Overall, Old Mutual Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Old Mutual Gap Cover Plans start from R225 ZAR. Old Mutual has a trust score of 4.3.
|🟥 Underwriters||Old Mutual Life Assurance Company (South Africa) Limited|
|🟧 Headquartered||Cape Town, South Africa|
|🟨 The average number of members||10,000+|
|🟩 Number of Markets||1|
|🟦 Market Share||<5%|
|🟪 Number of plans offered||1|
|🟥 Is a Mobile App offered||Yes, iOS, Android, and Huawei|
|🟧 Waiting Period||3 – 12 months|
|🟨 Exclusions||✅ Yes|
Old Mutual Gap Cover offers protection against medical expense shortfalls and co-payments. Furthermore, gap cover is available for only R225 per family per month. However, prospective members should note that the policy premium is R295 if any family member is over 65.
If the principal member and spouse/life partner are on different medical schemes, they can both be covered under the same Old Mutual Gap Cover policy, provided their medical scheme memberships are active.
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Choosing Old Mutual Gap Cover comes with a long list of advantages, including:
Finally, Old Mutual Covers premature births more than 41 days before the due date up to a maximum compensation limit of R15,000.
Old Mutual Gap covers the following:
|🟥 Tariff Shortfalls||Compensation of up to 500% of the medical scheme tariff fee is available.
For shortfalls where a non-designated service provider is used on a group network option, compensation is available up to a maximum limit of 100% of the medical scheme tariff fee.
Compensation is also available up to a maximum limit of 100% of the medical scheme tariff fee for shortfalls on maxillofacial, back, and spinal surgery.
|🟧 Co-payments and Deductibles||The cover includes MRI, CT, and PET scans and limited cover for certain diagnostic and medical procedures or treatments such as gastroscopies and colonoscopies.
The maximum compensation limit per policy per event is R50,000.
|🟨 Shortfalls from sub-limits||The policy covers up to a maximum of R5,000 per policy per annum for tariff shortfalls and co-payments for dental surgery performed in a hospital or day clinic under general sedation.|
|🟩 Dental Surgery Benefit||The dental surgery cover is limited to two events per policy per annum.|
|🟦 Penalty co-payments||A penalty co-payment for using a non-designated hospital is covered up to a maximum compensation limit of R15,000.
Limited to one event, per family, per annum.
|🟥 Oncology Tariff Shortfalls||Compensation of up to 500% of the medical scheme tariff fee is available, with a maximum compensation limit of R169,000 per beneficiary per annum.|
|🟧 Oncology Co-payments||A maximum co-payment of 20% is allowed.
Subject to the maximum compensation limit of R169,000 per beneficiary per annum.
|🟨 Oncology Sub-limits||The policy covers charges for services supplied that have exceeded the oncology sub-limits.|
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|🟥 Tariff Shortfalls||Compensation of up to 500% of the medical scheme tariff fee is available for outpatient procedures.
The cover is limited to certain diagnostic and medical procedures or treatments.
Compensation of up to a maximum of 100% of the medical scheme tariff fee is available for shortfalls where a non-designated service provider is used on a group network option.
|🟧 Co-payments and Deductibles||The policy includes MRI, CT, and PET scans and limited cover for certain diagnostic procedures such as gastroscopies and colonoscopies.|
|🟨 Accidental Casualty Benefit||The policy provides a casualty ward benefit related to a trauma event.
Limited to R15,000 per policy, per annum.
|🟩 External Appliance Benefit||The policy covers up to a maximum of R2,000 per annum for external appliances such as crutches, knee braces, arm slings, and moon boots.|
|🟥 Family Booster||Compensation of up to a maximum limit of R15,000 is available for a premature birth more than 41 days before the due date.|
|🟧 Dental Reconstruction Benefit||Compensation of up to a maximum limit of R40,000 per policy per annum is available if a beneficiary requires dental reconstruction due to trauma or oncology treatment.
The benefit applies to events occurring after the commencement of the cover.
|🟨 Medical Scheme Contribution Waiver||If the medical scheme’s principal member is the gap policy’s principal member and all beneficiaries are linked to a single medical scheme, medical scheme contributions over the policy lifetime are compensated for up to 6 months (R30,000).
The benefit is payable for the Medical Schemes of the Principal Member only if there is dual medical scheme membership.
