IN-HOSPITAL GAP COVERIn-hospital Tariff Top-up covers the client for shortfalls on hospital expenses incurred while the insured is an in-hospital patient between the NHRPL (National Health Reference Price List) tariff and the actual costs incurred whilst in hospital. This benefit is limited to 4 times (400 %) the stated NHRPL tariff. BENEFITS: The benefits payable are at 400 % of NHRPL rates. The claim is payable directly to the member, regardless of any other additional insurance which members may have regarding medical expenses. The insured will receive a benefit equal to the difference between the fees of the medical practitioner and those of NHRPL Benefits covered are at R1 Million irrespective of an individual or family per annum. As many Medical Schemes only reimburse members at 100% of the NHRPL tariff, this product is suitable for members of medical schemes in particular middle to lower level options. UNDERWRITING CRITERIA: A 3 month waiting period applies. 12 month pre-existing condition exclusion. Maximum age of entry is 64
HOSPITAL CASHThe Hospital Cash benefit provides a benefit payable per day to the insured in the event of hospitalisation. This product allows the client to determine the amount of money they would require for unexpected expenses incurred as an in hospital patient. (in-hospital patient means a patient admitted to hospital for a period longer than 12 hours) BENEFIT R 800 Daily Benefit R 600 Daily Benefit R 400 Daily Benefit R 300 Daily Benefit R 200 Daily Benefit CONDITIONS:
Cover commences from day 4 as an in hospital patient and extends to a maximum of 90 days per incident in hospital.
CONTRIBUTION WAIVERThe contribution waiver benefit is payable on the death or permanent and total disability of the principal member of the medical scheme. The contribution waiver provides a lump sum payment of up to 6, 12 or 24 month contributions directly to the medical scheme of the client with annual increases based on the schemes annual contribution.
BENEFIT 6 Months 12 Months 24 Months UNDERWRITING CRITERIA: A 3 month waiting period applies. 12 month pre-existing condition exclusion. Maximum age of entry is 64
STRATA HOSPITAL ASSISTANCE PLANThe Strata hospital assistance plan will pay benefits in respect of aspecific health condition and is structured on a stated benefit basis to cover non-medical expenses during the recovery period from a particular health event/condition (which might include the period after discharge from a hospital) and or to assist with any shortages with regard to hospitalization. Over 100 specific health conditions are covered and sums assured have been carefully calculated to ensure general consistency between the various health events/conditions and the expected non-medical expenses and implicit associated costs of pain and suffering. UNDERWRITING CRITERIA: A 3 month waiting period applies.
12 month pre-existing condition exclusion.
Maximum age of entry is 64
ESSENTIAL PROCEDURE PLANThe Strata Essential Procedure Plan is a stated benefit policy which pays a lump sum benefit to the insured in the event of any unforeseen medical or lifestyle related expenses that may be incurred due to hospitalisation or surgical intervention relating to any of the following procedures. STATED BENEFIT = R 1000.00 Cataract surgery, Colonoscopy, Sigmoidoscopy, Proctoscopy, Conservative back treatment Gastroscopy, Myringotomy (grommets) Tonsillectomy, Adenoidectomy STATED BENEFIT = R 5000.00 Spinal surgery, Joint replacement Nissen fundoplication ( Reflux surgery )
CONDITIONS: Benefits covered are at R 12500 per individual & R 25000 per family per annum. A 3 month waiting period applies. Maximum age of entry is 55.
HOSPITAL EXCESS COVERHospital Excess Cover allows the client to “buy-up” on his/her annual hospital benefit limit, giving the client added hospital cover up to R2 million per annum depending on the excess selected. EXCESS TO BE COVERED BY CLIENT / MEDICAL SCHEME BEFORE COVER COMMENCES R 100,000 Excess R 150,000 Excess R 200,000 Excess R 250,000 Excess R 300,000 Excess R 400,000 Excess R 500,000 Excess UNDERWRITING CRITERIA: A 3 month waiting period applies. 12 month pre-existing condition exclusion. Maximum age of entry is 64.
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