Online Will | Retirement | Tax-free Savings | Unit Trusts | Gap Cover | Funeral Cover | Life Insurance | Personal Loans
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.
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
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 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.
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.
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.
It's the smartest thing you'll do today.
I, the Primary Covered Person of the Family Funeral Plan or Accidental Death Plan indicated herein as the "Plan", am subject to the following: