FNB Gap Cover
Cover your
medical shortfalls
Let us help you cover your medical expenses when medical aid is not enough, from as little as R250 p.m.
Let us help you cover your medical expenses when medical aid is not enough, from as little as R250 p.m.
You or your family are most likely to encounter one or more of the following situations where you will incur costs for:
Payment shortfalls between what a medical practitioner has charged and what the medical scheme has paid in hospital.
Being admitted to a hospital outside of your approved network.
Co-payments - to your healthcare provider before undergoing certain treatments in hospital.
Being admitted to the casualty ward of a hospital for emergency treatment.
Choose a plan suitable for you and your family's needs.
Essential
From R250 p.m.
Comprehensive
From R370 p.m.
Elite
From R435 p.m.
Essential | Comprehensive | Elite | |
---|---|---|---|
|
From R250 p.m. |
From R370 p.m. |
From R435 p.m. |
Shortfall benefit |
300% of MST |
500% of MST |
Unlimited* |
Co-payment benefit: |
|
|
|
Sub-limit benefit |
- |
R20 000 per person, per year* |
R50 000 per person, per year* |
Non-network benefits: |
- |
R7 500 per plan per year* |
Unlimited |
Cancer benefit |
|
|
|
Shortfall |
300% of MST |
500% of MST |
Unlimited* |
Co-payment |
Subject to a maximum co-payment of 25% of the costs of treatment |
Subject to a maximum co-payment of 25% of the costs of treatment |
Subject to a maximum co-payment of 25% of the costs of treatment |
Sub-limit benefit |
Covers 25% of the remaining costs once cancer sub-limit reached |
Covers 25% of the remaining costs once cancer sub-limit reached |
Covers 25% of the remaining costs once cancer sub-limit reached |
Casualty benefit |
R4 000 per plan per year* |
R6 000 per plan per year* |
R20 000 per plan per year* |
MST - Medical Scheme Tariff*Benefits are dependent on the type of plan chosen and limited to the annual limit of R210 500 per person. Refer to the brochure for more information.
087 736 7772
Medical schemes typically cover medical expenses at the full medical scheme rate (100%). Medical specialists can charge up to 500%, leaving you with a costly shortfall. To protect you and your family financially, we offer you cover that has a range of benefits.
Affordable premiums that cover you, your spouse and up to three children.
Age of policyholder | Family premium | Additional dependant premium |
---|---|---|
<30 | R415 | R42 |
30-54 | R475 | R48 |
55-59 | R575 | R58 |
60-64 | R690 | R70 |
65+ | R790 | R80 |
Medical Expense Shortfall Benefit | Provides an additional *unlimited cover of the medical scheme rate, for shortfalls of service providers, less what is paid by the medical scheme. |
Co-Payment Benefit | Covers costs incurred when a medical scheme requires settlement before undergoing defined treatments. |
Sub-Limit | Covers the difference between the cost of treatment and what the medical scheme pays when your medical scheme applies a Rand-value limit. Pays up to a maximum of R50 000. |
Non-network | Pays the penalty for the voluntary use of a hospital that is not part of your Medical Scheme Hospital Network. |
Casualty Benefit | Provides a maximum of R20 000 cover per year, per Plan, for all services delivered in the casualty ward for conditions requiring immediate treatment, even if the costs are paid from the medical savings account. |
Cancer benefits | |
---|---|
Shortfall | Provides an additional *unlimited cover of the medical scheme rate, for Oncology treatment shortfalls of service providers, less what is paid by the medical scheme. |
Co-payment | Covers the Co-Payment applied once related costs have exceeded the specific limits defined by the medical scheme for Oncology treatments. This is subject to a maximum Co-Payment of 25% of the costs of treatment. |
Sub-limit | Covers charges related to the services for Oncology treatment when the medical scheme benefit option applies a limit. This benefit is limited to a maximum of 25% of the charged amount, less the amount paid by the medical scheme. |
Please note:
This Plan is not a medical scheme. The cover is not the same as that of a medical scheme nor is it a substitute for medical scheme membership. To enjoy cover, all the insured lives on your Plan must be members of your Medical Scheme.
*Subject to an overall annual statutory limit of R172 500. This may be reviewed annually to keep in line with inflation.
Children may be covered until they reach 26 years of age. Children over 21 must prove financial dependence. There is no age limit for a special needs child.
