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Overall, Auto & General Essential Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Auto & General Essential Gap Cover Plan starts from R99 ZAR. Auto & General has a trust score of 4.1.
π₯ Provider | π₯ Auto & General Essential Gap Cover |
π§ Years in Operation | 38 years |
π¨ Underwriters | 1Life Insurance Limited |
π© Market Share in South Africa | <5% |
π¦ Gap Cover Waiting Period | 10 months |
πͺ Do Exclusions Apply | β Yes |
π₯ Average Monthly Premium | R99 |
π§ Oncology Benefit | β Yes |
π¨ In-Hospital Benefit | β Yes |
π© Out-of-Hospital Cover | β Yes |
The Auto & General Essential Gap is one of three plans that starts from R99 per month. Auto & Generalβs Essential Gap has benefits for oncology, policy extenders, dental treatment, in-hospital shortfalls, PMBs, and more.
Auto & General Gap Cover has three plans to choose from:
π₯ Under 65 (based on the oldest beneficiary) premium per policy monthly | N/A |
π§ Premium per individual per policy monthly | R99 |
π¨ Premium per family per policy monthly | R180 |
π© Over 65βs (based on the oldest beneficiary) premium per policy monthly | R360 |
π₯ In-hospital Shortfalls | Covers procedure claim shortfalls up to 300% of medical scheme tariff. |
π§ Prescribed Minimum Benefits | All medical schemes must cover an emergency, 270, and 27 chronic conditions. Medical aid review is required. |
π¨ 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 R7,500 per policy annually. |
π© Dental Treatment Benefit | After your medical aid processes your account, A&E will cover the shortfall for authorized in-hospital or doctorβs 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. |
π¦ Oncology Gap Benefit | A&E will cover the difference between the service provider and medical scheme payment. Unlimited cover but subject to a per-insured-person annual limit. |
πͺ Policy Extender | A&E pays the full gap cover premium If the policyholder dies accidentally. Limited to 12 months. |
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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:
It should be noted that 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.Β 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.
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π₯ Provider | π₯ Auto & General Essential Gap Cover | π₯ Dis-Chem Gap Base | π₯ Liberty Essential Gap Cover |
π§ Years in Operation | 38 years | 36 years | 66 years |
π¨ Underwriters | 1Life Insurance Limited | Old Mutual Insure | Guardrisk Life Limited (FSP 76) |
π© Market Share in South Africa | <5% | <1% | >25% |
π¦ Gap Cover Waiting Period | 10 months | 3 β 12 months | 12 months |
πͺ Do Exclusions Apply | β Yes | β Yes | β Yes |
π₯ Average Monthly Premium | R99 | R134 | R333 |
π§ Oncology Benefit | β Yes | None | None |
π¨ In-Hospital Benefit | β Yes | β Yes | β Yes |
π© Out-of-Hospital Cover | β Yes | β Yes | None |
π¦ Maternity Benefit | None | None | None |
πͺ Scopes and Scans | None | None | β Yes |
π₯ Co-payment Cover | None | None | None |
π§ Emergency Room | β Yes | None | β Yes |
π¨ Accidental Cover | None | β Yes | β Yes |
π© Trauma Counseling | None | None | β Yes |
π¦ Premium Waiver | β Yes | β Yes | β Yes |
πͺ Non-DSP Co-Payment | None | None | None |
π₯ Prostheses | None | None | None |
π§ Travel Cover Extender | None | None | None |
π¨ Accidental Death/ Permanent Disability | None | β Yes | β Yes |
In our experience, Auto & General Essential Gap is an affordable and comprehensive gap cover option in South Africa. It offers valuable cover with benefits for in-hospital shortfalls, oncology, dental treatment, and more.
We can conclude that Auto & General Essential Gap provides a cost-effective solution with comprehensive benefits, making it worth considering for individuals and families seeking additional healthcare coverage.
Auto & General Essential Gap has a 10-month waiting period for specific conditions such as head, neck, and spinal procedures, hernia procedures, pregnancy and childbirth, and more.
Yes, Auto & General Essential Gap does provide cover for out-of-hospital treatments.
The information does not explicitly mention coverage for pre-existing conditions.
Yes, Auto & General Essential Gap is available for individuals over 65. The premium for this age group is R360 per policy monthly, based on the oldest beneficiary.
No, Auto & General Essential Gap does not offer prostheses or travel emergency cover.
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