Ambledown Gap Cover
Overall, Ambledown Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. Ambledown offers 7 Gap Cover plans, starting from R222 per month. Ambledown has a trust score of 5.1.
Ambledown Gap Cover has seven plans to choose from:
| 🔎 Ambledown Plan | 🅰️ The premium for members 18 – 65 | 🅱️ The premium for Members 66 years> |
| 🟥 Gap Cover 100 | R422 | R639 |
| 🟧 Gap Cover 200 | R288 | R401 |
| 🟨 GapPlus | R532 | R698 |
| 🟩 Gap Select | R627 | R912 |
| 🟦 Gap Supreme | R677 | N/A |
| 🟪 Gap LPE Advanced | R420 | R623 |
| 🟥 Guardian | R222 | R315 |
Ambledown Gap Cover – 12 Key Point Quick Overview
- ✅ Ambledown at a Glance
- ✅ Ambledown Gap Cover – Advantages over Competitors
- ✅ Ambledown Gap Cover Features
- ✅ How to apply for Gap Cover with Ambledown
- ✅ How can I change my Ambledown Gap Cover option?
- ✅ How to Submit a Claim for Gap Cover with Ambledown
- ✅ Ambledown Gap Cover Exclusions and Waiting Periods
- ✅ Ambledown Gap Cover vs Other Notable Providers
- ✅ Ambledown Gap Cover Pros and Cons
- ✅ Ambledown User Reviews
- ✅ Our Verdict on Ambledown Gap Cover
- ✅ Ambledown Gap Cover Frequently Asked Questions
Ambledown at a Glance
| 🔎 Date Established | 2004 |
| 📌 Underwriters | Guardrisk Insurance Company Limited |
| 📍 Headquartered | Bryanston, Sandton, South Africa |
| ➡️ The average number of members | 150,000+ |
| ↪️ Number of Markets | 1 |
| 📉 Market Share | 20% |
| 📈 The number of plans offered | 7 |
| 📊 Is a Mobile App offered | Yes, iOS and Apple |
| ⚠️ Waiting Period | 3 – 12 months |
| ⛔ Exclusions | ✅ Yes |
Ambledown Gap Cover for Medical Aid – Advantages over Competitors
The advantages of choosing Ambledown Gap Cover include, but are not limited to the following:
- ✅ Over and above the benefits of your medical insurance plan, this policy will pay up to R185,837 in hospital bills per year in medical expenses not covered by your health plan (depending on the plan chosen).
- ✅ Pays for co-pays for specific medical services.
- ✅ Offers benefits for medical evacuation in the event of an emergency.
- ✅ Provides a range of plans, including the Amble Gap Cover 100, Amble Gap Cover 200, Amble Gap Plus, Amble Gap Select, Amble Gap Supreme, and Amble Gap LPE, to meet a wide range of needs and budgets.
- ✅ After the first year of membership, pre-existing conditions are covered at no additional cost.
- ✅ Provides premium waiver benefits, which means the policyholder is not required to pay premiums if they are medically unable to work for more than 30 days due to an accident or illness.
- ✅ Provides members with access to expert medical opinions and advice from licensed medical professionals through its medical second opinion service.
- ✅ Permits must be submitted up to 180 days (or six months) after the first day of treatment.
- ✅ Provides a g-App for simple claim submission and tracking.
- ✅ Provides members with email and phone updates on the status of their claims.
Finally, Ambledown Gap Cover offers a wide selection of optional extras like trauma counseling, motor hijack cover, internal prosthesis, and body repatriation.
Ambledown Gap Cover Features
Ambledown Gap Cover 100 Plan
| 🟥 Gap Cover 100 | Gap Cover covers hospital services, listed outpatient procedures, cancer chemotherapy and radiotherapy, and kidney dialysis above the medical scheme tariff.
Gap Cover 100 provides 600% coverage.
Limited to R185,837 per year. |
| 🟧 Casualty Ward Benefit | Limited to R10,000 per event.
