GAP ADVANCED COVER
Our GAP Advanced Cover is designed and priced for Middle Aged Families with Teen Children.
It provides Intermediate Cover with a healthy spectrum of Benefits at an incredibly attractive Price.
It ensures that you and your Family are Covered for the most Common Types of Claims and Covers Medical Expense Shortfalls of up to 500% of the Medical Scheme Rate.
This extends Cura’s Gap Standard Cover to include the use of Non-DSP Hospital Co-Payment, Sub-limitation Cover (whilst as an in-patient), Sub-Limitation on intra ocular lenses, Cancer Treatment (for the purpose of this policy, outpatient treatment excludes specialist’s consultations), International Travel Insurance, and Pathology and Radiology Benefits once savings and/or day-to-day has been depleted.
Gap Cover is underwritten by GENRIC Insurance Company Limited (FSP: 43638).
GENRIC is an authorised Financial Services Provider and licensed non-life insurer
Please Note: GAP Cover is not a Medical Scheme, and the cover is not the same as that of a Medical Scheme. GAP Cover is not a substitute for a Medical Scheme Membership.
2025 CURA GAP ADVANCED COVER
| Cover | Annual Limit | Benefit Description | |
|---|---|---|---|
| Overall Annual Limit (OAL) of R210 580 per Insured (limit subject to regulatory amendments). | |||
 | Gap Cover | No penalty shortfalls will be covered under this policy. | The shortfall that arises after your medical aid has processed your account, as a result of the service providers charging above scheme tariff for authorised in-hospital procedures. The benefit pays up to 500% of scheme tariff less the higher of the amount paid by the scheme or the scheme tariff for in-hospital procedures/treatment and certain specified out-of-hospital procedures/treatments. You must belong to a registered South African medical scheme to qualify for Gap Cover. |
| Cover for all Prescribed Minimum Benefits (PMB’s) | R210 580.00 per Insured per annum. | A set of defined benefits, as per the Medical Schemes Act, in terms of which all medical schemes must cover the costs related to the diagnosis, treatment and care of any emergency medical condition; a limited set of 270 medical conditions; and 27 chronic conditions. | |
| Out-Patient Cover | Approximately 55 listed out-patient shortfalls are covered | Day procedure performed in a Doctor’s room. | |
 | In-hospital Co-payments / Deductibles (Includes out-of-hospital MRI and CT scans) | R210 580.00 per Insured per annum. | A co-payment or deductible is an upfront amount that needs to be paid to the hospital/day clinic/radiologist before undergoing certain procedures, as specified by your Medical Scheme. When you experience a co-payment for a procedure or scan (as specified by your Medical Scheme) you would need to pay for the co-payment up-front and then claim the amount back from your Cura Gap Policy. If your Medical Scheme pays for co-payments from your day-to-day benefits, you may still claim the amount. This benefit includes out-of-hospital MRI/CT scans. |
| Co-payment: Non-DSP Hospital | R8 000 per claim, 2 claims per policy per annum | The use of a Non-DSP hospital which results in a co-payment will be covered up to R18 000 per Insured per annum. | |
| Sub-limitations | R15 000 per Policy | A benefit equal to charges above any sub-limitation imposed by the Medical Scheme for treatment received whilst as an in-patient. | |
| Co-Payment on Rheumatoid Arthritis Biological Medication | R5 000 / Policy / Annum | ||
| Shortfall on Consumables In-Hospital | R5 500 per Insured | Benefit equal to the cost of consumables not covered by the Medical Scheme for treatment received for an in-patient and/or out-patient treatment (as stated in the Defined event of the Policy Contract). Covers shortfalls on disposable items such as surgical gloves, bandages, and gauze. | |
| TTO medication shortfalls as on hospital account, paid from Scheme Risk | R500 per Claim, Subject to Consumable Limit | ||
 | Internal Prosthesis | Included in R15 000 Sub-Limit | The shortfall on a service provider account that is not covered where you have reached the sub-limit for Internal Prosthesis imposed by your medical scheme AND which has been authorised and paid from the In-Hospital or Major Medical benefit. It covers the difference in Internal prosthesis (examples include hips, knees, and spinal prosthesis, Cochlear Implants, and even cardiac pacemakers.) |
 | Sub-limitations on Intra – Ocular Lenses | R9 000 per lens per annum | The shortfall on a service provider account that is not covered where you have reached the sub-limit for Intra-Ocular lenses imposed by your Medical Scheme AND which has been authorised and paid from the In-Hospital or Major Medical benefit. |
