GAP STANDARD COVER
Our GAP Standard Cover is designed and priced for Young Families who are usually planning to start a Family or already have a Young Child.
It offers the Essential Benefits and Covers Medical Expense Shortfalls for Specialists up to 500% of the Medical Scheme Rate. It includes co-payments or deductibles claimed by health service providers for treatment received whilst a covered member is an in- or out-patient and is further enhanced to provide, Casualty, Trauma Counselling, and a Consumables benefit.
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 STANDARD 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) | R20 000 per Incident, subject to OAL. | 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. |
| Shortfall on Consumables In-Hospital | R5 000 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 | ||
 | 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 R10 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. |
2025 CURA GAP STANDARD 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 700% 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) | R20 000 per Incident, subject to OAL.. | 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. |
| Shortfall on Consumables In-Hospital | R5 000 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 | ||
| 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 R10 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. |
What does Cura Administrators GAP Standard 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.
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.
All newborns must be registered on this policy within 30 days after birth.
Monthly Premium:
| Entry Age | Monthly Premium |
|---|---|
| Individual < 64 years | R345.00 per month |
| Family < 64 years | R530.00 per month |
| Individual > 65 years | R530.00 per month |
| Family > 65 years | R730.00 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 Standard 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.
- Hospital accommodation
- 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.
- No benefits shall be payable for any external appliances;
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.