Casualty ward benefit covers the cost of a medical or surgical procedure after an emergency in a hospital casualty unit where the medical scheme did not cover such costs. |
| 🟨 ER24 Virtual Support | 24/7 medical advice and support, ER24 emergency service, Mental Health self-assessment, and Lifestyle self-assessment screening. |
| 🟩 Boston Online Home Education | Boston Online Home Education can help your family’s Social Emotional Learning (SEL) and High School Learning.
Social Emotional Learning (SEL)
Online Caps support for Grades 10-12
Cambridge International Curriculum discount
Career Counseling |
Ambledown Gap Cover 200
| 🟥 Gap Cover 200 | Gap Cover covers hospital services, listed outpatient procedures, cancer chemotherapy and radiotherapy, and kidney dialysis above the medical scheme tariff.
Gap Cover 200 provides 300% cover.
Limited to R185,837 per year. |
| 🟧 Casualty Ward Benefit | Limited to R10,000 per event.
Casualty ward benefit covers the cost of a medical or surgical procedure after an emergency in a hospital casualty unit where the medical scheme did not cover such costs. |
| 🟨 ER24 Virtual Support | 24/7 medical advice and support, ER24 emergency service, Mental Health self-assessment, and Lifestyle self-assessment screening. |
| 🟩 Boston Online Home Education | Boston Online Home Education can help your family’s Social Emotional Learning (SEL) and High School Learning.
Social Emotional Learning (SEL)
Online Caps support for Grades 10-12
Cambridge International Curriculum discount
Career Counseling |
Ambledown GapPlus
| 🟥 Gap Cover | Gap Cover covers hospital services, listed outpatient procedures, cancer chemotherapy and radiotherapy, and kidney dialysis above the medical scheme tariff.
Gap Cover provides 600% coverage.
Limited to R185,837 per year. |
| 🟧 Major Medical Co-payment/Deductible Cover | The co-payment benefit covers the medical scheme’s co-payments or deductibles for in-hospital admissions, listed outpatient procedures, and CT, MRI, and PET scans.
Includes a one-time payment per family per year to cover the penalty imposed by a medical scheme for using a non-network hospital.
The maximum penalty co-payment is R13,000. |
| 🟨 Casualty Ward Benefit | Limited to R10,000 per event.
Casualty ward benefit covers the cost of a medical or surgical procedure after an emergency in a hospital casualty unit where the medical scheme did not cover such costs. |
| 🟩 ER24 Virtual Support | 24/7 medical advice and support, ER24 emergency service, Mental Health self-assessment, and Lifestyle self-assessment screening. |
| 🟦 Boston Online Home Education | Boston Online Home Education can help your family’s Social Emotional Learning (SEL) and High School Learning.
Social Emotional Learning (SEL)
Online Caps support for Grades 10-12
Cambridge International Curriculum discount
Career Counseling |
Ambledown Gap Select
| 🟥 Gap Cover | Gap Cover covers hospital services, listed outpatient procedures, cancer chemotherapy and radiotherapy, and kidney dialysis above the medical scheme tariff.
Gap Cover provides 600% coverage.
Limited to R185,837 per year. |
| 🟧 Major Medical Co-payment/Deductible Cover | The co-payment benefit covers the medical scheme’s co-payments or deductibles for in-hospital admissions, listed outpatient procedures, and CT, MRI, and PET scans.
Includes a one-time payment per family per year to cover the penalty imposed by a medical scheme for using a non-network hospital.
The maximum penalty co-payment is R13,000. |
| 🟨 Casualty Ward Benefit | Limited to R10,000 per event.
Casualty ward benefit covers the cost of a medical or surgical procedure after an emergency in a hospital casualty unit where the medical scheme did not cover such costs. |
| 🟩 Dread Disease/Severe Illness Benefit | Provides a one-time dread disease benefit, limited to cancer diagnosis. However, the cover ends at the age of 65.
The benefit includes the following:
All tumors classified histologically as pre-malignant, non-invasive, or cancer in situ
Lymphoma with HIV
Kaposi’s sarcoma with HIV
Skin cancer other than malignant melanoma
Non-invasive cancer cells
Prostate or breast cancer in its early stages – Stage1 (T1a, N0, M0, G1)
Limited to R50,000 per insured person upon diagnosis |
| 🟦 ER24 Virtual Support | 24/7 medical advice and support, ER24 emergency service, Mental Health self-assessment, and Lifestyle self-assessment screening. |
| 🟪 Boston Online Home Education | Boston Online Home Education can help your family’s Social Emotional Learning (SEL) and High School Learning.