 | Radiology and Pathology Services | R10 000 per Policy | Combined capped amount where a member’s available out of hospital benefits are depleted. This benefit provides an amount of R10 000 per policy per year for Radiology done by a Radiologist or blood tests done by a Pathologist when all available day-to-day benefits have been depleted. The Radiology benefit includes sonars done by a Radiologist but excludes sonars done by a GP or Gynaecologist. |
 | Oncology treatment | R100 000 / Insured | The co-payment or deductible that your medical aid charges you or approved treatment after the higher of your oncology limit or R100 000 / Insured has been reached, including co-payments on items such as biological medication, radiotherapy, and chemotherapy per treatment cycle. |
| Benefit due to a Mastectomy on the unaffected breast | R25 000 and 1 Event / Insured / Lifetime | 1 event per person, per lifetime (subject to qualifying criteria) if there is a short payment or ex-gratia benefit given by the medical scheme (Internal Prostheses included) | |
 | Non-Listed Biological Cancer Drugs (If scheme provided a portion) | R25 000 / Policy / Annum. | |
 | Casualty Benefit | R10 000 per Policy | The cost of emergency medical treatment or a surgical procedure performed in the hospital casualty unit, should such cost not be covered by the Medical Scheme. Emergency Triage Index applies. (Include: Orange and Red triage). This excludes medical appliances such as crutches, braces, wheelchairs, and take-home medication.“Emergency” means the sudden and unexpected onset of a health condition that requires immediate medical treatment and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or death. The determination of an Emergency will be done through diagnosis (through classification by the attending Medical Practitioner and / or the Casualty Unit) and not on symptoms presented. Emergency Triage Index applies (Orange and red triage). |
 | Trauma Counselling | R10 000 per Policy | This benefit covers counselling sessions with a registered counsellor or clinical psychologist that may be required after a serious or traumatic event. Insured must receive counselling within (1) one year of trauma incident. |
| THE FOLLOWING BENEFITS ARE NOT SUBJECT TO THE ANNUAL AGGREGATE LIMIT OF R210 580 PER INSURED PER ANNUM | |||
| First Time Cancer Lump Sum Benefit | Once-Off R14 000 per Insured | This benefit will provide a lump sum amount in the event of Stage 1 Cancer and higher. The benefit excludes pre-existing Cancer and Skin Cancer. |
| International Medical Travel Cover | R5 million per Insured | Maximum of 90 days per trip. Maximum age is 80 years at next birthday. |
 | 12 Months Medical Scheme Premium Waiver | Maximum R5 500 / Month. | This benefit will cover the monthly premium due to your Medical Scheme in the event of the accidental death and permanent disability of the Principal Member as a result of an accident for a period of 12-months. |
| Gap Premium Waiver | 6 Months | This benefit will cover the monthly premium of your Gap Cover in the event of the accidental death and permanent disability of the Principal Member as a result of an accident for a period of 12-months. | |
2025 CURA GAP ADVANCED COVER
| Cover | Annual Limit | Benefit Description | |
|---|---|---|---|
| Overall Annual Limit (OAL) of R210 580 per Insured (limit subject to regulatory amendments). | |||
| Gap Cover | No penalty shortfalls will be covered under this policy. | The shortfall that arises after your medical aid has processed your account, as a result of the service providers charging above scheme tariff for authorised in-hospital procedures. The benefit pays up to 500% of scheme tariff less the higher of the amount paid by the scheme or the scheme tariff for in-hospital procedures/treatment and certain specified out-of-hospital procedures/treatments. You must belong to a registered South African medical scheme to qualify for Gap Cover. |
| Cover for all Prescribed Minimum Benefits (PMB’s) | R210 580.00 per Insured per annum. | A set of defined benefits, as per the Medical Schemes Act, in terms of which all medical schemes must cover the costs related to the diagnosis, treatment and care of any emergency medical condition; a limited set of 270 medical conditions; and 27 chronic conditions. | |
| Out-Patient Cover | Approximately 55 listed out-patient shortfalls are covered | Day procedure performed in a Doctor’s room. | |
| In-hospital Co-payments / Deductibles (Includes out-of-hospital MRI and CT scans) | R210 580.00 per Insured per annum. | A co-payment or deductible is an upfront amount that needs to be paid to the hospital/day clinic/radiologist before undergoing certain procedures, as specified by your Medical Scheme. When you experience a co-payment for a procedure or scan (as specified by your Medical Scheme) you would need to pay for the co-payment up-front and then claim the amount back from your Cura Gap Policy. If your Medical Scheme pays for co-payments from your day-to-day benefits, you may still claim the amount. This benefit includes out-of-hospital MRI/CT scans. |
