The Best Medical Aids
The Best Hospital Plans
Overall, Ambledown Gap Cover 200 is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Ambledown Gap Cover 200 Plan starts from R288 ZAR. Ambledown has a trust score of 5.1.
🔎 Provider | 🥇 Ambledown Gap Cover 200 |
🟥 Years in Operation | 19 years |
🟧 Underwriters | Guardrisk Insurance Company Limited |
🟨 Market Share in South Africa | 20% |
🟩 Gap Cover Waiting Period | 3 – 12 months |
🟦 Do Exclusions Apply | ✅ Yes |
🟪 Average Monthly Premium | R288 |
🟥 Oncology Benefit | ✅ Yes |
🟧 In-Hospital Benefit | ✅ Yes |
🟨 Out-of-Hospital Cover | ✅ Yes |
The Ambledown Gap Cover 200 is one of seven plans that starts from R288 per month. Ambledown’s Gap Cover 200 has benefits for hospital services, covering up to 300%, lifestyle self-assessment screening, casualty wards, and more.
Ambledown offers 24/7 medical emergency assistance.
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 200 | R288 | R401 |
🟥 Gap Cover 200 | Gap Cover covers hospital services, listed out-patient 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 |
Regarding mental health, accounts related to depression, emotional matters, or mental illnesses are typically not covered by Ambledown’s Gap insurance. This means that expenses related to therapy sessions, counseling, or treatment for such conditions would not be eligible for coverage.
Similarly, rehabilitation for drugs or alcohol is generally not covered by a standard health gap plan offered by Ambledown unless it is specifically included in your Prescribed Minimum Benefits (PMB). PMB refers to the minimum level of care that health insurers are legally required to cover.
If your policy includes drug or alcohol rehabilitation as part of the PMB, you may be eligible for cover.
Ambledown applies the following waiting periods:
Membership Application:
Exceptions to Waiting Period:
Pre-existing Clause:
Upgrade of Cover:
However, the existing benefits enjoyed before the upgrade will not be subject to the waiting periods mentioned.
🔎 Provider | 🥇 Ambledown Gap Cover 200 | 🥈 GapCover® Standard | 🥉 Stratum Benefits Compact 300 |
🟥 Years in Operation | 19 years | N/A | 24 years |
🟧 Underwriters | Guardrisk Insurance Company Limited | Western National Insurance Company Limited | Guardrisk Insurance Company Limited (FSP 75) |
🟨 Market Share in South Africa | 20% | <1% | >5% |
🟩 Gap Cover Waiting Period | 3 – 12 months | 3 – 12 months | 3 – 12 months |
🟦 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
🟪 Average Monthly Premium | R288 | R292 | R276 |
🟥 Oncology Benefit | ✅ Yes | None | None |
🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | None |
🟨 Out-of-Hospital Cover | ✅ Yes | None | None |
🟩 Maternity Benefit | None | None | None |
🟦 Scopes and Scans | None | None | None |
🟪 Co-payment Cover | None | None | None |
🟥 Emergency Room | ✅ Yes | ✅ Yes | None |
🟧 Accidental Cover | ✅ Yes | ✅ Yes | None |
🟨 Trauma Counseling | None | None | None |
🟩 Premium Waiver | None | None | None |
🟦 Non-DSP Co-Payment | None | None | None |
🟪 Prostheses | None | None | None |
🟥 Travel Cover Extender | None | None | None |
🟧 Accidental Death/ Permanent Disability | None | None | None |
According to our research, Ambledown Gap Cover 200 from Ambledown, a reputable South African medical aid provider, offers a variety of benefits and features. The cover for hospital services, including procedures, chemotherapy, and dialysis, exceeds the medical scheme tariff. In addition, including a casualty ward benefit and medical advice 24 hours a day, 7 days a week through ER24 Virtual Support increases the value.
However, it is essential to note that the plan has certain restrictions.
Ambledown Gap Cover 200 is a short-term insurance policy designed to cover the ‘gap’ between what your medical aid will pay and what doctors or specialists may charge for specific treatments and procedures. It provides up to three times the Medical Scheme Rate in coverage (300%).
For families with insured members between 18 and 65, the monthly cost begins at R288. The monthly cost for families with individuals aged 66 and older begins at R401.
The annual cover maximum is R185,837 per insured person.
Yes, there are waiting periods. But, first, there is a three-month general waiting period during which no benefits are payable for treatment received unless the treatment results from an accident. Second, a 12-month pre-existing condition clause excludes cover for any treatment or advice received 12 months before the policy’s effective date.
The Medical Scheme Rate (MSR) is the amount your medical insurance will pay for particular treatments and procedures. The shortfall or ‘gap’ is the difference between the medical practitioner’s charge and the Medical Aid Tariff (MST) rate for specific in-hospital surgical and out-of-hospital authorized procedures.
We work with leading medical aid companies in South Africa.
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