Overall, CompliMed Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. CompliMed Gap Cover starts from R414 ZAR. CompliMed has a trust score of 4.3.
π₯ Date Established | 2003 |
π§ Underwriters | Turnberry Management Risk Solutions (Pty) Ltd |
π¨ Headquartered | South Africa |
π© The average number of members | 5,000+ |
π¦ Number of Markets | 1 |
πͺ Market Share | <5% |
π₯ Number of plans offered | 1 |
π§ Is a Mobile App offered | None |
π¨ Waiting Period | 3 β 12 months |
π© Exclusions | β Yes |
Choosing CompliMed comes with a comprehensive list of advantages. Advantages of choosing CompliMed include:
The product provides easy online claims submission and real-time claims tracking via the CompliMed mobile app or online portal.
READ more: 5 Best Gap Cover Options for Under R200
π₯ Medical Expense Shortfall Cover | Medical Aid Rate increased to 600% for specialists, GPs, Anaesthetists, Radiology, Pathology, Consumables, etc. Subject to the overall limit of R185,837. |
π§ Co-payment Cover | Subject to the overall limit of R185,837. |
π¨ Non-DSP Hospital Penalty Cover | Limited to R14,000 per admission. Limited to 2 claims per family per year. Subject to the overall limit of R185,837. |
π© Sub-Limit Cover | Limited to R38,000 per admission per insured. Subject to the overall limit of R185,837. |
π¦ Trauma Recovery Cover | Covers insured persons when the Medical Scheme applies sub-limits on step-down facilities for physical rehabilitation due to an accident that occurred while on the policy. Limited to R3,000 per admission per insured and R10,000 per family. Subject to the overall limit of R185,837. |
π₯ Co-Payments for MRI, CT, and PET scans | Subject to the overall limit of R185,837. |
π§ Co-Payments for Scopes | Limited to R4,000 per event. Limited to 2 claims per insured per year. Subject to the overall limit of R185,837. |
π¨ Sub-limit Cover for MRI, CT, and PET scans | Limited to R38,000 per event per insured. Subject to the overall limit of R185,837. |
π© Casualty Benefits for Accidents | Limited to R15,000 per event per insured. Subject to the overall limit of R185,837. |
πͺ Casualty Benefit for Illness | Limited to R3,500 per event. Limited to 3 claims per family per year. Subject to the overall limit of R185,837. Treatment is restricted to Monday to Friday, Weekends, and Public Holidays between 6 pm and 6 am. |
π₯ Traditional Cancer Cover | Pays for cancer treatment in a private facility, including sub-limits, deductibles, and co-payments. Subject to the overall limit of R185,837. |
π§ Biological Cancer Drug Cover | Covers Biological Cancer Drugs when the Medical Scheme has a sub-limit. Subject to the overall limit of R185,837. |
π¨ MRI and CT Scan Cover | Covers MRI and CT scans when no benefit is available through your Medical Scheme. Limited to R6,500 per event, with a maximum of two claims per family per year. Subject to the overall limit of R185,837. |
π© Trauma Care Cover | Covers the cost of trauma counseling consultations with a registered healthcare provider after a member has been diagnosed with a critical illness, has been the victim of a violent crime, or has lost an immediate family member. Limited to R2,000 per consultation and R8,000 per family per year. Subject to the overall limit of R185,837. |
π¦ Innovative Cancer Drug Cover | Cover for new and innovative cancer drugs. Each claim is limited to R10,000. Subject to the overall limit of R185,837. |
πͺ Breast Cancer Prevention Cover | Increases the Medical Aid rate up to 600% for Prophylactic Mastectomy. Subject to the overall limit of R185,837. |
π₯ Breast Cancer Reconstruction Cover | The medical aid rate is increased by up to 600% for breast reconstruction post-mastectomy because of cancer in the affected breast. Reconstructed for the unaffected breast for symmetry, while no benefit exists on the Medical Scheme, there is cover of up to R25,000 per insured per lifetime. Subject to the overall limit of R185,837. |
π₯ Cancer Diagnosis Benefit | There is a once-off payment for the first diagnosis of cancer according to the stage when the diagnosis is made as follows: Stage 1 β R5,000 Stage 2 β R15,000 Stage 3 β R20,000 Stage 4 β R25,000 |
π§ Medical Scheme Contribution Waiver | Limited to R6,000 per month for 6 months if death or permanent and total disability occurs because of an accident. |
π¨ Gap Premium Waiver | Covers the gap cover payment for 12 months if the contribution payer dies or becomes permanently and totally disabled. |
π© Personal Accident Benefit | Limited to R30,000 per insured on the policy if accidental death or permanent and total disability occurs. |
π¦ Critical Illness Benefit | Limited to R10,000 per insured on the policy if death or critical illness occurs, excluding cancer. |
πͺ International Cover | Limited to R5 million per insured and requires at least 48 hours before departure. |
π₯ Medical Expense Shortfall Cover | Increases the medical aid rate by up to 600% for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident (while on the Policy), and oral cancer (while on the Policy). Subject to the overall limit of R185,837. |
π§ Co-payment Cover | Subject to the overall limit of R185,837. |
π¨ Sub-Limit and Co-payment Cover for Dental Implants | Covers the cost of dental implants for reconstructive maxillofacial surgery due to an accident (occurring while the Policy was in effect) and oral cancer (diagnosed while on the Policy). The annual limit is R50,000 per family. Subject to the overall limit of R185,837. |
π© Sub-limit Cover | R30,000 per admission per insured for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident (while on the Policy), and oral cancer (diagnosed while on the Policy). Subject to the overall limit of R185,837. |
π¦ Basic Dental Medical Expense Shortfall Cover | Increases the Medical Aid rate for children up to and including 12 years old by up to 600%. The annual limit is R4,000 per family. Subject to the overall limit of R185,837. |
To apply for Gap Cover with CompliMed, follow these steps:
Start enjoying the additional financial protection provided by CompliMed Gap Cover.