| Co-payment: Non-DSP Hospital | R8 000 per claim, 2 claims per policy per annum | The use of a Non-DSP hospital which results in a co-payment will be covered up to R18 000 per Insured per annum. | |
| Sub-limitations | R15 000 per Policy | A benefit equal to charges above any sub-limitation imposed by the Medical Scheme for treatment received whilst as an in-patient. | |
| Co-Payment on Rheumatoid Arthritis Biological Medication | R5 000 / Policy / Annum | ||
| Shortfall on Consumables In-Hospital | R5 500 per Insured | Benefit equal to the cost of consumables not covered by the Medical Scheme for treatment received for an in-patient and/or out-patient treatment (as stated in the Defined event of the Policy Contract). Covers shortfalls on disposable items such as surgical gloves, bandages, and gauze. | |
| TTO medication shortfalls as on hospital account, paid from Scheme Risk | R500 per Claim, Subject to Consumable Limit | ||
| Internal Prosthesis | Included in R15 000 Sub-Limit | The shortfall on a service provider account that is not covered where you have reached the sub-limit for Internal Prosthesis imposed by your medical scheme AND which has been authorised and paid from the In-Hospital or Major Medical benefit. It covers the difference in Internal prosthesis (examples include hips, knees, and spinal prosthesis, Cochlear Implants, and even cardiac pacemakers.) |
| Sub-limitations on Intra – Ocular Lenses | R9 000 per lens per annum | The shortfall on a service provider account that is not covered where you have reached the sub-limit for Intra-Ocular lenses imposed by your Medical Scheme AND which has been authorised and paid from the In-Hospital or Major Medical benefit. |
| Radiology and Pathology Services | R10 000 per Policy | Combined capped amount where a member’s available out of hospital benefits are depleted. This benefit provides an amount of R10 000 per policy per year for Radiology done by a Radiologist or blood tests done by a Pathologist when all available day-to-day benefits have been depleted. The Radiology benefit includes sonars done by a Radiologist but excludes sonars done by a GP or Gynaecologist. |
| Oncology treatment | R100 000 / Insured | The co-payment or deductible that your medical aid charges you or approved treatment after the higher of your oncology limit or R100 000 / Insured has been reached, including co-payments on items such as biological medication, radiotherapy, and chemotherapy per treatment cycle. |
| Benefit due to a Mastectomy on the unaffected breast | R25 000 and 1 Event / Insured / Lifetime | 1 event per person, per lifetime (subject to qualifying criteria) if there is a short payment or ex-gratia benefit given by the medical scheme (Internal Prostheses included) | |
| Non-Listed Biological Cancer Drugs (If scheme provided a portion) | R25 000 / Policy / Annum. | |
| Casualty Benefit | R10 000 per Policy | The cost of emergency medical treatment or a surgical procedure performed in the hospital casualty unit, should such cost not be covered by the Medical Scheme. Emergency Triage Index applies. (Include: Orange and Red triage). This excludes medical appliances such as crutches, braces, wheelchairs, and take-home medication.“Emergency” means the sudden and unexpected onset of a health condition that requires immediate medical treatment and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or death. The determination of an Emergency will be done through diagnosis (through classification by the attending Medical Practitioner and / or the Casualty Unit) and not on symptoms presented. Emergency Triage Index applies (Orange and red triage). |
| Trauma Counselling | R10 000 per Policy | This benefit covers counselling sessions with a registered counsellor or clinical psychologist that may be required after a serious or traumatic event. Insured must receive counselling within (1) one year of trauma incident. |
| THE FOLLOWING BENEFITS ARE NOT SUBJECT TO THE ANNUAL AGGREGATE LIMIT OF R210 580 PER INSURED PER ANNUM | |||
| First Time Cancer Lump Sum Benefit | Once-Off R14 000 per Insured | This benefit will provide a lump sum amount in the event of Stage 1 Cancer and higher. The benefit excludes pre-existing Cancer and Skin Cancer. |
| International Medical Travel Cover | R5 million per Insured | Maximum of 90 days per trip. Maximum age is 80 years at next birthday. |
| 12 Months Medical Scheme Premium Waiver | Maximum R5 500 / Month. | This benefit will cover the monthly premium due to your Medical Scheme in the event of the accidental death and permanent disability of the Principal Member as a result of an accident for a period of 12-months. |
| Gap Premium Waiver | 6 Months | This benefit will cover the monthly premium of your Gap Cover in the event of the accidental death and permanent disability of the Principal Member as a result of an accident for a period of 12-months. | |
What does Cura Administrators GAP Advanced Cover entail?
