Frequently Asked Questions

Depending on the plan selected, cover may include:

• Accidents
• Illness
• Surgery
• Hospitalisation
• Chronic conditions (after waiting periods)

• Emergency surgery
• Specialist treatment
• Chronic conditions
• Hospital stays

• Dogs
• Cats

• Pre-existing conditions
• Routine check-ups and vaccinations (unless on a wellness plan)
• Cosmetic procedures
• Breeding-related costs
• Preventative treatments (unless specified)

• Accidents: often immediate or short waiting period
• Illness: typically 14–30 days
• Specific conditions (e.g., cruciate ligaments): longer waiting periods

Excess structures may include:

• Fixed excess per claim
• Percentage-based excess
• Annual excess

These may include:

• Annual overall limits
• Sub-limits per medical condition
• Sub-limits for specific treatments

You are generally free to use your preferred registered veterinarian, provided that the treatment is medically necessary and properly documented.

1. Paying the veterinarian directly for treatment
2. Submitting the claim form together with invoices
3. Receiving reimbursement according to your policy limits

• Age-related risk
• Claims history
• Inflation in veterinary costs
• Annual policy adjustments

• Waiting until their pet shows symptoms before applying for cover
• Not understanding waiting periods
• Choosing cover with very low benefit limits
• Failing to disclose their pet’s medical history

Without a valid will, your estate will be distributed according to the Intestate Succession Act — meaning you lose control over who inherits what.

• Your estate will be divided according to law
• Your spouse may not inherit everything
• Minor children’s inheritances may be paid into the Guardian’s Fund
• The administration process may take longer and become more costly

Executor’s fees are regulated and currently amount to 3.5% + VAT of the gross estate value.

Responsibilities include:

• Reporting the estate to the Master of the High Court
• Collecting assets
• Settling debts
• Paying taxes
• Distributing assets to beneficiaries

• The complexity of the estate
• Liquidity availability
• SARS and Master’s Office processes
• Whether a valid will is in place

• Outstanding debts
• Executor’s fees
• Property transfer costs
• Taxes

• Nominate a legal guardian
• Consider establishing a testamentary trust
• Ensure their inheritance is properly protected and managed

It ensures funds are professionally managed until beneficiaries reach a specified age.

• You get married or divorced
• You have children
• You buy or sell property
• Your financial position changes
• You start a business

• 20% on the first R30 million
• 25% on amounts above R30 million

• Safeguards the document
• Assists your family when needed
• Can activate the estate process promptly

• Procrastination
• Using generic online templates
• Ignoring estate liquidity planning
• Not seeking professional advice

• Hospitalisation
• Doctor and specialist visits
• Chronic medication
• Day-to-day medical expenses
• Emergency treatment

• Medical Aid (Medical Scheme) is regulated under the Medical Schemes Act and offers comprehensive healthcare benefits.
• Medical Insurance is a short-term insurance product with limited cover and lower benefit caps.

However, private healthcare costs can be extremely high, and Medical Aid provides financial protection against unexpected medical expenses.

• In-hospital treatment
• Prescribed Minimum Benefits (PMBs)
• Chronic medication (on certain plans)
• Specialist consultations
• Basic dentistry and optometry (on comprehensive plans)

• Emergency medical conditions
• Certain chronic conditions
• Specific life-threatening illnesses

• 3-month general waiting period
• 12-month waiting period for pre-existing conditions

Using providers outside the network may result in:

• Co-payments
• Reduced benefits

It may apply when:

• Using non-network providers
• Undergoing certain procedures
• Choosing a more expensive hospital

This is a portion of your contribution allocated for day-to-day expenses such as:

• GP visits
• Medication
• Basic dentistry

• At the beginning of the year
• During specific upgrade windows

• A 12-month waiting period may apply
• PMB conditions must still be covered (subject to scheme rules)

• The plan selected
• Number of dependants
• Income level (on some schemes)

• Benefits may be suspended
• Membership may be terminated
• Reinstatement may require underwriting

• Families wanting private healthcare access
• Individuals with chronic conditions
• Professionals seeking specialist care
• Anyone wanting financial protection against major hospital costs

Medical specialists often charge between 200% and 500% of medical scheme rates. Gap Cover helps cover the difference.

Example:

If your medical scheme pays 100% of its rate, but the specialist charges 300%, you are personally liable for the 200% shortfall. Gap Cover can cover that difference (within policy limits).

• In-hospital specialist shortfalls
• Co-payments for certain procedures
• Sub-limits on scans (MRI / CT)
• Cancer treatment shortfalls
• Accident-related shortfalls
• Penalty fees for non-network hospital use

Gap Cover is not a medical scheme and does not replace your medical aid. You must have an active medical scheme in order to qualify for Gap Cover.

• Immediate cover for accidents
• 3-month general waiting period
• 9–12 month waiting period for pre-existing conditions

Gap Cover policies have an annual overall limit per insured person, regulated by legislation. There may also be sub-limits per procedure or condition.

Some plans cover:

• Hospital admission co-payments
• MRI / CT scan co-payments
• Scope procedure co-payments

Some policies may provide limited cover for:

• Oncology
• Certain specialist consultations
• Day procedures

These conditions are usually subject to longer waiting periods.

Premiums vary depending on:

• The insurer
• The plan selected
• The number of insured members

It is often best to take Gap Cover when joining or upgrading your medical scheme to avoid unnecessary waiting periods later.

Gap Cover is regulated as a short-term insurance product and must comply with South African legislation, including maximum annual limits prescribed by regulation.

• Individuals with hospital plans
• Families concerned about specialist shortfalls
• Professionals wanting protection against large medical bills
• Anyone using private healthcare facilities

1. Your medical scheme has processed the claim.
2. You receive the shortfall statement.

• Medical emergencies
• Trip cancellations
• Lost or delayed baggage
• Travel delays
• Personal liability abroad

Even minor incidents such as a missed flight or lost luggage can result in significant unexpected costs. Travel Insurance protects you from financial loss and provides access to emergency assistance services while abroad.

• Emergency medical expenses abroad
• Medical evacuation and repatriation
• Trip cancellation or curtailment
• Lost, stolen or delayed baggage
• Passport loss
• Travel delay
• Personal liability

• Declared upfront
• Specifically accepted by the insurer (sometimes at an additional premium)

This ensures that cancellation cover is active in case you need to cancel due to unforeseen events before departure.

Certain countries, such as Schengen countries, require proof of Travel Insurance as part of the visa application process. Even where not mandatory, it is strongly recommended.

• Undeclared pre-existing conditions
• Travelling against medical advice
• Alcohol or drug-related incidents
• Participation in extreme sports (unless specifically covered)
• Unattended baggage
• Illegal activities

• Emergency medical treatment due to COVID-19
• Cancellation due to COVID-related illness

It is important to confirm whether your trip is leisure or business to ensure appropriate cover.

In a serious emergency:

1. Contact the assistance provider immediately.
2. They will arrange hospital admission and guarantees of payment where necessary.

The excess amount depends on:

• The plan selected
• The type of claim

Certain activities can be covered if:

• Declared beforehand
• An appropriate add-on or higher plan is selected

• The request is made before the original policy expires
• No claim event has already occurred

1. Complete a claim form.
2. Submit supporting documents (medical reports, police report, airline confirmation, etc.).
3. The insurer assesses and processes the claim.

• International travellers
• Families travelling abroad
• Business travellers
• Students studying overseas
• Cruise travellers