Cover for shortfall, or gap, in the event of hospitalisation involving surgery or medical treatment
Admed is a specially designed product, which provides cover for the shortfall, or gap, in the event of hospitalisation involving surgery or medical treatment, as well as for certain procedures performed on an outpatient basis. The shortfall, or gap, is defined as the amount by which the actual cost charged by the medical practitioner (e.g. anesthetists, surgeons, other specialists and GP’s) exceeds the amount paid by your medical aid.
Admed will pay up to 2 times the amount paid by your medical aid towards this shortfall, not exceeding the value of the shortfall (or gap). This means that the calculation of the amount payable to you will be based on how much your medical aid has paid and not on the scheme rate of your medical aid.
Admed Supreme Gap offers a comprehensive range of benefits including:
- Cover for shortfalls in medical practitioner costs (including Prescribed Minimum Benefits)
- Cover for co-payments / deductibles applied by your medical aid for certain procedures
- Cover for co-payments levied by your medical aid on oncology treatment programmes
- Cover for oncology treatment costs once your medical aid oncology benefit limit has been exceeded
- A lump sum benefit for first time cancer diagnosis
- Cover for shortfalls for internal prosthesis costs
- Benefits for accidental death and permanent total disability
- A lump sum benefit for long-term hospitalisation
- A fixed benefit for tooth repairs as a result of accidental injury
- Cover for casualty visit costs
Admed also offers Primary Gap for the customer that is seeking a less comprehensive gap cover solution. Primary Gap offers the following benefits:
- Cover for shortfalls in medical practitioner costs (not including Prescribed Minimum Benefits)
- Cover for co-payments / deductibles applied by your medical scheme for certain procedures (not including Prescribed Minimum Benefits)
To be eligible for cover you must be an active member of a South African medical aid. Gap cover does not replace or act as a substitute for your medical aid cover, nor does it cover you for every shortfall between what you are charged and what your medical aid pays.
Tel: 0860 333 350
Tel: 0860 102 936
Fax: +27 (11) 263 1419