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Stratum Benefits Gap Cover ( 🇿🇦2025*)

💙 Overall, Stratum Benefits Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Stratum Benefits Gap Cover Plans start from R197 ZAR on the Access Optimiser. Stratum Benefits has a trust score of 4.5.

👉🏿 Stratum Benefits Gap Cover has 5 plans to choose from:

✅️ Stratum Benefits Elite 500

✅️ Stratum Benefits Compact 300

✅️ Stratum Benefits Access Optimiser

✅️ Stratum Benefits Access Co pay Plus 300

✅️Stratum Benefits Meridian 400

🟥 Date Established	1999
🟧 Underwriters	Guardrisk Insurance Company Limited (FSP 75)
🟨 Headquartered	Gauteng, South Africa
🟩 Number of Markets	South Africa
🟦 Market Share	>5%
🟪 Number of plans offered	5
🟥 Is a Mobile App offered	✅ Yes
🟧 Customer Support Operating Hours	Monday to Friday – 8 am to 4h30 pm
🟨 Waiting Period	3 Months
🟩 Exclusions	✅ Yes

Stratum Benefits Gap Cover – 11 Key Point Quick Overview

Stratum Benefits Gap Cover Premiums

Stratum Benefits Access Optimiser

🅰️ Membership Type	🅱️ Monthly Contribution
🟧 Individual or Family <64 years	R197
🟨 Individual or Family >65 years	R262

Stratum Benefits Meridian400

🟥 Membership Type	🟦 Monthly Contribution
🟧 Individuals <64 years	R250
🟨 If the entire family is <64 years	R320
🟩 If you or a dependent is >65 years	R698

Stratum Benefits Compact 300

🟥 Membership Type	🟦 Monthly Contribution
🟧 Individuals <64 years	R330
🟨 If the entire family is <64 years	R399
🟩 If you or a dependent is >65 years	R629

Stratum Benefits Access Co-Pay Plus 300

🟥 Membership Type	🟩 Monthly Contribution
🟧 Individual or Family <64 years	R404
🟨 Individual or Family >65 years	R537

Stratum Benefits Elite500

🟥 Membership Type	🟪 Monthly Contribution
🟧 Individuals <64 years	R481
🟨 If the entire family is <64 years	R591
🟩 If you are 65 years or older	R780
🟦 If you or a dependent is >65 years	R954

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Stratum Benefits Gap Cover Features

Stratum Benefits Access Optimiser

💙 This plan is the booster option that covers certain medical procedures that the policyholder’s medical aid does not cover. Those who are 65 years and older, or those who apply as a family with a member of 65 years or older, will be subject to the premium for a family or >65 individuals.

💙 The benefits of this plan are subject to an annual OPL of R 210 580 per insured person per year, regardless of whether you are covered as an individual or a family. Thus, all approved claim amounts will be subtracted from the OPL.

Stratum Benefits Access Cover

💙 This provides cover for procedures that are not typically covered by medical aid.

🟥 The procedure not covered by Medical Aid	Access Cover Amount Provided
🟧 Arthroscopic Surgery	R72,000
🟨 Back / Neck Surgery	R72,000
🟩 Bunion Surgery	R20,000
🟦 A cochlear implant, auditory brain implant, and internal nerve stimulator surgery (Including the procedure, device, processor, and hearing aids)	R85,000
🟪 Dental Procedures for impacted teeth (children <18 years)	R20,000
🟥 Dental procedures – reconstructive surgery because of an accident	R85,000
🟧 Endoscopic Procedures	R10,000
🟨 Functional Nasal Surgery	R30,000
🟩 Joint replacement surgery (Including non-PMB joint replacements and internal prosthetic devices)	R60,000
🟦 Knee or shoulder surgery	R30,000
🟪 MRI or CT scan is required due to an accidental event	R15,000
🟥 Non-cancerous breast conditions (including breast reconstruction of a breast not affected by cancer)	R25,000
🟧 Esophageal reflux and hiatus hernia surgery	R60,000
🟨 Removal of varicose veins	R25,000
🟩 Skin disorders (including benign growths or lipomas)	R25,000

Stratum Benefits Casualty Cover

💙 This covers everything related to your accident, including:

✅ Facility and doctor consultation fees.
✅ You pay co-payments and deductibles related to your accident out of pocket, or your health insurance pays from your medical savings account.
✅ Basic Radiology
✅ Specialized radiology
✅ Pathology
✅ Medication was administered during your accident.

