You’re enrolled on a medical scheme and are feeling comfortable that you’ve fully taken care of you and your family’s medical needs. But what if there are medical procedures your scheme doesn’t cater for fully? What about the times when you’re forced to seek treatment outside your scheme’s network and have to cough up a co-payment? Sanlam Comprehensive gap cover comes into play at this point.
To avoid the possibility of having to dip into your savings to meet these shortfalls, you need to have medical gap cover. Given how expensive medical care in South Africa can be, getting gap cover only makes sense. Remember, however, that medical gap cover is not a replacement , or alternative to, medical scheme membership. In fact, being a medical scheme member is a prerequisite for taking out gap cover. The principle member, their spouse and children are all covered under gap cover.
Sanlam Gap Cover In Detail
Among the many gap cover providers in the South African, Sanlam Comprehensive gap cover deserves consideration as one of the more affordable options. The size of the company allows Sanlam to offer more affordable products. It is an insurance group that is currently present in 44 countries and claims to have the largest footprint of all the insurers in Africa.
Claims procedure
So you’ve received medical treatment and a shortfall has been brought to your attention. How do you go about making a claim so that you access the funds to plug the shortfall? First of all, you need to formally submit a claim using the form available for download on the Sanlam website. Before you set about filling it, note that the submission must be done not more than six months after whatever medical event you or another beneficiary sought treatment for.
Sanlam’s claims process is handled by a third party named Kaelo Risk Ltd. It is to them you will send your completed form and all required supporting documentation. Among the documents you need to attach to your claim are:
- Evidence of processing of your claim by your scheme (in form of a receipt)
- Doctor’s and hospital’s accounts
- Medical scheme member certificate
As soon as your claim is captured and authorised, the amount of the claim will be deposited into the bank account of the principal member.
What Sanlam Comprehensive Gap Cover Doesn’t Cover
Here are some of the conditions under which you will not qualify for this cover:
- If your claim is more than six months old.
- If the cover is for a claim that has been rejected.
- If you’re seeking dental treatment for a condition that is not the result of cancer or trauma.
- Treatment for being overweight. This includes stomach-stapling procedures.
- Cosmetic surgery not caused by cancer or some form of trauma.
Note that, like with most any medical scheme, the premiums for Sanlam’s Comprehensive Gap cover go higher as you get older. When you’re above 60 years you will pay twice the original premium. For this reason you’re well advised to take up gap cover at the earliest opportunity.
Use the form on this page to contact us for a gap cover quote