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Kaelo Gap Core (🇿🇦 2024)

Overall, Kaelo Gap Core is a trustworthy short-term insurance product designed to provide extra protection for those with medical aid. The Kaelo Gap Core Plan starts from R255 ZAR. Kaelo has a trust score of 4.1.

🔎 Provider	🥇 Kaelo Gap Core
🟥 Years in Operation	19 years
🟧 Underwriters	Centriq Insurance Company Limited
🟨 Market Share in South Africa	<1%
🟩 Gap Cover Waiting Period	12 months
🟦 Do Exclusions Apply	✅ Yes
🟪 Average Monthly Premium	R255
🟥 Oncology Benefit	None
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes

Kaelo Gap Core – 7 Key Point Quick Overview

Kaelo Gap Core Overview

The Kaelo Gap Core is one of two plans that starts from R255 per month. The Kaelo Gap Core Plan has benefits for sub-limit shortfalls, dental reconstruction, family protection, contribution waivers, hospital booster, and more.

Kaelo Gap Cover has two plans to choose from:

- Kaelo Gap
- Kaelo Gap Core

Kaelo Gap Core Premiums

🟥 Individuals <60 years	R255
🟧 Individuals 60 years>	R363
🟨 Family <60 years	R461
🟩 Family 60 years>	R659

Kaelo Gap Core Benefits and Cover Breakdown

Kaelo Gap Core Cover Benefits

🟥 Overall Annual Limit	There is an overall annual limit of R185,537 per insured per year.
🟧 Tariff Shortfalls	Subject to the overall annual limit of R185,537 per insured per year.
🟨 Shortfalls from Sub-limits	Limited to R30,700.
🟩 Out-of-Hospital Tariff Shortfalls	Limited to an additional 500% of the medical scheme tariff.
🟦 Dental Reconstruction Benefit	Limited to two events per family per year. Limited to R45,700 per year.

Kaelo Gap Core Benefit Extenders

🟥 Hospital Booster	Day 1 to 13 – R412 per day. Day 14 – 20 – R803 per day. Day 21 – Day 30 – R1,555 per day. Maximum benefit of R28,500 per insured per year.
🟧 Family Protector	Limited to R20,000 for children <6 years. Limited to R28,000 for all other insured persons.
🟨 Medical Scheme Contribution Waiver	Contributions will be covered for six months, up to R35,500. This benefit is only available once during the policy’s lifetime.
🟩 Gap Cover Premium Waiver	The Kaelo Health Gap Cover premium will be waived six months after the event. This benefit is only available once during the policy’s lifetime.
🟦 Road Accident Fund Claims	Covered by the policy.

Kaelo Gap Core Exclusions and Waiting Periods

Kaelo Gap Core Exclusions

💙The Kaelo Gap Cover has certain exclusions, including:

✅ The Gap Cover Policy does not cover claims not paid by the policyholder’s medical aid.
✅ Claims that the medical aid paid on an ex-gratia basis are not included.
✅ Charges by healthcare providers for Split Billing are not covered, but Balance Billing is.
✅ The policy does not cover infertility treatment.
✅ Treatments that occur outside the period of an Insured Event are not covered.
✅ The policy does not cover external prostheses, appliances, and convalescing equipment.
✅ The policy does not cover the harvesting or preserving of human tissues such as stem cells.
✅ Procedures like breast augmentation, gastroplasty, lipectomy, and gender reversal are not covered.
✅ Therapeutic massage therapists are not included on the cover.
✅ The policy does not cover rehabilitation, frail care, and hospice services.
✅ Step-down facilities are not included in the cover.
✅ Medicines to take-out (TTO) are not covered.

Specialized dental procedures such as crowns, bridges, and implants are not included.

Kaelo Gap Core Waiting Periods

💙Kaelo applies the following waiting periods to its policies:

✅ Exclusions specific to certain conditions will apply for 12 months.
✅ Concessions on waiting periods are arranged with Kaelo by your broker.
✅ Your broker will notify you when a concession period has been set.

These concessions apply only to employer groups.

Kaelo Gap Core vs Other Gap Cover Plans

🔎 Provider	🥇 Kaelo Gap Core	🥈 Total Risk Administrators Basic Cover 300	🥉 Stratum Benefits Base
🟥 Years in Operation	19 years	24 years	24 years
🟧 Underwriters	Centriq Insurance Company Limited	Auto & General Insurance Company Limited	Guardrisk Insurance Company Limited (FSP 75)
🟨 Market Share in South Africa	<1%	<5%	>5%
🟩 Gap Cover Waiting Period	12 months	3 – 12 months	3 Months
🟦 Do Exclusions Apply	✅ Yes	✅ Yes	✅ Yes
🟪 Average Monthly Premium	R255	R99	R252
🟥 Oncology Benefit	None	✅ Yes	✅ Yes
🟧 In-Hospital Benefit	✅ Yes	None	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes	✅ Yes	✅ Yes
🟩 Maternity Benefit	None	None	✅ Yes
🟦 Scopes and Scans	None	None	None
🟪 Co-payment Cover	None	None	None
🟥 Emergency Room	✅ Yes	✅ Yes	✅ Yes
🟧 Accidental Cover	✅ Yes	None	None
🟨 Trauma Counseling	None	✅ Yes	✅ Yes
🟩 Premium Waiver	✅ Yes	None	None
🟦 Non-DSP Co-Payment	None	None	None
🟪 Prostheses	None	None	None
🟥 Travel Cover Extender	None	✅ Yes	✅ Yes
🟧 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	✅ Yes

Our Verdict on Kaelo Gap Core

The Kaelo Gap Core plan offers a broad range of benefits that can provide valuable financial protection against medical shortfalls.

It is important to note the limitations of the Gap Core plan. For example, we found that the policy does not cover non-DSP payment benefits, trauma counseling, scopes, and scans, or maternity and oncology benefits.

Kaelo Gap Core plan is a comprehensive policy that offers a wide range of benefits designed to supplement your medical aid cover and protect against shortfalls. One of its key strengths is its flexibility.

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Kaelo Gap Core Frequently Asked Questions

What is the Kaelo Gap Core plan?

The Kaelo Gap Core plan is designed to supplement your medical aid coverage and protect against shortfalls, such as when your healthcare provider charges higher rates than your medical aid will pay.

What are the main benefits of the Kaelo Gap Core plan?

The plan offers cover for tariff shortfalls, shortfalls from sub-limits, out-of-hospital tariff shortfalls, and dental reconstruction.

What are the limits of the Kaelo Gap Core plan?

The plan has an Overall Annual Limit of R185 837 per Insured Party Per Annum, with specific limits for each benefit, such as shortfalls from sub-limits, dental reconstruction, hospital booster, family protector, and medical scheme contribution waiver.

Does the Kaelo Gap Core plan offer any lifestyle benefits?

Yes, as part of Kaelo Lifestyle, the plan offers counseling, coaching, legal, and financial advice.

How does the claim process work for the Kaelo Gap Core plan?

You have 6 months from the end of the insured event to submit your claim, and once all required documents have been received, your claim will be processed and paid within 7 to 14 working days.

Adriaan Schoeman

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.