Admed

Cover for medical expense shortfalls in the event of hospitalisation involving surgery or medical treatment

Admed is a specially designed short term insurance product, which provides cover for medical expense shortfalls (“gaps”) should you or a loved one need to undergo surgery whilst in hospital or a medical procedure on an outpatient (out-of-hospital) basis.

The medical expense shortfall is calculated as the difference between the amount charged by your medical practitioner (e.g. anesthetists, surgeons, other specialists and GP’s) and the amount paid towards this cost 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 actual shortfall. 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.

Gap cover is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for your medical scheme cover, nor does it cover you for every shortfall between what you are charged and what your medical aid pays.

To be eligible for cover you must be an active member of a South African medical aid.

Admed Supreme Gap offers a comprehensive range of benefits including:

  • Cover for medical expense shortfalls (gaps) 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
  • 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 medical expense shortfalls (gaps) 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)*

* The combined maximum amount that can be paid for these benefits is R150 000 per insured person per year.



Contact Admed

Admed complaints:
Tel: 0860 333 350
admedcomplaints@guardrisk.co.za
Admed Call centre:
Tel: 0860 102 936
Email: admed@guardrisk.co.za
Fax: +27 (11) 263 1419




Admed document links



Admed complaints policy



2017

Admed claim form 2017
Brochure
Individual no-advice application form
Option change form
Policy amendment form
Policy wording