Agility Gap Cover (🇿🇦 2024)

Overall, Agility Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those with medical aid. The Agility Gap Cover Plans start from R117 ZAR. Agility has a trust score of 4.1.   💙Agility GAP Cover has six plans to choose from:

• Agility Ultra Gap Cover
• Agility Gap 500 Gap Cover
• Agility Gap 200 Gap Cover
• Agility Combined 500 Gap Cover
• Agility Combined 400 Gap Cover
• Agility Combined 200 Gap Cover

     

Agility Gap Cover - Analysis of Providers' Main Features

1. ✅ Agility Gap Cover Features
2. ✅ Agility Gap Cover Premiums
3. ✅ Agility Gap Cover – Advantages Over Competitors
4. ✅ How to apply for Gap Cover with Agility
5. ✅ How can I change my Agility Gap Cover option?
6. ✅ How to Submit a Claim for Gap Cover with Agility
7. ✅ Agility Gap Cover Exclusions
8. ✅ Agility Gap Cover Waiting Periods
9. ✅ Agility User Reviews
10. ✅ Agility Gap Cover vs Other Notable Providers
11. ✅ Agility Gap Cover Pros and Cons
12. ✅ Our Verdict on Agility Gap Cover
13. ✅ Agility Gap Cover Frequently Asked Questions

   

Agility Gap Cover Features

 

Agility Gap 200

✅ Cover % and Overall Annual Limit

• Gap Cover %:  Up to twice the Medical Aid Tariff (200%).
• Overall Annual Limit:  Limited to R201,000 per beneficiary per year.

  ✅ In-Hospital Cover

• PMB Cover – In-Hospital Treatment:  Limited to R3,500 per policy per year.

  ✅ Out-of-Hospital Cover

• Emergency Room Benefits for Trauma, Accidents, and Illness: Limited to R2,500 per policy per year.

  ✅ Ancillary Cover

• Gap Premium Waiver if the Policyholder dies or is permanently disabled: 12 months.
• Medical Scheme Contribution Waiver if the main policyholder/member dies or is permanently disabled: Limited to R6,000 per policy per year for 6 months.

       

Agility Gap 500

✅ Cover % and Overall Annual Limit

• Gap Cover %: Up to five times the Medical Aid Tariff (500%).
• Overall Annual Limit: Limited to R201,000 per beneficiary per year.

  ✅ In-Hospital Cover

• PMB Cover – In-Hospital Treatment:  Limited to R15,000 per policy per year.

  ✅ Out-of-Hospital Cover

• Emergency Room Benefits for Trauma, Accidents, and Illness: Limited to R3,000 per policy per year.

  ✅ Ancillary Cover

• Gap Premium Waiver if the Policyholder dies or is permanently disabled: 12 Months.
• Medical Scheme Contribution Waiver if the main policyholder/member dies or is permanently disabled: Limited to R7,000 per policy per year for 6 months.

       

Agility Combined 200

✅ Cover % and Overall Annual Limit

• Gap Cover %: Up to twice the Medical Aid Tariff (200%).
• Overall Annual Limit: Limited to R201,000 per beneficiary per year.

  ✅ In-Hospital Cover

• Co-Payment Cover for Procedures, MRI, and CT scan co-payments in and out-of-hospital:  Unlimited cover but subject to the OAL.
• Co-Payment Cover for Procedures, MRI, and CT scan co-payments in and out-of-hospital:  There is no limit per event.
• PMB Cover – In-Hospital Treatment:  Limited to R3000 per policy per year.

  ✅ Out-of-Hospital Cover

• Emergency Room Benefits for Trauma, Accidents, and Illness:  Limited to R4,000 per policy per year.
• Out-patient Procedure Cover procedures performed in the doctor’s rooms:  Limited to R5000 per event and R16,000 per policy per year.

  ✅ Ancillary Cover

• Gap Premium Waiver if the Policyholder dies or is permanently disabled:  12 Months.
• Medical Scheme Contribution Waiver if the main policyholder/member dies or is permanently disabled:  Limited to R6,000 per policy per year for 6 months.