Social Emotional Learning (SEL)
Online Caps support for Grades 10-12
Cambridge International Curriculum discount
Career Counseling |
Ambledown Gap Supreme
| 🟥 Gap Cover | Gap Cover covers hospital services, listed outpatient procedures, cancer chemotherapy and radiotherapy, and kidney dialysis above the medical scheme tariff.
Gap Cover provides 600% coverage.
Limited to R185,837 per year. |
| 🟧 Major Medical Co-payment/Deductible Cover | The co-payment benefit covers the medical scheme’s co-payments or deductibles for in-hospital admissions, listed outpatient procedures, and CT, MRI, and PET scans.
Includes a one-time payment per family per year to cover the penalty imposed by a medical scheme for using a non-network hospital.
The maximum penalty co-payment is R13,000. |
| 🟨 Sub-limitation Cover | The sub-limitation benefit covers charges that exceed the medical scheme’s defined in-hospital sub-limits. |
| 🟩 Cancer Cover | The cancer benefit covers the shortfall — either the co-payment or the sub-limitation — for traditional cancer treatment methods or the sub-limitation for cancer treatment with defined biological drugs, immunotherapy, hormone therapy, targeted therapy, photodynamic therapy, or stem cell transplants. |
| 🟦 Extended Cancer Cover | Extended Cancer Treatment Cover covers charges above the Medical Scheme sub-limitation for defined biological Cancer drugs for defined oncological conditions or specific sub-groups of:
Cancer
Immunotherapy
Hormone Therapy
Targeted Therapy
Photodynamic Therapy
Stem Cell Transplant |
| 🟪 Casualty Ward Benefit | Limited to R10,000 per event.
Casualty ward benefit covers the cost of a medical or surgical procedure after an emergency in a hospital casualty unit where the medical scheme did not cover such costs. |
| 🟥 Dread Disease/Severe Illness Benefit | Provides a one-time dread disease benefit, limited to cancer diagnosis. However, the cover ends at the age of 65.
The benefit includes the following:
All tumors classified histologically as pre-malignant, non-invasive, or cancer in situ
Lymphoma with HIV
Kaposi’s sarcoma with HIV
Skin cancer other than malignant melanoma
Non-invasive cancer cells
Prostate or breast cancer in its early stages – Stage1 (T1a, N0, M0, G1)
Limited to R50,000 per insured person upon diagnosis |
| 🟧 Premium Waiver Benefit | Pays 6 months of medical scheme contributions and Gap Cover premiums once.
Cover ends at the age of 65. |
| 🟨 ER24 Virtual Support | 24/7 medical advice and support, ER24 emergency service, Mental Health self-assessment, and Lifestyle self-assessment screening. |
| 🟩 Boston Online Home Education | Boston Online Home Education can help your family’s Social Emotional Learning (SEL) and High School Learning.
Social Emotional Learning (SEL)
Online Caps support for Grades 10-12
Cambridge International Curriculum discount
Career Counseling |
Ambledown Gap LPE Advanced
| 🟥 LPE Advanced | Provides a benefit equal to the cost of in-hospitalization and associated medical expenses (as defined) for one of the listed procedures less the medical scheme option’s cover.
The Listed Procedures mentioned below are limited to the actual costs incurred, calculated at the Medical Scheme Rate, and subject to a specific limitation of R100,000 in aggregate per insured person per annum.
The defined listed procedures covered include:
In-hospital dentistry for impacted teeth for minors under 18 or reconstructive plastic surgery due to an accident during the cover
Rhinoplasty
Oesophageal reflux and hiatus hernia surgery.
Neck and back surgery
Joint replacements, including but not limited to hips, knees, shoulders, and elbows
Cochlear implants, auditory brain implants, and internal nerve stimulators, including procedures, devices, and processors.
