Sanlam Gap Insurance – The Most Affordable

    April 4, 2019

    Not only is Sanlam a household name but it is also one of the most tried and trusted financial services companies in South Africa. So, it is no surprise that Sanlam gap insurance policies are among the most affordable you will find.

    For a mere R298 a month, you can insure yourself and your family against the horrendous financial shortfalls between what your medical scheme will pay for certain prescribed hospital treatments and procedures and what the medical profession charge for their services.

    In fact, several procedures, whether performed in-hospital or as an outpatient service, can cost as much as five times more than what your medical scheme prescribes in its tariff rate.

    A Sanlam gap cover policy offers the following in-hospital benefits:

    Sanlam gap insurance

    Tariff Shortfalls

    It will pay up to 500% percent of the shortfall between your medical scheme tariff and the fees imposed by the medical profession.

    Sub-Limits

    Sub-limits are imposed by medical schemes for certain procedures such as a prosthesis. A Sanlam gap cover policy pays an amount of R48 500 per event.

    Co-payments

    Co-payments are imposed for specified hospital procedures. Sanlam offers unlimited cover for specified procedures.

    Deductibles

    Deductibles are another form of co-payment payable by members of medical schemes when admitted to hospital. Sanlam offers unlimited cover.

    Penalty Co-Payments

    Sanlam gap cover pays R14 000 annually per family

    Out of hospital benefits

    The following out-of-hospital benefits apply:

    Co-Payments

    Co-payments must be made upfront before a hospital will proceed with treatment. Policyholders are covered for:

    • MRI Scans  (unlimited) – required for tumours, spinal cord injuries and the examination of soft tissue in tendon and ligament injuries
    • CT scans (unlimited) – required for bone injuries, lung and chest diagnostics and cancer detection

    Oncology sub-limits

    Oncology treatments are limited to R157 000 per insured person annually

    Emergency Casualty Benefit

    The emergency casualty benefit covers facility and consultation fees up to R14 000 per event, limited to one event annually

    Additional Sanlam gap insurance benefits

    Hospital Cash Benefit

    Policyholders receive cash payments for every day spent in hospital following an accident or premature birth (six weeks or earlier). These amounts are:

    • R350 daily for up to 13 days
    • R700 daily for day 14 to 20
    • R1 400 daily for day 21 to 30

    The policy will pay a maximum of R30 000 per beneficiary annually.

    Premature Birth

    A payment of R13 200 is made for premature births exceeding six weeks before the due date.

    Death or Permanent Disability

    A once-off lump-sum payment is made in the event of the death or permanent disability of a member as follows:

    • Illness – R13 000 per member
    • Accident – R26 000 per member

    Medical Scheme and the Sanlam Gap Insurance Policy Premium Waiver

    Should the principal member of the gap cover policy die or become disabled, policy beneficiaries are covered for a maximum of R5 000 a month for six months.

    Dental Reconstruction

    Dental reconstruction work necessitated by trauma, cancer and tumours are covered for the amount of R44 000 per event.

    Sanlam will also assist policyholders with Road Accident Fund (RAF) claims, any legal assistance related to that claim and will pay claimants 100% of the RAF Benefit Allocation.

    For assistance and a medical gap cover quote just complete and then submit the form on this page. (Medical aid members only!)

    All info was correct at time of publishing