Stratum Medical Shortfall Insurance Details

December 14, 2021

Stratum prides itself on covering the gap that exists when medical schemes do not pay private health care costs and offer an array of benefits that stamps the company’s unwavering commitment to superior and quality service. Here we will have a look at Stratum medical shortfall insurance.

Gap Benefit

Stratum’s Gap Benefit offers policyholders peace of mind.

It fills the financial shortfall between tariff ceilings imposed by medical schemes and charges imposed for medical procedures. It offers an extra 500 percent for the shortfall.

Furthermore, there are no limits to the number of annual claims for the following:

  • Doctors or specialists
  • Basic black and white x-rays. This does not include specialised radiology such as MRI, CT and PET scans.
  • Pathology
  • Physiotherapy
  • Disposable items such as surgical gloves, bandages and gauze
  • Medication provided as part of in or out of hospital care, but not including medication taken at home


The Gap Benefit covers medical procedures in the hospital, private rooms, clinics or other registered premises.

The following are examples of how the GAP Benefit covers medical shortfalls:

Charge For Childbirth

  • Gynaecologist R18 000, Your medical scheme pays R12 000, the gap cover benefit will cover R6 000.
  • Anaesthetist R5 000, Your medical scheme pays R3 000, the gap cover benefit will cover R2 000.
  • Paediatrician R3 500, Your medical scheme pays R2 500, the gap cover benefit will cover R1 000.


GAP does not cover hospital charges that are substantially higher than the policy holder’s medical scheme limits.

Co-Payment Benefit with Stratum Medical Shortfall Insurance

It provides peace of mind to cover shortfalls when you need upfront payment before undergoing a medical procedure. Whether in or out of a hospital. Stratum also pays up to R8 250 per policy annually when members volunteer to use a hospital or day clinic, not by the member’s medical scheme.

GAP does not cover upfront fees by medical practitioners that cannot claim from the policy holder’s medical scheme.

Oncology Benefit

Stratum’s oncology benefit covers members whose medical schemes only pay a designated amount or percentage of the amounts charged by medical practitioners, but is limited to R450 000 per member annually. This includes approved oncology treatment such as radiotherapy, chemotherapy, basic and specialised radiology, pathology, specialist consultations, registered oncology facility fees, biological or specialised medication.

Oncology Optimiser Benefit with Stratum Medical Shortfall Insurance

Stratum’s Oncology Optimiser Benefit kicks in when medical scheme limits are reached. The benefit is limited to R100 000 per person annually.

Cancer Diagnosis Benefit

Stratum’s diagnoses benefit provides a once-off payment of R30 000 when a member is diagnosed with cancer for the first time and treatment is necessary as part of an approved oncology treatment plan.

Casualty Benefit with Stratum Medical Shortfall Insurance

Stratum Medical Shortfall InsuranceStratum cover for casualties is limited to R10 000 per policy annually and includes:

  • Doctor/Specialist consultations
  • Basic black and white x-rays. It does not include specialised radiology such as MRI, CT and PET scans
  • Pathology
  • Disposable items such as surgical gloves, bandages and gauze
  • Medication
  • Upfront casualty co-payments or facility fees


Here is an example of how the Casualty Benefit from Stratum Medical Shortfall Insurance covers financial shortfalls.

The charge for a casualty event will be R3 500; your medical scheme pays nothing, The casualty benefits will cover R3 500

So Stratum’s sub-limit benefit covers medical scheme shortfalls for internal prostheses, MRI and CT scans. Members receive R30 000 per event with a maximum limit of R60 000 per person annually. It also covers two MRI, or CT scans up to a limit of R2 500 per scan per policy annually.

Here is an example of the coverage provided by the Sub-Limit Benefit:

  • Hip Replacement will charge R47 000; your medical scheme pays R37 200, The Sub-Limit benefit will cover R9 800.
  • Cardiac Pacemaker, will charge R33 000, your medical scheme pays R28 800, The Sub-Limit benefit will cover R4 200.
  • Cochlear Implants, will charge R188 000, your  medical scheme pays R168 800, The Sub-Limit benefit will cover R20 000
  • MRI and CT scans will charge R7 450; your  medical scheme pays R4 950, The Sub-Limit benefit will cover R2 500


Trauma Counselling Benefit with Stratum Medical Shortfall Insurance

This Stratum product will refund expenses for counselling by a registered practitioner, as well as consultation fees for clinical psychologists or psychiatrists not covered by the member’s medical scheme or when the member gets payment from his/her medical scheme savings account. Payment limits to R10 000 per policy annually.

Additional Benefits

Also, Stratum’s motto that a load shared is a load halved” offers security in the face of unexpected change that causes financial hardship. So cover remains unchanged.

  • The gap policy premium waiver benefit is to cover the Stratum Benefits policy premiums for 12 months in the event of death, permanent disability or forced retrenchment
  • in the event of death or permanent disability the medical scheme, contribution waiver benefit covers medical scheme contributions for 6 months to a maximum of R4 500  monthly of the medical scheme principal member
  • In the event of the accidental death of the principal insured or spouse the accidental death benefit provides a payment of R10 000.  A payment of R5 000 is made for the accidental death of a dependant


Road Accident Benefit

Stratum’s road accident benefit includes facilitating claims related to death and injury suffered while travelling by road.


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All info was correct at time of publishing