Standard Bank GapAssist Gap Cover

 

Overall, Standard Bank GapAssist is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. Standard Bank GapAssist starts from R225 ZAR. Standard Bank has a trust score of 4.4.

 

Standard Bank GapAssist Gap Cover has three plans to choose from:

• • Standard Bank GapAssist Universal
  • Standard Bank GapAssist Optimal
  • Standard Bank GapAssist Essential

 

🟥 Date Established	1862 (Standard Bank)
🟧 Underwriters	Standard Insurance Limited
🟨 Headquartered	Johannesburg, South Africa
🟩 The average number of members	10,000+
🟦 Number of Markets	1
🟪 Market Share	<10%
🟥 The number of plans offered	3
🟧 Is a Mobile App offered	Yes, iOS, Huawei, and Android
🟨 Customer Support Operating Hours	Monday to Friday – 08h30 am to 4 pm
🟩 Waiting Period	12 Months
🟦 Exclusions	✅ Yes

 

 

 

Standard Bank GapAssist Gap Cover – 12 Key Point Quick Overview

 

1. ✅ Standard Bank GapAssist Gap Cover Premiums
2. ✅ Standard Bank GapAssist – Advantages Over Competitors
3. ✅ Standard Bank GapAssist Gap Cover Features
4. ✅ How to apply for Gap Cover with Standard Bank GapAssist
5. ✅ How can I change my Standard Bank GapAssist Gap Cover option?
6. ✅ How to Submit a Claim for Gap Cover with Standard Bank GapAssist
7. ✅ Standard Bank GapAssist Gap Cover Exclusions
8. ✅ Standard Bank GapAssist Gap Cover Waiting Periods
9. ✅ Standard Bank GapAssist Gap Cover vs Other Notable Providers
10. ✅ Standard Bank GapAssist Gap Cover Pros and Cons
11. ✅ Our Verdict on Standard Bank GapAssist Gap Cover
12. ✅ Standard Bank GapAssist Gap Cover Frequently Asked Questions

 

 

Standard Bank GapAssist Gap Cover Premiums

 

Standard Bank GapAssist Universal Gap Cover

 

💙 Cover for Individuals	💶 Monthly Contribution
🟥 <35 Years	R478 per month
🟧 <55 Years	R478 per month
🟨 55 – 64 Years	R606 per month
🟩 >65 Years	R710 per month
💙 Cover for Families	💶 Monthly Contribution
🟥 Where all insured are <65 Years	R606 per month
🟧 Where one or more insured are >65 Years	R710 per month

 

Standard Bank GapAssist Essential Gap Cover

 

💙 Cover for Individuals	💶 Monthly Contribution
🟥 <35 Years	R351 per month
🟧 <55 Years	R351 per month
🟨 55 – 64 Years	R439 per month
🟩 >65 Years	R520 per month
💙 Cover for Families	💶 Monthly Contribution
🟥 Where all insured are <65 Years	R439 per month
🟧 Where one or more insured are >65 Years	R520 per month

 

Standard Bank GapAssist Optimal Gap Cover

 

💙 Cover for Individuals	💶 Monthly Contribution
🟥 <35 Years	R225 per month

 

 

Standard Bank GapAssist – Advantages Over Competitors

 

• ✅ Standard Bank GapAssist provides comprehensive gap cover to help cover the difference between medical aid rates and the actual cost of medical treatment.
• ✅ Offers three gap cover plans to choose from, catering to different budgets and cover requirements.
• ✅ Covers a range of medical expenses, including in-hospital and out-of-hospital expenses, co-payments, prostheses, and oncology treatment co-payments.
• ✅ Covers emergency room treatment, casual facility emergency treatment for children under 11, and robotic medical procedures.
• ✅ Offers benefits for accidental dentistry, accidental death and disability, trauma counseling, and medical aid gap cover premium waiver.
• ✅ No general or condition-specific waiting periods are typically imposed, and previous gap cover with similar benefits may reduce waiting periods for pre-existing conditions.
• ✅ Provides worldwide emergency medical assistance and emergency medical transportation.
• ✅ Easy online application process with no medical examinations required.
• ✅ Available to individuals and families, with the option to add extended family members.
• ✅ Offers flexible payment options, including monthly or annual payments.
• ✅ Provides access to a 24/7 medical emergency helpline.