💙 External medical items, such as a neck brace, are provided by the medical facility.

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Stratum Benefits Illness Cover

✅ Only for children younger than 10 years of age
✅ If your child younger than 10 years old becomes ill outside of normal business hours, we will cover the cost of a visit to a casualty facility and all healthcare provider bills associated with the visit.
✅ Stratum Benefits will reimburse the amount you pay out of pocket, or your medical savings account deducted from your medical aid.

👉🏿 Casualty Cover is limited annually per plan per policy.

Stratum Benefits Accidental Disability and Death

✅ If either of you becomes totally and permanently disabled or dies in an accident, the amount benefit per plan will differ.

👉🏿 Limited to one claim per person per year maximum.

Stratum Benefits Lifestyle Benefit

Internationa Travel

✅ Cover is limited to 1 event per policy per year up to a maximum of 31 days shared between all travellers.
✅ We need to know about your upcoming trip 7 days before departure and proof of travel will need to be submitted when applying for cover online.
✅ Our cover does not apply if you have similar cover through another provider, such as your medical aid.
✅ Our cover may not be used to extend cover already provided by another insurer.
✅ Pre-existing medical conditions are excluded from cover.

Stratum Benefits Meridian400

💙 The base is Stratum Benefits’ foundation option, which covers the most frequent gaps in cover for doctors’ and specialists’ private fees that you are likely to encounter.

Meridian400 Benefits and Cover

✅ Gap Benefit – In and Out-of-Hospital is covered up to 400% and subject to an OPL of R210,580 per insured person annually.
✅ Dental Cover is paid up to 400%, and there are limits between R10,000 and R28,000 per policy per year, depending on the procedure.
✅ Maternity Cover is covered when professionals charge more than the medical aid rate when delivering a baby. In addition, shortfalls are covered if the medical aid pays a specific amount from a hospital benefit.
✅ Radiology shortfall is up to 400% on top of your medical aids rate cover.
✅MRI, CT and Pet scan copayments – It can be claimed as needed, but subject to their admission co – payment benefit procedure.
✅MRI, CT and Pet scan sublimit – limited to R5000 per year per insured person.
✅ Casualty Benefit – Accidental Events Out-of-Hospital. Stratum Benefits will reimburse the shortfalls or total cost of your casualty event if your medical aid pays for it from your medical savings account or you pay for it out of pocket. Limited to R9000 per insured person per year.
✅ Casualty Benefit – Illness Out-of-Hospital. Stratum Benefits will reimburse the shortfalls or total cost of your casualty event if your medical aid pays for it from your medical savings account or you pay for it out of pocket. Limited to 2 events per year and limited to R3000 per event.
✅ Trauma Counselling is limited to 3 consultation up to R2000 per consultation per policy per year.

Stratum Benefits Compact 300

💙 Compact 300 is a well-rounded plan with the right benefits to cover the most common medical expense gaps.

✅ Gap Benefit – In and Out-of-Hospital is covered up to 300% and subject to an OPL of R210,580 per insured person annually.
✅ Co-Payment Benefit covers claims on admission and procedure-related co-payments and deductibles up to R20,000. Alternatively, you can claim penalty co-payments on non-DSP providers up to R10,000 per policy annually.
✅ Dental Cover is paid up to 300%, and there are limited to R30 000 per policy per year, depending on the procedure and subject to an OPL of R210,580 per insured person annually.
✅ Maternity Cover is covered when professionals charge more than the medical aid rate when delivering a baby. In addition, shortfalls are covered if the medical aid pays a specific amount from a hospital benefit.
✅ Sub-Limit Benefit covers up to R30,000 per insured person per event as follows:
✅ When your medical aid pays a portion of the cost from a sub-limit or annual limit, Stratum Benefits will cover the remaining cost of any internal prosthetic device implanted in your body.