Bunionectomy
Arthroscopy.
Varicose vein removal
Lipomas and benign growths |
| 🟧 Gap Cover 100 | Gap Cover covers hospital services, listed outpatient procedures, cancer chemotherapy and radiotherapy, and kidney dialysis above the medical scheme tariff.
Gap Cover 100 provides 600% coverage.
Limited to R185,837 per year. |
| 🟨 Casualty Ward Benefit | Limited to R10,000 per event.
Casualty ward benefit covers the cost of a medical or surgical procedure after an emergency in a hospital casualty unit where the medical scheme did not cover such costs. |
| 🟩 ER24 Virtual Support | 24/7 medical advice and support, ER24 emergency service, Mental Health self-assessment, and Lifestyle self-assessment screening. |
| 🟦 Boston Online Home Education | Boston Online Home Education can help your family’s Social Emotional Learning (SEL) and High School Learning.
Social Emotional Learning (SEL)
Online Caps support for Grades 10-12
Cambridge International Curriculum discount
Career Counseling |
Ambledown Guardian
| 🟥 Major Medical Co-payment/Deductible Cover | The co-payment benefit covers the medical scheme’s co-payments or deductibles for in-hospital admissions, listed outpatient procedures, and CT, MRI, and PET scans.
Includes a one-time payment per family per year to cover the penalty imposed by a medical scheme for using a non-network hospital.
The maximum penalty co-payment is R13,000. |
| 🟧 Sub-limitation Cover | The sub-limitation benefit covers charges that exceed the medical scheme’s defined in-hospital sub-limits. |
| 🟨 Cancer Cover | The cancer benefit covers the shortfall — either the co-payment or the sub-limitation — for traditional cancer treatment methods or the sub-limitation for cancer treatment with defined biological drugs, immunotherapy, hormone therapy, targeted therapy, photodynamic therapy, or stem cell transplants. |
| 🟩 Extended Cancer Cover | Extended Cancer Treatment Cover covers charges above the Medical Scheme sub-limitation for defined biological Cancer drugs for defined oncological conditions or specific sub-groups of:
Cancer
Immunotherapy
Hormone Therapy
Targeted Therapy
Photodynamic Therapy
Stem Cell Transplant |
| 🟦 Casualty Ward Benefit | Limited to R10,000 per event.
Casualty ward benefit covers the cost of a medical or surgical procedure after an emergency in a hospital casualty unit where the medical scheme did not cover such costs. |
| 🟪 Dread Disease/Severe Illness Benefit | Provides a one-time dread disease benefit, limited to cancer diagnosis. However, the cover ends at the age of 65.
The benefit includes the following:
All tumors classified histologically as pre-malignant, non-invasive, or cancer in situ
Lymphoma with HIV
Kaposi’s sarcoma with HIV
Skin cancer other than malignant melanoma
Non-invasive cancer cells
Prostate or breast cancer in its early stages – Stage1 (T1a, N0, M0, G1)
Limited to R50,000 per insured person upon diagnosis |
| 🟥 Premium Waiver Benefit | Pays 6 months of medical scheme contributions and Gap Cover premiums once.
Cover ends at the age of 65. |
| 🟧 ER24 Virtual Support | 24/7 medical advice and support, ER24 emergency service, Mental Health self-assessment, and Lifestyle self-assessment screening. |
| 🟨 Boston Online Home Education | Boston Online Home Education can help your family’s Social Emotional Learning (SEL) and High School Learning.
Social Emotional Learning (SEL)
Online Caps support for Grades 10-12
Cambridge International Curriculum discount
Career Counseling |
READ more about the 5 Best Gap Cover Options for Under R3000
How to apply for Gap Cover with Ambledown
Here is a step-by-step guide on how to submit claims to Ambledown Gap Cover:
- ✅ Obtain a claim form from the Ambledown website at www.ambledown.co.za.
- ✅ Fill out the claim form with all the required information.
- ✅ Gather all supporting documentation, such as medical bills and receipts, and attach them to the claim form.
- ✅ Submit the completed claim form and supporting documentation by email.
