Guardian
About this plan
Guardian is a comprehensive Ambledown gap cover plan that helps cover specialist fee shortfalls, hospital co-payments, cancer treatment shortfalls, casualty ward treatment, and selected medical expense limits. It is designed for members who want broader financial protection against unexpected healthcare costs alongside their medical scheme.
Monthly premium
From
R269
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Guardian
Ambledown Guardian Gap Cover (🇿🇦 2025)
Overall, Ambledown Guardian Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those with medical aid. The Ambledown Guardian Gap Cover Plan starts from R245 ZAR. Ambledown has a trust score of 5.1.
Ambledown Guardian Gap Cover - 7 Key Point Quick Overview
- ✅ Ambledown Guardian Overview
- ✅ Ambledown Guardian Premiums
- ✅ Ambledown Guardian Benefits and Cover Breakdown
- ✅ Ambledown Guardian Exclusions and Waiting Periods
- ✅ Ambledown Guardian vs Other Gap Cover Plans
- ✅ Our Verdict on Ambledown Guardian
- ✅ Ambledown Guardian Frequently Asked Questions
Ambledown Guardian Overview
The Ambledown Guardian is one of seven plans that starts from R245 per month. Ambledown’s Guardian has benefits for waiving premiums, online home education, severe illness, sub-limit cover, cancer, and more. 💙Ambledown Gap Cover has seven plans to choose from:
Ambledown Guardian Premiums
| 🔎 Ambledown Plan | 🅰️ Premium for members 18 – 65 | 🅱️ Premium for Members 66 years> |
| ↪️ Guardian | R245 | R348 |
Ambledown Guardian Benefits and Cover Breakdown
| 🟥 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 R15,000. |
| 🟧 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 R11,000 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. |
Ambledown Guardian Exclusions and Waiting Periods
Ambledown Guardian Exclusions
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 Guardian Waiting Periods
Ambledown applies the following waiting periods: Membership Application:- ✅ All applications for a new membership with Ambledown will be subject to a 3-month general waiting period.
- ✅ The waiting period can be waived if the claims qualify as an accident according to the policy definition.
- ✅ The waiting period can also be waived if the client switches gap cover policies within the same insurer (GICL), provided the new policy offers similar benefits.
- ✅ A 12-month pre-existing clause will apply, excluding claims for any treatment received for a condition 12 months before the policy’s inception.
- ✅ Benefits for pre-existing conditions will be payable once the membership is over 12 months, regardless of when the illness manifested or the injury occurred.
Ambledown Guardian vs Other Gap Cover Plans
| 🔎 Provider | 🥇 Ambledown Guardian | 🥈 Netcare GapCare500+ | 🥉 Discovery Health Gap Comprehensive |
| 🟥 Years in Operation | 19 years | 27 years | 31 years |
| 🟧 Underwriters | Guardrisk Insurance Company Limited | The Hollard Insurance Company Limited | Discovery Insure Ltd |
| 🟨 Market Share in South Africa | 20% | <5% | >56% |
| 🟩 Gap Cover Waiting Period | 3 – 12 months | 3 – 12 months | 12 months |
| 🟦 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Average Monthly Premium | R245 | R415 | R248 |
| 🟥 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 | ✅ Yes |
| 🟪 Co-payment Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟥 Emergency Room | ✅ Yes | ✅ Yes | None |
| 🟧 Accidental Cover | ✅ Yes | ✅ Yes | None |
| 🟨 Trauma Counseling | None | ✅ Yes | None |
| 🟩 Premium Waiver | ✅ Yes | ✅ Yes | None |
| 🟦 Non-DSP Co-Payment | ✅ Yes | ✅ Yes | None |
| 🟪 Prostheses | None | ✅ Yes | None |
| 🟥 Travel Cover Extender | None | None | ✅ Yes |
| 🟧 Accidental Death/ Permanent Disability | None | ✅ Yes | ✅ Yes |