Stratum Benefits Access Co-Pay Plus 300

💙 Cover for most common medical expense shortfalls on doctors’ and specialists’ accounts is provided by this booster option, which kicks in if your primary medical aid plan does not already cover a particular medical procedure or event.

Stratum Benefits Access Cover

💙 This provides cover for procedures that are not typically covered by medical aid.

🟥 The procedure not covered by Medical Aid	Access Cover Amount Provided
🟧 Arthroscopic Surgery	R72,000
🟨 Back / Neck Surgery	R72,000
🟩 Bunion Surgery	R20,000
🟦 The cochlear implant, auditory brain implant, and internal nerve stimulator surgery (Including the procedure, device, processor, and hearing aids)	R85,000
🟪 Dental Procedures for impacted teeth (children <18 years)	R20,000
🟥 Dental procedures – reconstructive surgery because of an accident	R85,000
🟧 Endoscopic Procedures	R10,000
🟨 Functional Nasal Surgery	R30,000
🟩 Joint replacement surgery (Including non-PMB joint replacements and internal prosthetic devices)	R60,000
🟦 Knee or shoulder surgery	R30,000
🟪 MRI or CT scan is required due to an accidental event	R15,000
🟥 Non-cancerous breast conditions (including breast reconstruction of a breast not affected by cancer)	R25,000
🟧 Esophageal reflux and hiatus hernia surgery	R60,000
🟨 Removal of varicose veins	R25,000
🟩 Skin disorders (including benign growths or lipomas)	R25,000

Stratum Benefits – Benefits

✅ Gap Benefit – In and Out-of-Hospital is covered and subject to an OPL of R210,580 per insured person annually.
✅ Dental Cover is paid as follows:
✅ Gap Benefit – Stratum Benefit pays up to 300%.
✅ There are limits between R20,00 and R85,000 per policy per year, depending on the procedure.

Elite500

💙 The Elite plan is the premium option with the widest range of benefits and coverage.

Elite500 Benefits and Cover

✅ Gap Benefit – In and Out-of-Hospital is covered up to 500% and subject to an OPL of R210,580 per insured person annually.
✅ Co-Payment Benefit includes the following:
✅ Admission and Procedure Co-Payments where the policyholder can claim as many admission and procedure co-payments and deductibles, up to a limit of R210,580 per year per insured person.
✅ Penalty Co-payments are covered up to R15,000 per policy annually.
✅ Robotic Surgery Co-payments are covered up to R10,000 per policy annually.
✅ The dental Cover includes the following:
✅ Gap Benefit – paid up to 500%, and there are limited to R50,000 per policy per year, depending on the procedure.
✅ Co-Payment Benefits on Admissions and Procedures are covered up to the OPL R210,580 per insured person yearly.

How to apply for Gap Cover with Stratum Benefits

👉🏿 To apply for Stratum Benefits Gap Cover, you can follow these steps:

✅ You can find more information about their gap cover offerings and obtain a quote by visiting Stratum’s official website.
✅ Review and compare the quotes from Stratum and other insurance providers to determine which option best suits your needs.
✅ Once you have selected Stratum as your preferred provider, you can complete the online application form. You will be asked to provide personal and medical information and details about your current medical cover.
✅ After you have completed the form, you can submit it online. Stratum will then process your application and provide you with a policy document.
✅ Once your policy is approved, you must pay the premium to activate the cover. However, Stratum offers flexible payment options to make this process as convenient as possible.

