FAQ
GAP FAQs
From waiting periods to is my family covered, here's everything you need to know about The Unlimited GAP Cover.
Yes – 3 months from joining before you can claim (you will need your medical aid number to claim)
12 months before you can claim on anything related to a condition that you have claimed on or have been afflicted with for 12 months before you got your Gap cover.
HOWEVER – if you are in an emergency accident within your first 3 months of Gap cover and your medical aid do pay out – you are covered by your Gap cover.
Only expenses NOT paid for by your registered medical aid and for Government Employees GEMS / Polmed medical aid will be covered by The Unlimited Gap Cover up to the specified limits.
No. If you claim, you need to comply with the Medical Scheme rules about the use of a hospital that is a Designated Service Provider, a Preferred Service Provider, an Associated Hospital or a Network Hospital. You can get this information from you Medical Scheme.
No, this product only covers immediate family which includes the spouse of the principal member and children.
Yes. If you are NOT the principal or main member on the medical aid, HOWEVER you are covered as a dependent on a registered medical aid and for Government Employees a member of GEMS OR POLMED medical aid, you can still take The Unlimited Gap Cover. You will then be the principal member of The Unlimited Gap Cover.
No. The treatment received in a casualty ward must not be for regular physical check-ups or any other treatment, except emergency medical treatment.
A claim is opened via the G-App . It must be completed in full and submitted via the App with all supporting documentation within 6 months of the first day of treatment / hospitalization, or you can call our claims team at 0861990000
31 days written notice must be given to The Unlimited via email to customercare@theunlimited.co.za
You will be covered for up to R185 800 per year for expenses that are not covered by your medical aid – i.e. shortfalls in cover. You can use up to R10 000 of your cover per year to pay expenses in casualty for emergency procedures.
You can claim on any pre-existing condition after we have received 12 payments from you.
Within 2 weeks (10-working days) of receipt of all supporting documentation.
This policy does not have the Co-payment benefit.
Regrettably, we don’t provide pre-authorisation on claims. Please contact your medical aid directly. You can read through your Gap policy terms and conditions for the benefits, limitations and exclusions that apply to your Gap cover.
Yes, if they are biological or adopted children and are on your GEMS/Polmed medical aid.
No. They would need to be members of a registered medical aid and for Government Employees a member of GEMS/Polmed medical aid and they will have to take out an additional Gap Cover policy themselves.
No. You need to be a member of a registered medical aid and for Government Employees a member of GEMS or Polmed medical aid to have The Unlimited Gap Cover. It does not replace a medical aid. The policy covers shortfalls in payments to medical service providers (up to the specified limits) that your medical aid does not cover. (Note that the procedure will need to have been approved by your medical aid first and carried out at a designated service provider facility).
Cover for the grandchild is subject to the child being legally adopted or fostered. Then the eligible child conditions will be applicable.
1. Download the g-App from your App Store
a. Website: https://bit.ly/387VPeT
b. Android store: https://bit.ly/387PSia
c. Apple Store: https://apple.co/3ydVCBH
2. Support Documents needed for your GAP Claim
a. Medical Aid Statement
b. Doctors accounts
c. Hospitals accounts
d. Proof of bank details (Only applicable for your first claim)
3. Complete the opening of your Claim via the g-App, including the uploading of all your support documents
4. Submit your GAP Cover Claim via g-App including all your supporting documents
5. You will get a confirmation that your Claim has been received with your reference number
6. Your Claim will be sent to our assessors and you’ll receive feedback accordingly
a. We’ll be in touch should further documents be required
7. If all supporting documents have been received, then it will take 10-working days to assess and complete your Claim
8. You will receive confirmation of the outcome of your Claim once it has been finalised
9. Should we not receive all your supporting documents, then your claim will be closed after 6-months from the date your claim was opened.
The principal member needs to provide his/her own banking details for payment to be made. We do not pay the service provider.
• Any procedure not covered or declined by GEMS or Polmed Medical Schemes.
• Pre-existing conditions (unless waived).
• Depression, insanity or mental stress or psychotic / psychoneurotic disorders.
• When you are admitted to hospital and undergo medical and surgical procedures and/or operations or treatment while in hospital.
• AND, In the case of going to a casualty ward if the treatment was a result of an emergency you can claim for it on your Gap Policy.
In order to be covered by The Unlimited Gap, you need to be a member of a registered medical aid and for Government Employees a member of GEMS or POLMED medical aids.
You need to be older than 18 years to be the main member.
You need to be able to afford the low premium of R350 per month.
Gap Cover is for when the bills from your stay in hospital are more than what your medical aid is willing to pay. That Gap in the payment amount is what Gap cover is all about – it fills the gap between your medical aid and the hospital bills. In the case of The Unlimited Gap cover, we cover up to 500% of the medical aid rates and up to R185 800 in hospital expenses per year. Included in that amount, we will also pay up to R10 000 in casualty medical bills for when you get admitted into hospital from casualty.
You have 15 days to make good on the payment. If you have two failed payments in a row, your cover will automatically stop, and your policy will be cancelled. You will not have cover if you have not paid your premium.
• Provided all of them are on your GEMS/Polmed medical aid, all children who are defined as eligible are covered.
• “Eligible Child” means a child, or stepchild or legally adopted child of the principal member who is under 21 and not insured under a similar policy.
• If a child is unmarried and a dependent on the principal member’s medical aid, then they can be covered up to the age of 26.
• There is no age restriction for children who are mentally or physically unable to look after themselves, as long as the children are dependent on the principal member for support and maintenance. A child can only be covered if they are covered by GEMS/Polmed medical aid scheme.
This is a medical condition you had before taking this cover. For example, if you are treated for hypertension by a doctor BEFORE the start date of this policy and are admitted to hospital due to a stroke, seven months AFTER the start date of the policy and the hypertension is the cause of the stroke, you are not covered.
A person has to be a minimum of 18 years old and under the age of 65 years.
• Our Medical advice line can be used after your first successful payment.
• GAP Cover is subject to a total of 3 payments having been received.
• For pre-existing conditions, after we’ve received 12 payments from you.
If the claim is within the benefit structure of the policy, it will be considered for payment. Where the accounts for the Specialist are declined by your registered medical aid and for Government Employees GEMS. or Polmed Medical Scheme in part or in full, then it won’t be considered for gap cover. This typically occurs when the Specialist is not part of the Medical Aids’ Network of Providers (Designated Service Provider – DSP) and or operates in a hospital facility that doesn’t belong to the Medical Aids’ Network of Listed Hospitals (Designated Service Provider – DSP).
Yes, your monthly fee for The Unlimited Gap will cover you, your spouse and all of your children who are financially dependent on you – up to 21 years, and in certain cases, up to 26 years. If you have other spouses or other adult dependants you wish to cover, you can take out an additional GAP cover product for them.
No. Any medical procedure/surgery that is not covered by your medical aid and for Government Employees GEMS/Polmed medical aid will not be covered by your Gap product. Only the SHORTFALL of expenses (up to the Gap Cover limits) not covered by your medical aid where the procedure/surgery has been pre-approved by your medical aid will be covered.
The Unlimited Gap Cover is reviewed annually with adjustments taking effect on 1 January every year. We can adjust the premium however we will give you 31 days’ written notice.
