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Overall, Auto & General Absolute Gap is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Auto & General Absolute Gap Plan starts from R209 ZAR. Auto & General has a trust score of 4.1.
🔎 Provider | 🥇 Auto & General Absolute Gap Cover |
🟥 Years in Operation | 38 years |
🟧 Underwriters | 1Life Insurance Limited |
🟨 Market Share in South Africa | <5% |
🟩 Gap Cover Waiting Period | 10 months |
🟦 Do Exclusions Apply | ✅ Yes |
🟪 Average Monthly Premium | R450 |
🟥 Oncology Benefit | ✅ Yes |
🟧 In-Hospital Benefit | ✅ Yes |
🟨 Out-of-Hospital Cover | ✅ Yes |
The Auto & General Absolute Gap is one of three plans that starts from R450 per month. Auto & General’s Absolute Gap has benefits for out-of-hospital co-payments, internal prostheses, emergency medical treatment, PMBs, policy extenders, and more.
Auto & General Gap Cover has three plans to choose from:
🟥 Under 65 (based on the oldest beneficiary) premium per policy monthly | R450 |
🟧 Premium per individual per policy monthly | N/A |
🟨 Premium per family per policy monthly | N/A |
🟩 Over 65’s (based on the oldest beneficiary) premium per policy monthly | R630 |
🟥 In-hospital Shortfalls | Covers procedure claim shortfalls up to 700% of medical scheme tariff. |
🟧 Prescribed Minimum Benefits | All medical schemes must cover an emergency, 270, and 27 chronic conditions. Medical aid review is required. |
🟨 Emergency Medical Treatment in a Casualty Unit | A&E will pay for emergency room or casualty unit treatment up to the specified amount if you are in an accident. Limited to R20,000 per policy annually. |
🟩 In Network Hospital Co-payments | A&E will pay your medical aid co-payment/deductible for certain in-hospital and doctor-performed procedures. Unlimited, but with a per-insured-person annual limit. |
🟦 Out of Network Hospital Co-Payments | Limited to 2 co-payments/deductibles per policy per year. Limited to R15,000. |
🟪 Co-payment Benefit – Out-of-hospital MRI, CT, and PET scans | The co-payment or deductible of your medical aid charges for MRI/CT/PET scans that have been authorized and paid from the in-hospital or Major Medical benefit. Limited to two policy scans per year. Unlimited but subject to the annual aggregate limit per insured person. |
🟥 Sub-limit Benefit – Internal Prostheses | A&E will cover the shortfall up to R20,000 per policy per year if you reach your medical aid’s sub-limit for Internal Prostheses authorized and paid for from your In-Hospital or Major Medical benefit. |
🟧 Sub-limit benefit – MRI, CT, and PET scans | Limited to 2 MRI/CT/PET scans per policy per year up to R4,400 per scan. |
🟨 Dental Treatment Benefit | After your medical aid processes your account, A&E will cover the shortfall for authorized in-hospital or doctor’s office dental procedures paid from the in-hospital or major medical benefit only. The unlimited cover is provided but with a per-insured-person annual limit. |
🟩 Global Fee Benefit | A&E will cover any service provider overcharges for a specific procedure like robotic surgery. Limited to R22,000 per policy annually. |
🟦 Oncology Gap Benefit | A&E will cover the difference between the service provider and medical scheme payment. Unlimited, but with a per-insured-person annual limit. |
🟪 In-network Oncology Co-payment | Unlimited with a per-insured-person annual limit. Limited to R40,000 per event |
🟥 Out-of-network Oncology Co-payment | Limited to 2 annual co-payments per policy up to R15,000. |
🟧 Oncology Extender Benefit | Unlimited, but with a per-insured-person annual limit. |
🟨 Oncology “New Tech” Benefit | Keytruda®, Xalkori®, Tagrisso®, Yervoy®, Zelboraf®, Imbruvica® will be covered by A&E. Limited to R15,000 per policy annually. |
🟩 Policy Extender | A&E will cover the gap cover premium if the main policyholder dies accidentally. Limited to 12 months. |
🟦 Medical Aid Contribution Waiver | A&E will cover a policyholder’s medical aid contribution for 6 months after the main policyholder’s accidental death. Limited to R6,000 monthly. |
Auto & General does not include its specific exclusions on its policy document. However, below we provide some typical exclusions that might relate to gap cover:
Non-adherence to medical advice: Failure to follow prescribed medical advice or treatment could lead to claim denial.
There is no general three-month waiting period when you register a Gap Cover policy. However, a 10-month condition-specific waiting period applies. No claims may be submitted within the first 10 months of membership for any Gap Cover policy if they relate to any of the following conditions:
There is a nine-month waiting period if a policyholder is diagnosed with cancer before membership.
🔎 Provider | 🥇 Auto & General Absolute Gap Cover | 🥈 Bonitas MedGap Supreme Plan | 🥉 Total Risk Administrators Absolute Cover Plus |
🟥 Years in Operation | 38 years | 41 years | 24 years |
🟧 Underwriters | 1Life Insurance Limited | Centriq Insurance Company Limited | Auto & General Insurance Company Limited |
🟨 Market Share in South Africa | <5% | 5%> | <5% |
🟩 Gap Cover Waiting Period | 10 months | 3 – 12 months | 3 – 12 months |
🟦 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
🟪 Average Monthly Premium | R450 | R334 | R535 |
🟥 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 | ✅ Yes |
🟧 Accidental Cover | ✅ Yes | ✅ Yes | None |
🟨 Trauma Counseling | None | ✅ Yes | ✅ Yes |
🟩 Premium Waiver | ✅ Yes | ✅ Yes | ✅ Yes |
🟦 Non-DSP Co-Payment | ✅ Yes | ✅ Yes | ✅ Yes |
🟪 Prostheses | ✅ Yes | ✅ Yes | ✅ Yes |
🟥 Travel Cover Extender | None | None | ✅ Yes |
🟧 Accidental Death/ Permanent Disability | None | ✅ Yes | ✅ Yes |
In our expert opinion, Auto & General Absolute Gap offers comprehensive coverage for various healthcare needs, with notable features including high cover for in-hospital shortfalls, co-payment benefits, and authorized scans.
We have found that the plan’s monthly premiums, from R450 per month for those under 65, are competitive.
The premium per policy monthly for individuals under 65, based on the oldest beneficiary, is R450.
Yes, Auto & General Absolute Gap covers out-of-network hospital co-payments, up to 2 co-payments/deductibles per policy per year, with a limit of R15,000.
Yes, there is a 10-month waiting period for specific conditions under Auto & General Absolute Gap. During this period, no claims related to those conditions can be submitted.
Yes, the plan covers the co-payment or deductible for authorized MRI, CT, and PET scans paid from the in-hospital or major medical benefit, subject to a limit of two policy scans per year and an annual aggregate limit per insured person.
No, based on the provided information, Auto & General Absolute Gap does not offer cover for accidental death or permanent disability.
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