 

 

Underwritten by Guardrisk Insurance Company Ltd, an authorized financial services provider, and registered insurer.

 

 

Standard Bank GapAssist Gap Cover Features

 

Standard Bank GapAssist Universal Gap Cover Benefits and Cover

 

Standard Bank GapAssist Universal Gap Cover offers extensive medical expense shortfall cover and financial protection against various health risks. This option is available in both individual and family plans.

 

Section A – Medical Expense Shortfall Cover

 

• ️ In-hospital and out-of-hospital cover up to 500% of the medical aid tariff.
• ️ General co-payments for hospital admission, CT, PET, and MRI scans are covered, as well as non-network co-payments up to R11,600 per policy per year.
• ️ Casualty and emergency room treatments are covered up to R22,100 per policy annually.
• ️ The plan also covers internal prostheses and artificial joints with a limit of R38,500 per policy per year and robotic medical procedures up to R33,000 per policy annually.
• ️ MRI, PET, and CT scans over the medical aid sub-limit are covered up to R3,200 for every insured person annually.
• ️ Children under 11 receive emergency treatment for after-hours care at casualty facilities, which is covered up to R2,500 per policy per year.
• ️ The plan also covers co-payments for oncology treatments exceeding annual cancer limits up to 25% of the treatment cost. In addition, it offers continued treatment for oncology treatments up to 20% of the insured person’s treatment costs.

 

 

Cosmetic breast reduction for insured individuals after a single mastectomy due to breast cancer diagnosed after the policy’s inception is covered up to R24,000.

 

Section B – Health Insurance Benefits

 

• ️ Offers enhanced cancer cover up to R30,000 for unexpected costs during the initial cancer diagnosis for Stage 2 diagnoses (regional) and Stage 1 prostate cancer with a Gleason score of 8 or higher.
• ️ Accidental dentistry is covered up to R22,500 for an accidental tooth fracture at a rate of R3,200 per tooth, regardless of the medical aid contribution.
• ️ Accidental death and disability cover is up to R50,000 for members under 65.
• ️ Trauma counseling is covered for up to R800 per session. An annual limit of R26,500 for treatment initiated within six months of the event paid up to six months of treatment.

 

 

The Medical Aid Gap Cover Premium Waiver covers 12x the combined medical aid, up to R110,000 for insured individuals under 65.

 

Standard Bank GapAssist Essential Gap Cover Benefits and Cover

 

For those seeking affordable cover for the most common medical expense shortfalls and additional financial protection against various health risks, there is Standard Bank GapAssist Essential Gap Cover. This option is available in both individual and family plans.

 

Section A – Medical Expense Shortfall Cover

 

• ️ In-hospital and out-of-hospital cover up to 300% of the medical aid tariff. The plan also covers general co-payments for hospital admission, CT, PET, and MRI scans.
• ️ Casualty and emergency room treatments are covered up to R22,100 per policy annually.
• ️ Children under 11 receive emergency treatment for after-hours care at casualty facilities, which is covered up to R2,500 per policy per year.

 

 

Robotic medical procedures are covered up to R33,000 per policy annually.

 

Section B – Health Insurance Benefits

 

• ️ Covers accidental dentistry up to R22,500 for an accidental tooth fracture, regardless of the medical aid contribution, and paid at a rate of R3,200 per tooth fractured.
• ️ Accidental Death and Disability cover is up to R50,000 for members under 65.
• ️ The plan covers trauma counseling up to R800 per session. An annual limit of R26,500 for treatment initiated within six months of the event paid up to six months of treatment.