- ✅ Alternatively, download the g-App to submit and track your claim quickly and easily.
- ✅ Wait for Ambledown to assess your claim. A decision will be made within ten (10) working days from receipt of all the correct documents.
- ✅ If there are any unforeseen delays, Ambledown will communicate them and indicate the expected final decision date.
Ambledown may use your email address and telephone number to inform you of the claim’s progress.
How can I change my Ambledown Gap Cover option?
To change your Ambledown Gap Cover option, you will need to follow these steps:
- ✅ Contact Ambledown Financial Services via phone or email to request a change of plan.
- ✅ Provide your policy number and personal information for identification purposes.
- ✅ Request information on the plans available and which would best suit your needs.
- ✅ Complete the necessary application form for the new plan and submit it to Ambledown Financial Services.
- ✅ Await approval of your new plan and the effective date of the change.
- ✅ Ensure you know any waiting periods or exclusions that may apply to your new plan.
Cancel your previous plan to avoid being charged for two plans simultaneously.
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How to Submit a Claim for Gap Cover with Ambledown
To submit a claim for Gap Cover with Ambledown, follow these steps:
- ✅ Download the claim form from the Ambledown website or request it from Ambledown Financial Services.
- ✅ Complete the claim form fully, ensuring all required fields are filled in accurately.
- ✅ Collect and attach all supporting documentation, such as medical scheme remittance advice, hospital accounts, and accounts for in-hospital attending medical practitioners, as well as any receipts or other documentation required for your specific claim.
- ✅ Submit your claim form and supporting documentation to Ambledown Financial Services via email, fax, or post.
- ✅ Await assessment of your claim by Ambledown, which should take no longer than 10 working days from receipt of all the correct documents. Furthermore, you will be informed of unforeseen delays and indicate the expected final decision date.
Payment will be made directly into your bank account if your claim is approved.
Ambledown Gap Cover Exclusions and Waiting Periods
Ambledown Gap Cover Exclusions
Your Gap insurance will not cover any costs you incur immediately. For example, accounts related to depression, emotional matters, or mental illnesses are typically not covered by gap insurance.
Rehabilitation for drugs or alcohol is typically not covered by a health gap plan unless specifically included in your PMB.
Ambledown Gap Cover Waiting Periods
All applications for a new membership with Ambledown will be subject to a 3-month general waiting period. This is unless the claims qualify as an accident in terms of the policy definition or if the client changes gap cover policies with similar benefits offered by different product providers within the same insurer (GICL).
Additionally, a 12-month pre-existing clause will apply, excluding claims for any treatment received for a condition 12 months before the policy’s inception.
However, benefits will be payable once the membership is over 12 months, regardless of when the illness manifested, or the injury occurred.
If a member upgrades their cover, the additional benefits obtained will be subject to a 3-month general waiting period and a 12-month pre-existing clause.
However, the existing benefits enjoyed before the upgrade will not be subject to the waiting periods mentioned.
Ambledown Gap Cover vs Other Notable Providers
| 🔎 Gap Cover Provider | 🥇 Ambledown | 🥈 Stratum Benefits | 🥉 Sirago |
| 🟥 Number of Plans | 7 | 11 | 8 |
| 🟧 Average Price | R222 | R167 | R289 |
| 🟨 Waiting Periods | 3 – 12 months | 3 months | 3 months |
| 🟩 Exclusions | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟦 Oncology Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 In-Hospital Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟥 Out-of-Hospital Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟧 Maternity Benefit | None | ✅ Yes | ✅ Yes |
| 🟨 Scopes and Scans | ✅ Yes | ✅ Yes | None |
| 🟩 Co-payment Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟦 Emergency Room | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Accidental Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟥 Trauma Counseling | None | ✅ Yes | ✅ Yes |
| 🟧 Premium Waiver | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟨 Non-DSP Co-Payment | None | ✅ Yes | ✅ Yes |
| 🟩 Prostheses | None | ✅ Yes | None |
| 🟦 Accidental Death/ Permanent Disability | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Travel Cover Extender | None | None | None |
Ambledown Gap Cover Pros and Cons
| ✅ Pros | ❎ Cons |
| Provides cover for in-hospital medical expenses that exceed medical scheme benefits, up to R185,837 per policy year | A 12-month waiting period applies to pre-existing conditions. |
| Covers co-payments for certain medical procedures | A 3-month waiting period applies to additional benefits obtained when a member upgrades cover. |
| Offers different plans to cater to various needs and budgets | Some plans have age limits for new members to join. |
| Provides emergency medical evacuation benefits | Certain conditions and procedures are excluded from cover. |
| Offers premium waiver benefits | No cover for out-of-hospital medical expenses. |
| Provides a medical second opinion service to members | No coverage for non-medical expenses, such as travel or accommodation. |
| Allows claims to be submitted up to 180 days or six months from the first day of treatment | No cover for cosmetic or elective medical procedures. |
Read more about the 5 Best Hospital Plans for young children
Ambledown User Reviews
Exceptional Support.
