How Medical Gap CoverInsurance Works
View the Frequently Asked Questions.
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From R125 monthly contribution.
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.
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:
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:
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:
Alternatively, if you sign an authority for Xelus to obtain the relevant claims information (on the claim form), they will obtain any outstanding supporting documents on your behalf. Claims are processed as and when it is received and claims are paid out on a daily basis.
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. By law, service providers may not be paid directly.
Individual or family monthly premium
Up to 5-times medical aid tariff
R33 000 per event/condition
Up to R7 500 per event
R 550 per day - Day 7 to 13
R1 100 per day - Day 14 to 20
R1 650 per day - Day 21 to 30
R11 000 per event
Illness - R11 000 per member
Accidental - R22 000 per member
6 months - Max R3 300 per month
Up to R33 000 per event/condition
End to end legal assistance in RAF Claims (% RAF Benefit Allocation to Claimant)
R13 000 per event/condition
Up to R5 000 per event
R275 per day - Day 7 to 13
R550 per day - Day 14 to 20
R825 per day - Day 21 to 30
R8 250 per event
Illness - R8 250 per member
Accidental - R16 500 per member