💙 Your gap cover will become active from the date of payment, and you can start using it to claim for any uninsured medical expenses when the waiting period has passed.

How can I change my Stratum Benefits Gap Cover option?

👉🏿 To change your Stratum Benefits Gap Cover option, you can follow these steps:

✅ Contact Stratum’s customer service by phone, email, or through their online platform. Explain that you would like to make changes to your gap cover option.
✅ The customer service representative will ask you to provide information about your current policy, the changes you would like to make, and your reasons for making these changes.
✅ Stratum’s customer service representative will assist you in reviewing the available options and help you determine which option best suits your needs.
✅ You must complete a change request form if you decide to change your gap cover option. This form will outline the changes you request, and any additional information required.
✅ Submit the change request form to Stratum and wait for confirmation of the changes. Stratum will process your request and provide you with updated policy information.
✅ Suppose the changes result in an increase in your premium. In that case, you will need to pay the additional amount to activate the changes. Stratum offers flexible payment options to make this process as convenient as possible.

💙 Stratum Benefits policyholders should note that their gap cover option may impact their overall cover and result in additional costs. Hence, it is important for them to carefully consider the implications before making any changes.

How to Submit a Claim for Gap Cover with Stratum Benefits

👉🏿 Policyholders who want to claim from Stratum Benefits must ensure that they follow these conditions:

✅ A separate claim form must be submitted for each medical event being claimed.
✅ Ensure the form is completed thoroughly, including Your Claim Reimbursement Profile and the Authorization & Declaration Acceptance sections, and sign it.

👉🏿 Once the claim form is completed, the policyholder must ensure that they provide the following documentation according to their claim:

✅ Detail Hospital Account
✅ Healthcare or Service Provider Account
✅ Medical Aid Statements
✅ Medical Aid Pre-Authorization Letter

👉🏿 Once you have gathered the documents, you can submit everything to Stratum Benefits.

Stratum Benefits Gap Cover Exclusions

Stratum Benefits Plans Group A

✅ Access Optimiser
✅ Access Co-Pay Plus and Access Co-Pay Plus 300 (On Access Benefit)
✅ Corporate Access
✅ Corporate Access Plus 500 (Access)

10-Month Limited Pay-Out Benefit

💙 If you claim Stratum Benefits’ Access Cover within the first 10 months of cover for a medical event related to either of the following procedures, only 20% of the claim will be covered by Stratum Benefits:

✅ Arthroscopic Surgery
✅ Back / Neck Surgery
✅ Bunion Surgery
✅ The cochlear implant
✅ Dental Procedures for impacted teeth (children <18 years)
✅ Dental procedures – reconstructive surgery because of an accident
✅ Endoscopic Procedures
✅ Functional Nasal Surgery
✅ Joint replacement surgery
✅ Knee or shoulder surgery
✅ MRI or CT scan is required due to an accidental event.
✅ Non-cancerous breast conditions
✅ Esophageal reflux and hiatus hernia
✅ surgery
✅ Removal of varicose veins
✅ Skin disorders

Stratum Benefits Plans Group B

✅ Base, Compact 300
✅ Access Co-Pay Plus and Access Co-Pay Plus 300 (On Gap and Co-Payment Benefit)
✅ Elite, Corporate Suite (Compact, Elite, Elite Plus)
✅ Corporate Access Plus 500 (Gap)

10-Month Limited Pay-Out Benefit

💙 If you make a claim on Stratum Benefits’ Base Cover within the first 10 months of cover for a medical event related to either of the following procedures, only 20% of the claim will be covered by Stratum Benefits:

✅ Adenoidectomy
✅ Cardiovascular procedures
✅ Cataract removal
✅ Dentistry
✅ Hernia repair
✅ Hysterectomy
✅ Joint replacements
✅ MRI, CT, and PET scans
✅ Myringotomy/grommets
✅ Nasal and sinus surgery
✅ Pregnancy and childbirth
✅ Scopes
✅ Spinal procedures
✅ Tonsillectomy

Other Exclusions across all plans

✅ Your Gap Cover policy has different benefits that cover shortfalls in medical costs.