To submit a claim for Gap Cover with CompliMed, follow these steps:
Keep a copy of your claim form and all supporting documentation for your records.
Discover more about Medical Aid Plans
CompliMed does not cover any of the following:
Step-down facility costs must be authorized and paid by the medical scheme for trauma recovery cover.
All benefits are subject to a 3-month general waiting period (except in the event of an accident that occurred while on the Policy).
If the Policy’s start date coincides with the start date of the Medical Schemes, there will be no 3-month general waiting period for Medical Expense Shortfall Cover (increasing the medical aid rate up to 600%).
π Gap Cover Provider | π₯ CompliMed | π₯ Turnberry | π₯ Old Mutual |
π₯ Underwriters | Turnberry Management Risk Solutions (Pty) Ltd | Lombard Insurance Company | Old Mutual Life Assurance Company (South Africa) Limited |
π§ Number of Plans | 1 | 5 | 1 |
π¨ Average Price | R414 | R164 | R225 |
π© Waiting Periods | 3 β 12 months | 3 β 12 months | 3 β 12 months |
π¦ Exclusions | β Yes | β Yes | β Yes |
πͺ Oncology Benefit | β Yes | β Yes | β Yes |
π₯ In-Hospital Benefit | β Yes | β Yes | β Yes |
π§ Out-of-Hospital Cover | β Yes | β Yes | β Yes |
π¨ Maternity Benefit | None | None | None |
π© Scopes and Scans | β Yes | β Yes | β Yes |
π¦ Co-payment Cover | β Yes | β Yes | β Yes |
πͺ Emergency Room | β Yes | β Yes | β Yes |
π₯ Accidental Cover | β Yes | β Yes | β Yes |
π§ Trauma Counseling | β Yes | β Yes | None |
π¨ Premium Waiver | β Yes | β Yes | β Yes |
π© Non-DSP Co-Payment | β Yes | β Yes | β Yes |
π¦ Prostheses | None | β Yes | None |
πͺ Accidental Death/ Permanent Disability | β Yes | β Yes | β Yes |
π₯ Travel Cover Extender | β Yes | None | None |
β Pros | β Cons |
Provides financial protection for medical expenses not covered by medical scheme | May not cover all medical expenses |
Range of plan options to suit different needs and budgets | May require additional information or documentation |
Covers both in-hospital and day-to-day medical expenses | Pre-existing conditions may be excluded |
Additional benefits such as dental cover | Waiting periods may apply |
Great Service.
In early 2015, I enrolled in Gap Cover with CompliMed. Since then, my family has encountered three situations requiring hospitalization where our medical aid coverage fell short of meeting the associated expenses. On each occasion, I knew that CompliMed would cover the gap. Their commitment to delivering the best possible service has been consistently demonstrated, and I remain grateful for their assistance. – Kelly White
Professional Provider.
I am pleased to report that my recent claim against my Gap cover policy was handled expeditiously and professionally. I submitted the claim on 28th September, and to my satisfaction, it was settled within two days on 2nd October. This is the second claim I have made this year, and both times the service provided by CompliMed has been exceptional. I would highly recommend them. – Lauren Oliver
Great Support.
I submitted a claim to CompliMed for a CT scan that was not covered by my medical aid on 23rd October 2022. To my delight, the claim was processed and settled remarkably, and I received payment by 25th October 2022. I want to express my gratitude to CompliMed for their excellent service and prompt response. – Blake Coetzee
CompliMed Gap Cover is a comprehensive insurance product that provides financial protection to cover the shortfall between medical scheme benefits and the actual cost of medical treatment.Β The product offers a range of plan options to suit customers’ specific needs and budgets and covers both in-hospital and day-to-day medical expenses, including co-payments, deductibles, and shortfalls.
CompliMed Gap Cover includes a range of additional benefits, such as cover for dental expenses, international travel, accidental death and disability, and trauma recovery.
CompliMed Gap Cover is an insurance product that provides financial protection for medical expenses not covered by your medical scheme.
CompliMed Gap Cover covers in-hospital and day-to-day medical expenses, including co-payments, deductibles, and shortfalls.
CompliMed Gap Cover includes a range of additional benefits such as dental cover, international travel cover, accidental death and disability cover, and trauma recovery benefits.
CompliMed Gap Cover has no general waiting period, but waiting periods may apply to certain benefits.
Pre-existing conditions may be excluded from cover under CompliMed Gap Cover.
Claims can be submitted via email, post, or through the CompliMed mobile app or online portal.
Payment for approved Gap cover claims is typically made within a few days.
CompliMed Gap Cover has no overall limit on claims. However, an overall annual limit of R185,837 per insured per year exists.
You can contact CompliMed’s customer service team to cancel your policy by phone or email. Cancellation may be subject to the terms and conditions of your policy.
Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.
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