waiting periods apply:
Comprehensive Medical Gap Cover
Claims are assessed by Kaelo Risk (Pty) Ltd, the Sanlam Gap Cover administrator. Claims must be submitted within 6 months of an event.
Claim submissions can be sent to: Email: sanlamclaims@kaelo.co.za Fax: 086 501 8521 Or contact Kaelo Risk at: 0861 11 11 67
Download claim form
We require the following documents from you to process your claim:
An e-mail and SMS is sent to the member when:
Please note that payments will be made directly into the principal member’s bank account.
Tariff Shortfalls The difference between the specialist’s fee and the medical scheme tariff.
Additional 5-times medical aid tariff
Sub-Limits A sub-limit is a limit when a medical scheme imposes a Rand limit, known as a sub-limit, on certain in-hospital medical procedures or prosthetic devices and a shortfall occurs.
R52 100 per event/condition
Co-payments The excess payable upfront to the hospital before treatment or a procedure.
Unlimited cover for specified procedures
Deductibles A deductible is a co-payment payable by a member on admission to hospital.
Penalty Co-Payment
1 per family per annum (maximum R15 000)
Co-Payments The excess payable upfront to the hospital before treatment or a procedure.
MRI/CT Scans: Unlimited Oncology sub-limits: Limited to statutory maximum of R165 000 per insured per annum
Emergency Casualty Benefit The Casualty Benefit will pay for the facility fee and consultation associated with admissions into the emergency room or casualty ward of a private hospital.
Up to R15 000 per event
Hospital Cash Benefit A cash payment you receive for every day you spend in hospital due to an accident or premature birth (6 weeks or earlier).
If you’re a Sanlam Reality member, please refer to the Sanlam Reality section for more information on your Hospital Cash Benefit.
R 380 per day: Day 1 to 13 R 750 per day: Day 14 to 20 R1 500 per day: Day 21 to 30 Maximum of R25 190 per beneficiary per annum
Premature Birth More than 6 weeks before due date.
R14 000 per event
Death/Permanent Disability A single per Insured payment if the Insured dies or is disabled and unable to work in the given profession.
Accidental: R28 000 per member
Medical Scheme and the Sanlam Gap Policy Premium Waiver Your medical aid payments will be covered for your family for up to six months up to a maximum of R5 500 per month in the event of death or permanent disability of the principal member.
6 months – Max R5 500 per month
Dental Reconstruction Dental work in the event of trauma or cancers and tumours. Cosmetic work is excluded.
Up to R48 000 per event/condition
Road Accident Fund Claims (RAF)
An end-to-end legal service is provided by the nominated service provider of Kaelo Risk to assist Insured members with legitimate claims against the Road Accident Fund.
New regulations for gap cover stipulate that:
After submission of these forms, you will be contacted within 48 hours by Sanlam Healthcare Consultants. Sanlam Healthcare Consultants is an authorised FSP (FSP 2759), a full subsidiary of Sanlam Life.