The gap provider demonstrated exceptional support to clients during a difficult period, specifically regarding claims affected by the Constantia liquidation. – Catherine du Toit
Professional and Efficient.
Ambledown Gap Cover proved professional and efficient when processing a childbirth-related claim, with payment made within 10 days. The service is recommended for those seeking reliable gap cover. – Tracy van Dyk
Excellent.
Amble down Gap Cover displayed excellent service delivery when addressing an incorrect claim submission. The Claims Operations Executive Manager contacted the client, and the claim was professionally handled and paid out. Ambledown Gap Cover is recommended to handle and resolve claims effectively. – Thembi Thompson
Our Verdict on Ambledown Gap Cover
Ambledown Gap Cover offers a comprehensive range of plans to cater to various needs and budgets, such as the Amble Gap Cover 100, Amble Gap Cover 200, Amble Gap Plus, Amble Gap Select, Amble Gap Supreme, and Amble Gap LPE.
These plans cover in-hospital medical expenses exceeding medical scheme benefits, up to R185,837 per policy year. Ambledown Gap Cover also covers co-payments for certain medical procedures, provides emergency medical evacuation benefits, and offers premium waiver benefits.
Additionally, Ambledown Gap Cover provides a comprehensive range of value-added benefits, such as trauma counseling, motor hijack cover, internal prosthesis, and body repatriation, depending on the plan chosen.
Sharpen your knowledge with a better understanding of Medical Aid in SA
Ambledown Gap Cover Frequently Asked Questions
What is Ambledown Gap Cover?
Ambledown Gap Cover is a form of insurance that covers medical expenses not fully covered by your medical aid.
How does Ambledown Gap Cover work?
Ambledown Gap Cover covers the shortfall between what your medical aid pays and what your medical expenses cost.
What does Ambledown Gap Cover include?
The cover offered by Ambledown Gap Cover can vary depending on the plan you choose but typically includes things like in-hospital expenses, co-payments, and medical scheme shortfalls.
How much does Ambledown Gap Cover cost?
Ambledown Gap Cover costs from R222 per month on the Guardian option.
Can I customize my Ambledown Gap Cover plan?
Yes, Ambledown offers a variety of Gap Cover plans that you can customize based on your individual needs and budget.
Do I need to have medical aid to qualify for Ambledown Gap Cover?
Yes, Ambledown Gap Cover is designed to work with your medical aid, so you must have a medical aid plan to be eligible for Gap Cover.
How do I submit a claim for Ambledown Gap Cover?
To submit a claim for Ambledown Gap Cover, you can download the claim form from their website or request it from Ambledown directly. Complete the form and attach any required supporting documentation before submitting via email, fax, or post.
How long does it take for Ambledown to process a claim?
Ambledown aims to process claims within 10 working days of receiving all required documentation. However, this may vary depending on the complexity of your claim and any unforeseen delays.
What is the waiting period for Ambledown Gap Cover?
The waiting period for Ambledown Gap Cover is typically three months for new members, but this may vary depending on your specific plan.
Does Ambledown Gap Cover have any exclusions?
Yes, Ambledown Gap Cover has some exclusions, which may vary depending on your chosen plan. It is important to review the policy documents carefully to understand what is and is not covered.
