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Sanlam Comprehensive Gap Cover Plan

2022 Benefits

Individuals younger than 60 years
R233.00*
Families younger than 60 years
R409.00*
Individuals older than 60 years
R466.00*
Families older than 60 years
R815.00*

Benefits

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.

R57 500 per event/condition

Co-payments
The excess payable upfront to the hospital before treatment or a procedure.

Subject to the Core Benefit Limit

Deductibles
A deductible is a co-payment payable by a member on admission to hospital.

Subject to the Core Benefit Limit

Penalty Co-Payment

A maximum of two such events are covered under this benefit per annum and up to a maximum amount of R16 500 per event, subject to the Core Benefit Limit.

For further benefits please download the Sanlam Gap Retail Brochure for 2022

Benefits

Co-Payments
The excess payable upfront to the hospital before treatment or a procedure.

  • MRI Scans: A CT scan is best suited for viewing bone injuries, diagnosing lung and chest problems, and detecting cancers. An MRI is suited for examining soft tissue in ligament and tendon injuries, spinal cord injuries, and tumours. CT scans are widely used in emergency rooms because the scan takes less than 5 minutes. An MRI, on the other hand, can take up to 30 minutes.
  • Oncology: Oncology is a branch of medicine that deals with cancers and tumours.

MRI/CT Scans: Unlimited
Oncology sub-limits: Limited to statutory maximum of R177 800 per insured per annum

Accidental 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.

Subject to a maximum of R16 500 per event.

Child Casualty Benefit
Child Casualty Illness: Child Casualty Illness: Benefits relating to this clause will only be paid in respect of emergency out-patient services that are provided within a casualty ward of a hospital. The benefit is only payable in the event of after-hours treatment in an emergency situation. After-hours is Mondays to Fridays between 18:00 and 08:00 and all-day Saturdays, Sundays and South African public holidays. The benefit payable is equal to the total cost of treatment less the amount paid by your medical scheme from your Hospital/ Risk Benefit. If payment is made from your available medical savings account, or from your own pocket, we will reimburse that too.

Subject to a maximum of two such events per annum and a maximum of R2 500 per event. Limited to children under age 12.

For further benefits please download the Sanlam Gap Retail Brochure for 2022

Benefits

Hospital Cash Benefit
A cash payment you receive for every day you spend in hospital due to an accident or premature birth (more than 41 days before the originally expected natural birth date of 40 weeks).

If you’re a Sanlam Reality member, please refer to the Sanlam Reality section for more information on your Hospital Cash Benefit.

A maximum of two hospital episodes are covered under this benefit per annum, up to a maximum amount of R27 690 per annum. The benefit is payable from day one of the hospital episode: R450 per day from the 1st to the 13th day (inclusive). R820 per day from the 14th to the 20th day (inclusive). R1 610 per day from the 21st to the 30th day (inclusive). Max R27 690.00 per annum.

Family Booster
The natural or surgically assisted birth of 1 or more infants that occurs more than 41 days before the originally expected natural birth date of 40 weeks as verified by the clinical records of the mothers attending physician.

Lump sum benefit is R15 000.

Family Protector
The lump sum benefit is payable upon the death or permanent disability of an insured party due to accidental harm.

Limited as follows:

Children below 6 years: R20 000

All other insured parties: R30 000

Medical Scheme and the Sanlam Gap Policy Contribution Waiver
The benefit payable is equal to the monthly medical scheme and Gap contribution applicable after the qualifying event, multiply by 6 and subject to an overall annual limit. This benefit is limited to one event over the policy lifetime.

The benefit payable is subject to an overall maximum limit of R35 500.

Dental Reconstruction
The lump sum Benefit will only be paid in the event of Dental Reconstruction Surgery being required as a direct result of Accidental Harm or from Oncology Treatment that occurred after the Inception of this Policy.

A maximum of two such events are covered under this benefit per annum and up to a maximum amount of R49 900 per annum subject to the Core Benefit Limit.

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.

For further benefits please download the Sanlam Gap Retail Brochure for 2022

Retirement Annuity - Buy Online

Tax-free Savings - Invest Online

Unit Trusts - Invest Online

Sanlam Smart Invest is a platform designed to help you set your goals, and reach them more easily than ever before. Our simple and easy to use online unit trust investment process helps you plan your savings journey and ensure you achieve it.

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It's the smartest thing you'll do today.

Funeral Cover - Buy Online

I, the Primary Covered Person of the Family Funeral Plan or Accidental Death Plan indicated herein as the "Plan", am subject to the following:

  1. Sanlam icover is a division of Sanlam Developing Markets Limited, a registered long-term insurer and licensed financial services provider. All references to Sanlam or Sanlam icover refers to Sanlam Developing Markets Ltd.
  2. The Plan will be administered by Sanlam icover in South Africa. All amounts relating to the Plan, particularly payments and benefits, will be expressed, calculated and paid in South African currency. All claims payments will be made in South Africa.
  3. I accept that no advice was provided to me through a Sanlam appointed broker or advisor, and the decision to purchase the Plan online was taken in my personal capacity and on my own volition.
  4. I accept full responsibility for informing Sanlam icover of any changes to the identification information provided (e.g. surname change, contact details etc.)
  5. I am aware that in terms of the Financial Advisory and Intermediary Services Act, 37 of 2002 (FAIS), I may request a copy of any document that I or someone on my behalf submitted to Sanlam icover that pertains to this Plan.
  6. In terms of the Prevention of Organised Crime Act (number 121 of 1998), I guarantee that the funds with which any payment is or will be made to Sanlam icover, in terms of this Plan, are derived from a lawful source. In addition, I declare myself willing to answer any questions with regard to the origin of such funds and to provide additional information when required by Sanlam icover.
  7. I understand that all information that I have captured will be recorded electronically in Sanlam icover’s computer system, and that a Membership Certificate for the Plan which I have purchased will be sent electronically to the email address I provided as part of the online purchase process. The electronic records of Sanlam icover’s computer system will form the record of this Plan and may be used as evidence at any proceedings.
  8. I guarantee that all information herein is complete and correct. This guarantee applies also to information which in Sanlam icover's reasonable opinion is relevant to the insurance risk and which is contained in other documents or provided telephonically. If any of the aforesaid information is not complete or correct, Sanlam icover may cancel this Plan. If this happens, all premiums paid in terms of this Plan will be forfeited.

Medical Gap Cover - Apply Online Now

Sanlam Comprehensive Gap Cover Plan Individual or family monthly premium:

  • Individual
    0-59 years R233pm
    60+ years R466pm
  • Families
    0-59 years R409pm
    60+ years R815pm

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Personal Loans

 

 

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