Waiting Periods Applicable:
- 3-month general waiting period.
- 12-month waiting period for pre-existing conditions.
- 9-months waiting period on pregnancy (if pregnant with inception).
Concessions on the above waiting periods will be considered for group schemes.
Maximum Entry Age:
No Maximum entry age is applicable to this policy.
All newborns must be registered on this policy within 30 days after birth.
Child dependants are covered until they reach the age of 21 years, with the option to continue cover as a principal insured and no new underwriting or waiting periods will apply.
This age may be extended up to 27 (twenty-seven) in respect of an unmarried child who is financially dependent on the Principal Insured Person, is not employed, is covered under the Principal Insured Person’s medical scheme (Affidavit for above will be required) and/or is a full-time student at a recognised institute.
Monthly Premium:
| Entry Age | Monthly Premium |
|---|---|
| Individual < 64 years | R480.00 per month |
| Family < 64 years | R561.00 per month |
| Individual > 65 years | R561.00 per month |
| Family > 65 years | R760.00 per month |
Premiums (incl. VAT) are for a single person. Premiums are reviewed and may be adjusted annually.
Terms and conditions apply in terms of exclusions and claim procedures.
CURA GAP Advanced COVER EXCLUSIONS
The Product Provider shall not be liable for costs incurred for hospitalisation, bodily injury, sickness, or related disease directly or indirectly because of or in consequence of:
- Exposure to discharged nuclear weaponry fallout or by ionising radiation or contamination by radioactivity from any nuclear matter or from any nuclear waste from the combustion of nuclear fuel. For this exception, combustion shall include any self-sustaining process of nuclear fission.
- Suicide, attempted suicide, or intentional self-injury.
- Consuming any drug or narcotic unless prescribed by and taken in accordance with the instructions of a registered medical practitioner (other than the insured person).
- Drug Addiction.
- An event directly attributable to the insured person having a blood alcohol concentration exceeding the legal permitted level, or the insured person presenting with alcoholism or an illness resulting from alcohol abuse.
- Participation in:
- Active military duty, police duty, police reservist duty (only applicable to Gap Cover and short-term products), civil commotion, labour disturbances, riot, strike, or the activities of locked out workers).
- Aviation other than as a passenger (excl. commercial pilots).
- Any form of race or speed test, other than on foot or
non-mechanically propelled vehicle, vessel, craft, or
aircraft.
- Any procedure not covered or declined by the medical scheme.
- No benefits shall be payable for an insured event for which the insured person received treatment or advice 12 months prior to becoming an insured person. This exclusion applies to the first 12 months of cover only.
- No benefits shall be payable for pregnancy or childbirth for a period of 9 months from inception of the policy.
- Investigations, treatment or surgery for artificial insemination or hormone treatment for infertility.
- Depression, insanity or mental stress or psychotic/psychoneurotic disorders.
- No benefits shall be payable in the event of fraudulent claim submission.
- Hospital accommodation
The table of benefits do not apply to any territory outside of the borders of the Republic of South Africa, Botswana, Lesotho, Swaziland, Namibia, Zimbabwe, and Mozambique.