The benefit is subject to the availability of the overall annual limit.
|🟩 Step-down Facility Benefit||A maximum compensation limit of R5,000 is available, limited to one event per policy, per annum, if the principal member of the medical scheme, who is also the principal member of the gap policy, spends a minimum of 10 consecutive days in a step-down or sub-acute facility.|
To apply for Gap Cover with Old Mutual, follow these steps:
Reviewing the policy document carefully and understanding its terms and conditions before signing up is important.
To submit a claim for Gap Cover with Old Mutual, follow these steps:
If the claim is denied, you may appeal the decision by following the appeals process outlined in your Gap Cover policy.
Old Mutual Gap Cover does not compensate for the following:
and many more. A full exclusion list will be provided by Old Mutual.
Old Mutual Gap Cover has a general waiting period of 3 months and a pre-existing condition waiting period of 12 months. The policy does not cover Prescribed Minimum Benefits (PMBs).
|🔎 Gap Cover Provider||🥇 Old Mutual||🥈 Discovery Health||🥉 Ambledown|
|🟥 Number of Plans||1||2||7|
|🟧 Average Price||R225||R130||R203|
|🟨 Waiting Periods||3 – 12 months||12 Months||3 – 12 months|
|🟩 Exclusions||✅ Yes||✅ Yes||✅ Yes|
|🟦 Oncology Benefit||✅ Yes||✅ Yes||✅ Yes|
|🟪 In-Hospital Benefit||✅ Yes||✅ Yes||✅ Yes|
|🟥 Out-of-Hospital Cover||✅ Yes||✅ Yes||✅ Yes|
|🟧 Maternity Benefit||None||✅ Yes||None|
|🟨 Scopes and Scans||✅ Yes||✅ Yes||✅ Yes|
|🟩 Co-payment Cover||✅ Yes||✅ Yes||✅ Yes|
|🟦 Emergency Room||✅ Yes||None||✅ Yes|
|🟪 Accidental Cover||✅ Yes||None||✅ Yes|
|🟥 Trauma Counseling||None||None||None|
|🟧 Premium Waiver||✅ Yes||None||✅ Yes|
|🟨 Non-DSP Co-Payment||✅ Yes||None||None|
|🟦 Accidental Death/ Permanent Disability||✅ Yes||None||✅ Yes|
|🟪 Travel Cover Extender||None||✅ Yes||None|
|✅ Pros||❎ Cons|
|Provides cover for medical expense shortfalls and co-payments||Excludes Prescribed Minimum Benefits (PMBs)|
|Covers principal member, spouse/life partner, and children up to 26 years of age||Excludes certain treatments, such as those related to obesity, gender reversal procedures, and therapeutic massage|
|One price per family, including up to 6 family members||Excludes some medical expenses, such as out-patient consultations and psychiatric or psychological conditions|
|Allows for the principal member and spouse/life partner on different medical schemes to be covered on the same policy||Has waiting periods for certain conditions|
Old Mutual Gap Cover offers a range of benefits to members of registered medical schemes, including cover for medical expense shortfalls and co-payments.
The policy covers the principal member, their spouse/life partner, and children up to 26 years of age. One price is charged per family, including up to six family members, even if they are on different medical schemes.
However, it is important to note that there is a 3-month general waiting period and a 12-month waiting period for pre-existing conditions. In addition, Prescribed Minimum Benefits (PMBs) are excluded from cover, and several other exclusions are listed in the policy wording.
Overall, Old Mutual Gap Cover can provide valuable protection against medical expense shortfalls and co-payments for members of registered medical schemes.
Discover more about Dis-Chem Gap Cover
Old Mutual Gap Cover is a type of insurance policy that helps to cover the shortfall between what your medical scheme pays and the actual costs of medical treatment.
Yes, there is a 3-month general waiting period and a 12-month waiting period for pre-existing conditions.
The policy exclusions for Old Mutual Gap Cover include certain medical treatments, such as cosmetic surgery and gender reversal procedures, and participation in certain activities, such as hazardous sports.
You can submit a claim for Old Mutual Gap Cover by completing a claim form and submitting it along with all necessary supporting documentation.
Old Mutual Gap Cover costs R225 per family per month unless a member is over 65. If a member is over 65, gap cover costs R295 per family monthly.
The policy benefits of Old Mutual Gap Cover include cover for medical scheme shortfalls and co-payments and cover for certain medical treatments not covered by your medical scheme.
Old Mutual Gap Cover does cover pre-existing conditions. However, there is a 12-month waiting period before you can claim such conditions.
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