 

Discover the 5 Best Gap Cover Options for Under R200

       

Agility Combined 400

✅ Cover % and Overall Annual Limit

• Gap Cover %:  Up to four times the Medical Aid Tariff (400%).
• Overall Annual Limit:  Limited to R201,000 per beneficiary per year.

  ✅ In-Hospital Cover   ✅ Out-of-Hospital Cover   ✅ Ancillary Cover  

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Agility Combined 500

✅ Cover % and Overall Annual Limit

• Gap Cover %:  Up to five times the Medical Aid Tariff (500%).
• Overall Annual Limit:  Limited to R201,000 per beneficiary per year.

  ✅ In-Hospital Cover   ✅ Out-of-Hospital Cover   ✅ Ancillary Cover        

Agility Ultra Gap Cover

✅ Cover % and Overall Annual Limit

• Gap Cover %: Up to five times the Medical Aid Tariff (500%).
• Overall Annual Limit: Limited to R201,000 per beneficiary per year.

    ✅ In-Hospital Cover   ✅ Out-of-Hospital Cover   ✅ Ancillary Cover        

Agility Gap Cover Premiums

 

Individuals and Families <65 Years

 

Individuals and Families 65 Years>

   

Agility Gap Cover for Medical Aid - Advantages Over Competitors

  The advantages of choosing Agility Gap Cover include the following:  

• ✅ Agility Gap Cover offers a variety of plans to accommodate the varying needs and budgets of families and individuals. Plans range from basic to comprehensive, with varying coverage and benefits options.
• ✅ Agility Gap Cover does not require medical underwriting, so individuals can enroll without undergoing any medical tests or exams.
• ✅ Agility Gap Cover does not require co-payments or upfront payments, allowing individuals to focus solely on their recovery without financial concerns.
• ✅ The claims process for Agility Gap Cover is straightforward, and claims are settled quickly and efficiently.

    Finally, Agility Gap Cover offers comprehensive coverage to help individuals pay for medical expenses not covered in full by their medical aid plans. This includes hospitalization costs, specialist and general practitioner consultations, dentistry, and optometry.    

How to apply for Gap Cover with Agility

  The application process for Gap Cover with Agility is straightforward. Following are the steps for applying for Gap Cover:  

• ☑️ Visit the Agility Gap Cover website or call their customer service department to receive a quote for the Gap Cover plan that best meets your needs and budget.
• ☑️ After receiving the quote and deciding to proceed with the application, you can submit the form online or via email.
• ☑️ Include your personal information, medical aid information, and any pre-existing medical conditions among the information and documentation required.
• ☑️ You will receive a policy document detailing the terms and conditions of your Gap Cover plan after your application has been processed and approved.

    Then, you can use your Gap Cover plan to cover the remaining medical expenses not covered by your medical aid plan.    

How can I change my Agility Gap Cover option?

  Agility allows policyholders to change their gap cover option at any given time. To change your option, you can follow these steps:  

• ✅ Determine the modifications you wish to make to your policy. Then, contact Agility Gap Cover to discuss your options and determine which plan best meets your needs and budget.
• ✅ Once you have determined the desired changes, you must notify Agility Gap Cover in writing of your intent to modify your policy. You may do so via fax, email, or postal mail, using their recorded contact information.
• ✅ Wait for Agility Gap Cover to confirm that your request has been processed. You will receive this confirmation in writing.
• ✅ Verify that the changes have been accurately reflected in the new policy documents and that you understand the terms and conditions of the updated policy.

    Ensure that your contact information is accurate so that Agility Gap Cover can contact you regarding your policy.    

How to Submit a Claim for Gap Cover with Agility

  Follow these steps to claim from Agility Gap Cover:  

• ☑️ Confirm that your premium payments are current and that your policy is in good standing.
• ☑️ Report your claim as soon as possible to Agility Gap Cover, even if you do not intend to file a claim immediately.
• ☑️ Include a fully completed and signed claim form, hospital and related accounts, your Medical Scheme Statement, and an Accident Report or pre-authorization letter provided by your medical scheme to support your claim.
• ☑️ Ensure all policy conditions have been met and all required documents submitted within 90 days of your Medical Scheme paying their portion of the claim.
• ☑️ Once Agility Gap Cover has validated your claim and received all required documents, the claim will be evaluated for payment.