Cause of claim | Waiting period for the insured person/s |
---|---|
All causes other than accidents | 3 months from the start date of cover |
Specific pre-existing conditions including maternity | 12 months from the start date of cover |
Affordable premiums that cover you, your spouse and up to three children.
Age of policyholder | Family premium | Additional dependant premium |
---|---|---|
<30 | R350 | R35 |
30-54 | R395 | R40 |
55-59 | R475 | R50 |
60-64 | R565 | R57 |
65+ | R645 | R65 |
Medical Expense Shortfall Benefit | Provides an additional 500% cover of the medical scheme rate, for shortfalls of service providers, less what is paid by the medical scheme. |
Co-Payment Benefit | Covers costs incurred when a medical scheme requires settlement before undergoing defined treatments. |
Sub-Limit | Covers the difference between the cost of treatment and what the medical scheme pays when your medical scheme applies a Rand-value limit. Pays up to a maximum of R20 000. |
Non-network | Pays the penalty, up to R7 500 per year per policy, for the voluntary use of a hospital that is not part of your Medical Scheme Hospital Network. |
Casualty Benefit | Provides a maximum of R6 000 cover per year, per Plan, for all services delivered in the casualty ward for conditions requiring immediate treatment, even if the costs are paid from the medical savings account. |
Cancer benefits | |
---|---|
Shortfall | Provides an additional 500% cover of the medical scheme rate, for Oncology treatment shortfalls of service providers, less what is paid by the medical scheme. |
Co-payment | Covers the Co-Payment applied once related costs have exceeded the specific limits defined by the medical scheme for Oncology treatments. This is subject to a maximum Co-Payment of 25% of the costs of treatment. |
Sub-limit | Covers charges related to the services for Oncology treatment when the medical scheme benefit option applies a limit. This benefit is limited to a maximum of 25% of the charged amount, less the amount paid by the medical scheme. |
Please note:
This Plan is not a medical scheme. The cover is not the same as that of a medical scheme nor is it a substitute for medical scheme membership. To enjoy cover, all the insured lives on your Plan must be members of your Medical Scheme.
Children may be covered until they reach 26 years of age. Children over 21 must prove financial dependence. There is no age limit for a special needs child.
Cause of claim | Waiting period for the insured person/s |
---|---|
All causes other than accidents | 3 months from the start date of cover |
Specific pre-existing conditions including maternity | 12 months from the start date of cover |
Affordable premiums that cover you, your spouse and up to three children.
Age of policyholder | Family premium | Additional dependant premium |
---|---|---|
<30 | R240 | R25 |
30-54 | R265 | R27 |
55-59 | R308 | R30 |
60-64 | R365 | R37 |
65+ | R485 | R50 |
Medical Expense Shortfall Benefit | Provides an additional 300% cover of the medical scheme rate, for shortfalls of service providers, less what is paid by the medical scheme. |
Co-Payment Benefit | Covers costs incurred when a medical scheme requires settlement before undergoing defined treatments. |
Casualty Benefit | Provides a maximum of R4 000 cover per year, per Plan, for all services delivered in the casualty ward for conditions requiring immediate treatment, even if the costs are paid from the medical savings account. |
Cancer benefits | |
---|---|
Shortfall | Provides an additional 300% cover of the medical scheme rate, for Oncology treatment shortfalls of service providers, less what is paid by the medical scheme. |
Co-payment | Covers the Co-Payment applied once related costs have exceeded the specific limits defined by the medical scheme for Oncology treatments. This is subject to a maximum Co-Payment of 25% of the costs of treatment. |
Sub-limit | Covers charges related to the services for Oncology treatment when the medical scheme benefit option applies a limit. This benefit is limited to a maximum of 25% of the charged amount, less the amount paid by the medical scheme. |
Please note:
This Plan is not a medical scheme. The cover is not the same as that of a medical scheme nor is it a substitute for medical scheme membership. To enjoy cover, all the insured lives on your Plan must be members of your Medical Scheme.
Children may be covered until they reach 26 years of age. Children over 21 must prove financial dependence. There is no age limit for a special needs child.
Cause of claim | Waiting period for the insured person/s |
---|---|
All causes other than accidents | 3 months from the start date of cover |
Specific pre-existing conditions including maternity | 12 months from the start date of cover |