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Overall, Ambledown GapPlus Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Ambledown GapPlus Gap Cover Plan starts from R532 ZAR. Ambledown has a trust score of 5.1.
🔎 Provider | 🥇 Ambledown GapPlus |
🟥 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 | R532 |
🟥 Oncology Benefit | ✅ Yes |
🟧 In-Hospital Benefit | ✅ Yes |
🟨 Out-of-Hospital Cover | ✅ Yes |
The Ambledown GapPlus is one of seven plans that starts from R532 per month. Ambledown’s GapPlus has benefits for chemotherapy, scopes, and scans, penalties imposed when using a non-network hospital, casualty wards, and more.
Ambledown Gap Cover has seven plans to choose from:
🔎 Ambledown Plan | 🅰️ The premium for members 18 – 65 | 🅱️ The premium for Members 66 years> |
↪️ GapPlus | R532 | R698 |
🟥 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 |
POLL: 5 Best Gap Cover Options for Under R2000
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 GapPlus | 🥈 Cura Administrators Gap Standard | 🥉 Kaelo Gap Core |
🟥 Years in Operation | 19 years | 26 years | 19 years |
🟧 Underwriters | Guardrisk Insurance Company Limited | GENRIC Insurance Company Limited | Centriq Insurance Company Limited |
🟨 Market Share in South Africa | 20% | <5% | <1% |
🟩 Gap Cover Waiting Period | 3 – 12 months | 3 – 12 months | 12 months |
🟦 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
🟪 Average Monthly Premium | R532 | R281 | R255 |
🟥 Oncology Benefit | ✅ Yes | None | None |
🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
🟨 Out-of-Hospital Cover | ✅ Yes | None | None |
🟩 Maternity Benefit | None | None | None |
🟦 Scopes and Scans | ✅ Yes | ✅ Yes | None |
🟪 Co-payment Cover | ✅ Yes | ✅ Yes | None |
🟥 Emergency Room | ✅ Yes | ✅ Yes | None |
🟧 Accidental Cover | ✅ Yes | None | ✅ Yes |
🟨 Trauma Counseling | None | None | None |
🟩 Premium Waiver | None | None | ✅ Yes |
🟦 Non-DSP Co-Payment | ✅ Yes | None | None |
🟪 Prostheses | None | None | None |
🟥 Travel Cover Extender | None | None | None |
🟧 Accidental Death/ Permanent Disability | None | None | ✅ Yes |
Ambledown GapPlus is a robust gap cover plan in South Africa with many benefits. Despite higher premiums than competitors, it covers various services, including chemotherapy, scans, and casualty wards.
The plan offers a 600% gap cover limited to R185,837 per year and a co-payment benefit covering the medical scheme’s co-payments for in-hospital admissions and outpatient procedures. However, it excludes mental health and substance rehabilitation services.
No, Gap products like Ambledown GapPlus are not substitutes for Medical Aid. Instead, they fall under the definition of “accident and health policy” in the Short-Term Insurance Act No.53 of 1998 or the Long-term Insurance Act of 1998.
No, Ambledown GapPlus primarily covers in-hospital shortfalls and co-payments, along with certain listed procedures that might be performed on an outpatient basis.
Yes, there is an opportunity to cover immediate and extended family members with Ambledown GapPlus.
Out–of–hospital benefits are not covered. However, according to our research, certain listed procedures are covered on an outpatient basis. It is advisable to refer to the policy document for more comprehensive details.
Claims are typically assessed and paid, provided all the relevant documentation is received upfront within 14 days.
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