💙 Depending on the benefit you are claiming, your medical aid must first pay a portion of the cost of your medical event before Stratum Benefits can take care of the rest if you meet the benefit’s requirements.

Stratum Benefits Gap Cover Waiting Periods

✅ Waiting periods are in effect from the beginning of the policy, the date of upgrading the policy options, and the start date of cover for everyone added after the initial policy start date.
✅ There is a three-month general waiting period during which Stratum Benefits does not provide cover unless a claim is filed for accidental events after the policy commenced.

💙 There is a 12-month pre-existing condition waiting period for investigations, medical procedures, surgeries, or any illness or medical condition-related treatments diagnosed within 12 months you started your policy with Stratum Benefits.

Stratum Benefits Gap Cover vs. Other Notable Providers

🔎 Gap Cover Provider	🥇 Stratum Benefits	🥈 Sirago	🥉 Discovery Health
🟥 Number of Plans	5	8	2
🟧 Average Price from	R197	R172	R157
🟨 Waiting Periods	3 months	3 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	✅ Yes	✅ Yes	✅ Yes
🟨 Scopes and Scans	✅ Yes	None	✅ 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	None	None
🟦 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	None
🟪 Travel Cover Extender	✅ Yes	None	✅ Yes

Sharpen your knowledge with a better understanding of Economical Medical Aids in South Africa

Stratum Benefits Gap Cover Pros and Cons

✅ Pros	❌ Cons
Stratum Benefits has a good reputation and proven record of providing gap cover	There are several claim limits and waiting periods
There are flexible options provided for individuals, families, and corporate clients	Even though Stratum Benefits provides gap cover, it might not be enough to cover all medical expenses, especially if you have pre-existing conditions

Our Verdict on Stratum Benefits Gap Cover

💙 Stratum Gap Cover offers an extensive selection of customized Gap Cover products for individuals, families, and companies.

💙 Stratum Benefits has offered award-winning Medical Aid Gap Cover for over a decade. In addition, for the past two years s, Stratum has received the FIA’s Product Supplier of The Year award. Therefore, Stratum Benefits is considered one of the superior gap cover providers in South Africa.

Stratum Benefits Gap Cover Frequently Asked Questions

Where can I view Stratum benefits for 2025?

You can view the 2025 benefits and plan options on the official Website of Stratum Benefits under “Gap Cover.”

What is the Stratum Gap Cover Contact Number?

You can contact Stratum Benefits on 010 593 0981.

Does Stratum have a WhatsApp number?

Yes, Stratum Benefits can be contacted via WhatsApp on 087 255 5793.

Who is eligible for gap cover with Stratum Benefits?

Stratum Benefits Gap Cover is available to individuals who are members of a medical aid scheme in South Africa. Certain medical aid schemes and membership levels are not eligible for gap cover, so it is important to check with Stratum Benefits to confirm your eligibility.

What types of medical expenses are covered by Stratum Benefits Gap Cover?

Stratum Benefits Gap Cover covers medical expenses not covered by your medical aid, including co-payments, deductibles, and hospital fees. Cover can vary depending on the specific gap cover option you choose, so it is important to review the terms and conditions of your policy.

How do I claim with Stratum Benefits Gap Cover?

To make a claim with Stratum Benefits Gap Cover, you need to provide Stratum with proof of payment for your medical expense and a claim form. Claims can be submitted online, by mail, or by fax. Stratum provides a quick and efficient claim process. In addition, it will assist you with any questions or concerns you may have about making a claim.

Can I change my gap cover option with Stratum Benefits?

Yes, you can change your gap cover option with Stratum Benefits anytime. However, changes to your policy may impact your coverage and could result in additional costs, so it is important to carefully consider the implications before making any changes.

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.