    Agility Gap Cover will pay the benefit as quickly as possible if your claim is approved, subject to your policy's terms and conditions.    

Agility Gap Cover Exclusions

  Agility Gap Cover exclusions include, but are not limited to, the following:  

• ✅ Uncovered or unintended claims
• ✅ Alternative legislation claims
• ✅ Pre-existing conditions will be excluded for 12–24 months. This includes any condition for which an Insured person sought medical advice or treatment by a Registered Medical Professional or exhibited symptoms before this policy's inception.
• ✅ Claims within three months, excluding accidents
• ✅ Routine medical advice
• ✅ Diagnostic or routine physical exams
• ✅ Drugs, prescriptions,
• ✅ Alcohol, drug, or substance intoxication, use, abuse, or addiction, except for registered drugs prescribed by a Registered Medical Professional.
• ✅ Depression, insanity, psychosis, and stress-related and affective disorders are psychiatric conditions.
• ✅ Suicide, attempted suicide, or self-harm

    and many more. A full list of exclusions will be made available by Agility.    

Agility Gap Cover Waiting Periods

  Agility Gap Cover does not detail its waiting periods in the policy wording. However, as with most gap cover providers, the following waiting periods could apply:  

• ☑️ All new policies are subject to a three-month general waiting period during which no claims will be paid. This waiting period is intended to deter individuals from purchasing insurance only when they need to file a claim.
• ☑️ If you have a pre-existing medical condition when you join Agility Gap Cover, there is a 12-month to 24-month waiting period before you can file a claim for treatment related to that condition (as per the policy exclusions).

    A 10-month waiting period might apply to maternity-related claims, meaning that you must have been a policyholder for at least 10 months before you can file a claim for maternity-related care.    

Agility User Reviews

  Very Happy. Regarding the complaint I submitted against Agility Gap Cover last week, I would like to express my appreciation for the high professionalism and friendly service demonstrated by the individuals handling my complaint. I am pleased to report that my complaint was resolved promptly and efficiently, and I am satisfied with the outcome. - Samantha Barkley    

Agility Gap Cover vs Other Notable Providers

     

Agility Gap Cover Pros and Cons

    Read more about the 5 Best Hospital Plans for people not working (Unemployed)     

Our Verdict on Agility Gap Cover

  In our experience, Agility Gap Cover offers comprehensive medical coverage that can be a valuable addition to any medical aid plan. The plans are flexible and can be tailored to suit individuals' and families' specific needs and budgets. We appreciate that no medical underwriting is required, and there is a decent overall annual limit on all policies of up to R191,000. The claims process is straightforward, and claims are settled quickly and efficiently once all the required documents are received. In addition, the value-added benefits, such as Gap Cover and Medical Scheme Contribution Waivers, are also a plus. However, according to our research, there are some drawbacks to Agility Gap Cover. For example, the waiting periods for pre-existing conditions and certain benefits can be lengthy, which could disadvantage some individuals.      

Agility Gap Cover Frequently Asked Questions

 

What is Agility Gap Cover?

Agility Gap Cover is a type of medical insurance that supplements your medical aid plan with additional cover.  

What does Agility Gap Cover include?

Agility Gap Cover covers medical expenses not fully covered by your medical aid plan, such as co-payments, deductibles, and other out-of-pocket expenses.  

How does Agility Gap Cover work?

When your medical aid plan does not cover all your medical expenses, you can submit a claim to Agility Gap Cover to cover the remaining balance.  

Are there waiting periods for Agility Gap Cover?

Yes, there are waiting periods for certain benefits and conditions, which vary based on the policy you select. These include a general waiting period of three months up to 12 or 24 months for pre-existing conditions.  

Can I customize my Agility Gap Cover plan?

Yes, Agility Gap Cover offers flexible plans that can be customized to meet your needs and budget.  

Are there any annual limits on claims for Agility Gap Cover?

Yes, there are annual limits on the claims for Agility Gap Cover. An overall limit of R191,000 and sub-limits apply according to plans and their unique benefits.  

Can I cancel my Agility Gap Cover policy?

Yes, you may cancel your Agility Gap Cover policy at any time by providing written notice and a 31-day cancellation notice.