 

 

Medical Aid Gap Cover Premium Waiver covers 12 times the combined medical aid, up to R110,000, for insured individuals under 65.

 

Standard Bank GapAssist Optimal Gap Cover Benefits and Cover

 

For individuals under 35, Standard Bank GapAssist offers Optimal Gap Cover, which provides high cover at an affordable price.

 

Section A – Medical Expense Shortfall Cover

 

• ️ The in-hospital and out-of-hospital cover is up to 500% of the medical aid tariff.
• ️ Additionally, the plan covers general co-payments imposed by the policyholder’s medical aid for hospital admission, CT, PET, and MRI scans.
• ️ Non-network co-payments charged by the policyholder’s medical aid for treatment with a non-DSP provider are covered up to R11,600 per policy per year.
• ️ MRI, PET, and CT scans over the medical aid sub-limit are covered up to R3,200 for every insured person annually.
• ️ Casualty and emergency room treatments are covered up to R22,100 per policy annually.

 

 

The plan also covers internal prostheses and artificial joints with a limit of R38,500 per policy per year and robotic medical procedures up to R33,000 per policy annually.

 

Section B – Health Insurance Benefits

 

• ️ The cover offered for accidental dentistry is up to R22,500 for an accidental tooth fracture, regardless of the medical aid contribution.
• ️ Accidental Death and Disability cover is up to R50,000 for members under 65.
• ️ The plan also covers trauma counseling up to R800 per session. An annual limit of R26,500 for treatment initiated within six months of the event paid up to six months of treatment.

 

 

Medical Aid Gap Cover Premium Waiver covers 12 times the combined medical aid, up to R110,000 for insured individuals under 65.

 

Sharpen your knowledge with a better understanding of Low-cost Medical Aid in SA

 

 

How to apply for Gap Cover with Standard Bank GapAssist

 

To apply for Gap Cover with Standard Bank GapAssist, follow these steps:

 

• ✅ Visit the Standard Bank GapAssist website or contact the bank directly to request a quote and application form.
• ✅ Complete the application form and provide all necessary personal and medical information.
• ✅ Choose the Standard Bank GapAssist Gap Cover option that best suits your needs and budget.
• ✅ Submit the application form and wait for the bank to process your application.
• ✅ If your application is approved, you will receive a confirmation of cover and other relevant documents.
• ✅ Make sure to pay your monthly premiums on time to ensure that you are covered at all times.

 

 

It is important to carefully review the terms and conditions of your Standard Bank GapAssist policy before applying to ensure that you understand all benefits, exclusions, and waiting periods.

 

 

How can I change my Standard Bank GapAssist Gap Cover option?

 

To change your Standard Bank GapAssist Gap Cover option, follow these steps:

 

• ✅ Contact Standard Bank GapAssist directly or log in to your account on the Standard Bank website.
• ✅ Request to change your current Gap Cover option to a different one.
• ✅ Provide any additional information or documentation that may be required for the change, such as updated personal or medical information.
• ✅ Wait for the bank to process your request and confirm the new Gap Cover option.
• ✅ Once your new Gap Cover option has been confirmed, review the terms and conditions of your new policy and understand any changes to benefits, exclusions, and waiting periods.

 

 

Ensure you continue paying your monthly premiums on time to maintain your coverage.

 

 

How to Submit a Claim for Gap Cover with Standard Bank GapAssist

 

To submit a claim for Gap Cover with Standard Bank GapAssist, you can follow these steps:

 

• ✅ Download and complete the Gap Cover claim form from the Standard Bank GapAssist website or contact their call center to request a form.
• ✅ Submit the completed claim form and all necessary supporting documentation, such as medical invoices, statements, and receipts.
• ✅ Ensure the claim is submitted within six months of the treatment or service date.
• ✅ Claims can be submitted online via the Standard Bank GapAssist website, app, via email, or by post to the following address:
• ✅ Standard Bank GapCover Claims, PO Box 2566, Houghton 2041
• ✅ Once the claim is received, it will be assessed, and a response will be sent to you within 14 days.
• ✅ If the claim is approved, payment will be made directly into your bank account.

