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.
How medical gap coverinsurance works.
View the Frequently Asked Questions.
Find out more about Sanlam's Comprehensive Gap Cover Plan.
From only R252 per month.
Note: Graph values show actual payments made by medical aidschemes and gap cover amounts paid out by Xelus (Pty) Ltd,the administrator for Sanlam Gap Cover.
Yes, the following waiting periods apply:
Comprehensive Medical Gap Cover
Claims are assessed by Xelus 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@xelus.co.za Fax: 086 501 8521 Or contact Xelus 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.
R252 per month (younger than 60 years old) R605 per month (60 years and older)
Tariff Shortfalls The difference between the specialist’s fee and the medical scheme tariff.
Up to 5-times medical aid tariff
Sub-Limits A sub-limit is a limit within the amount of cover that your medical aid provides, for a specific in-hospital event or procedure. This means that should the cost for a certain procedure exceed the applicable limit, you will be liable to pay the shortfall.
R44 000 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 R12 800)
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 R150 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 R12 800 per event (maximum one event per year)
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 300 per day: Day 1 to 13 R 600 per day: Day 14 to 20 R1 200 per day: Day 21 to 30 Maximum of R20 000 per beneficiary per annum
Premature Birth More than 6 weeks before due date.
R12 000 per event
Death/Permanent Disability A single per member payment if the member dies or is disabled and unable to work in the given profession.
Illness: R12 000 per member Accidental: R24 000 per member
Medical Scheme Premium Waiver Your medical aid payments will be covered for your family for up to six months up to a maximum of R4 400 per month in the event of death or permanent disability.
6 months – Max R4 400 per month
Dental Reconstruction Dental work in the event of trauma or cancers and tumours. Cosmetic work is excluded.
Up to R40 000 per event/condition
Road Accident Fund Claims (RAF)
End-to-end legal assistance in RAF Claims (100% RAF Benefit Allocation to Claimant)
Sanlam Reality members on the Reality Plus and Reality Health membership options can get discounts of up to 30% on qualifying risk products. For more information on how to join, visit the Sanlam Reality website.
Comprehensive Gap Cover
Hospital Cash Benefit (only payable for accidents and premature births – 6 weeks or earlier, subject to a maximum of R20 000 per beneficiary per annum)
The enhanced benefits below are only available to Sanlam Reality Members.
R 600 per day: Day 1 to 13 R1 200 per day: Day 14 to 20 R1 800 per day: Day 21 to 30
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.