 

 

If you have any questions or need assistance with the claims process, contact the Standard Bank GapAssist call center for support.

 

 

Standard Bank GapAssist Gap Cover Exclusions

 

GapAssist Specific Exclusions

 

Under the Specific Exclusions of Standard Bank GapAssist Gap Cover, the following items are not covered:

 

• ✅ Cosmetic surgery, except when required due to illness or injury.
• ✅ Penalty co-payments imposed by medical aids for non-compliance with rules.
• ✅ Medication and other materials.
• ✅ External prosthetics.
• ✅ Cancer treatment or planned procedures received outside the Republic of South Africa.
• ✅ Pre- and post-hospitalization doctor and specialist charges.
• ✅ Treatment for obesity or treatments required because of obesity.
• ✅ Treatment for depression, mental, or stress-related conditions.
• ✅ Claims not covered by medical aid.
• ✅ Split billing charges.
• ✅ Private and home nursing.
• ✅ Hospital charges and day-to-day medical practitioner charges.
• ✅ Breast or dental implants.
• ✅ Emergency medical transportation.
• ✅ Out-of-hospital dental procedures.
• ✅ Experimental procedures or procedures paid for by the medical aid on an exception or ex-gratia basis.

 

 

Diagnosis or treatment for sleeping disorders and more.

 

GapAssist Pre-existing Conditions

 

In addition, benefits are not paid for claims that originate from pre-existing conditions related to the following:

 

• ✅ Nuclear weapons or nuclear or ionizing radiation.
• ✅ Suicide, attempted suicide, or intentional self-injury.
• ✅ Use of drugs or narcotics not prescribed and taken according to the instructions of a registered medical practitioner.
• ✅ Illness or injury caused by using alcohol.
• ✅ Illegal behavior or breaking the law of the Republic of South Africa.
• ✅ Participation in war, terrorism, invasion, rebellion, active military duty, police duty, civil commotion, labor disturbances, riots, strikes, or activities of locked-out workers.
• ✅ Aviation accidents, except on a commercial flight as a fare-paying passenger.

 

 

Participation in any race or speed test involving any mechanically propelled vehicle, vessel, craft, or aircraft.

 

You might consider reading more about the 5 Best Dental Gap Cover

 

 

Standard Bank GapAssist Gap Cover Waiting Periods

 

The waiting periods for Standard Bank GapAssist are as follows:

 

• ✅ Standard Bank GapAssist does not impose general or condition-specific waiting periods after the policy’s commencement date.
• ✅ Medical conditions for which medical advice, diagnosis, care, or treatment was received or would reasonably have been recommended 12 months before the policy’s start date will not be eligible for benefits 12 months from the start date.
• ✅ Pregnancy before the policy’s start date is considered a pre-existing condition, and pregnancy and birth-related claims will be excluded for 12 months from the start date.
• ✅ If the policyholder had prior coverage under another Medical Expense Shortfall Policy with similar benefits, the pre-existing condition waiting period would only apply to the remaining portion of the waiting period from the previous policy.

 

 

For benefits not provided under the previous policy, the full 12-month exclusion will apply.

 

 

Standard Bank GapAssist Gap Cover vs Other Notable Providers

 

🔎 Gap Cover Provider	🥇 Standard Bank GapAssist	🥈 Zestlife	🥉 Discovery Health
🟥 Number of Plans	3	3	2
🟧 Average Price	R225	R225	R130
🟨 Waiting Periods	12 months	3 – 12 months	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	None	✅ Yes
🟨 Scopes and Scans	✅ Yes	✅ Yes	✅ Yes
🟩 Co-payment Cover	✅ Yes	✅ Yes	✅ Yes
🟦 Emergency Room	✅ Yes	✅ Yes	None
🟪 Accidental Cover	✅ Yes	✅ Yes	None
🟥 Trauma Counseling	✅ Yes	✅ Yes	None
🟧 Premium Waiver	✅ Yes	✅ Yes	None
🟨 Non-DSP Co-Payment	✅ Yes	✅ Yes	None
🟩 Prostheses	✅ Yes	✅ Yes	None
🟦 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	None
🟪 Travel Cover Extender	None	None	✅ Yes

 

You might like the Best Medical Aids in South Africa that Cover nip and tuck Surgery

 

 

Standard Bank GapAssist Gap Cover Pros and Cons

 

✅ Pros	❎ Cons
Comprehensive cover for medical expense shortfalls and various health risks	Some medical conditions and pregnancy may have waiting periods before being covered
Three plan options to choose from with varying levels of coverage and affordability	Does not cover all medical expenses, including cosmetic surgery, private nursing, and certain treatments
No annual limits on in-hospital or out-of-hospital cover	Exclusions for pre-existing conditions and specific treatments
Covers general co-payments and non-network co-payments charged by medical aids	Some benefits, such as accidental dentistry and trauma counseling, have annual limits

 

 

Our Verdict on Standard Bank GapAssist Gap Cover

 

Standard Bank GapAssist offers comprehensive benefits and covers medical expense shortfalls and additional health-related risks.  The plan options cater to different needs, budgets, and age groups, with flexible payment options and the ability to add family members.

The lack of general or condition-specific waiting periods and the option to waive premiums for medical aid gap cover are appealing features of the product.

 

 

Standard Bank GapAssist Gap Cover Frequently Asked Questions

 

What is Standard Bank GapAssist Gap Cover?

Standard Bank GapAssist Gap Cover is an insurance product that covers the shortfall between what your medical aid covers and what healthcare providers charge for their services.

 

How does Standard Bank GapAssist work?

Standard Bank GapAssist will cover the difference, subject to the policy’s terms and conditions, if there is a shortfall between what your medical aid covers and what healthcare providers charge.

 

What are the benefits of Standard Bank GapAssist?

The benefits of Standard Bank GapAssist include extensive medical expense shortfall cover, financial protection against various health risks, and a range of health insurance benefits.

 

How much does Standard Bank GapAssist cost?

The cost of Standard Bank GapAssist depends on the type of policy, the level of coverage, and other factors such as the age and health status of the policyholder. GapAssist typically starts from R225 for the Optimal Option.

 

What is the claims process for Standard Bank GapAssist?

To make a claim, you must complete a claims form and provide all relevant documents and information. Claims can be submitted online, via the app, by email, or by post.

 

Does Standard Bank GapAssist cover pre-existing conditions?

Standard Bank GapAssist does not cover pre-existing conditions unless the insurer discloses and accepts them.

 

Can I change my Standard Bank GapAssist Gap Cover option?

Yes, you can change your Standard Bank GapAssist Gap Cover option, subject to the policy’s terms and conditions.

 

How do I make changes to my Standard Bank GapAssist policy?

You can change your Standard Bank GapAssist policy by contacting the insurer directly and requesting the changes.

 

What are the exclusions of Standard Bank GapAssist?

The exclusions of Standard Bank GapAssist include cosmetic surgery, penalty co-payments, medication and other materials, external prosthetics, and more. A full list can be found in the policy’s terms and conditions.

 

What happens if I miss a premium payment?

If you miss a premium payment, your policy may lapse or be canceled, and you may no longer be covered. Contact the insurer immediately to arrange payment and avoid losing your cover.

 

Can I cancel my Standard Bank GapAssist policy?

Yes, you can cancel your Standard Bank GapAssist policy at any time, subject to the policy’s terms and conditions.

 

Is Standard Bank GapAssist available to non-South African residents?

Standard Bank GapAssist is only available to South African residents with valid ID numbers.