💙 Overall, Stratum Benefits Access Co pay Plus 300 is a trustworthy short-term insurance product designed to provide extra protection for those with medical aid. The Plan starts from R404 ZAR. Stratum Benefits has a trust score of 4.5.
| 🔎 Provider | 🥇 Stratum Benefits Access Co pay Plus 300 |
| 🟥 Years in Operation | 25 years |
| 🟧 Underwriters | Guardrisk Insurance Company Limited (FSP 75) |
| 🟨 Market Share in South Africa | >5% |
| 🟩 Gap Cover Waiting Period | 3 Months |
| 🟦 Do Exclusions Apply | ✅ Yes |
| 🟪 Average Monthly Premium | R404 |
| 🟥 Oncology Benefit | ✅ Yes |
| 🟧 In-Hospital Benefit | ✅ Yes |
| 🟨 Out-of-Hospital Cover | ✅ Yes |
💙 The Stratum Benefits Access Co pay Plus 300 is one of eleven plans that starts from R404 per month. Stratum Benefits’ Base has benefits for first-time cancer diagnosis, accidental death, casualty, illness, radiology, maternity cover, and more.
👉🏿 Stratum Benefits Gap Cover has 5 plans to choose from:
✅️ Stratum Benefits Compact 300
✅️ Stratum Benefits Access Optimiser
✅️ Stratum Benefits Access Co pay Plus 300
✅️Stratum Benefits Meridian 400
| 🟥 Membership Type | 🟩 Monthly Contribution |
| 🟧 Individuals or Families <64 years | 🟦 R404 |
| 🟨 Individuals or Families>65 years | 🟪 R537 |
💙 This plan is an enhanced alternative designed to encompass specific medical procedures not included in the policyholder’s existing medical cover.
💙 It applies to individuals aged 65 and above and families with at least one member aged 65 or above, who will be subjected to the premium associated with a family or individuals over 65.
💙 Under this plan, the benefits offered are contingent upon an annual Out-of-Pocket Limit (OPL) of R210 580 per policy, regardless of whether the policyholder is covered as an individual or as part of a family. Consequently, any approved claim amounts will be deducted from the OPL.
💙 This provides cover for procedures that are not typically covered by medical aid.
| 🟥 The procedure not covered by Medical Aid | Access Cover Amount Provided |
| Adenoidectomy, myringotomy (grommets) or tonsillectomy | R15 000 |
| 🟧 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 |
| 🟥 Gap Benefit | Gap Benefit covers in and out-of-hospital expenses up to 300% with an annual Out-of-Pocket Limit (OPL) of R210 580 per insured person. |
| 🟧 Co-payment Benefit | Allows unlimited claims for co-payments and deductibles, as long as they don’t exceed R6,500 per policy per year. |
| 🟨 Dental Cover | • Dental procedures, such as dental implants and wisdom teeth extractions: Limited to R 30 000 per policy per year. Dental procedures due to accidental events or cancer treatment: Subject to the OPL of R 210 580 per insured person per year |
| 🟩 Maternity Cover | Includes cover for shortfalls in childbirth expenses both in and out-of-hospital, subject to medical aid payments and specific benefit conditions. Stratum Benefits refunds co-payments and deductibles for elective caesareans. |
| 🟦 Radiology Cover | Provides Gap Cover up to 300% of shortfalls, with unlimited cover for co-payments and deductibles from medical aid savings or out-of-pocket expenses. |
| 🟪 Casualty Benefit – Accidents and Illness | Covers accidental events and illness out-of-hospital, reimbursing shortfalls or total costs if paid from medical aid savings or out-of-pocket expenses. Limited to R3,000 per policy per year. |
| 🟥 Accidental Death and Disability | Cover offers R5,000 each for the insured person and their spouse in the event of total and permanent disability or death due to an accident, limited to one event per year. |
💙 Suppose you claim within the first 10 months of cover for certain medical events/procedures (arthroscopic surgery, bunion surgery, reconstructive dental procedures, etc.). In that case, Stratum Benefits will only cover 20% of the claim amount.
💙 Waiting periods apply from the policy start date, policy option upgrades, and for new members added after the initial policy start date. There is a three-month general waiting period for all claims except accidental events.
💙 Additionally, there is a 12-month waiting period for pre-existing conditions, including investigations, procedures, surgeries, and treatments related to illnesses or medical conditions diagnosed within 12 months of starting the policy with Stratum Benefits.
| 🔎 Provider | 🥇 Stratum Benefits Access Co pay Plus 300 | 🥈 Sirago Gap Lite | 🥉 Standard Bank GapAssist Essential |
| 🟥 Years in Operation | 25 years | 31 years | 62 years (Standard Bank) |
| 🟧 Underwriters | Guardrisk Insurance Company Limited (FSP 75) | GENRIC Insurance Company Limited (FSP: 43638) | Standard Insurance Limited |
| 🟨 Market Share in South Africa | >5% | >10% | <10% |
| 🟩 Gap Cover Waiting Period | 3 Months | From 3 months (up to 12) | 12 Months |
| 🟦 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Average Monthly Premium | R404 | R289 | R397 |
| 🟥 Oncology Benefit | ✅ Yes | None | None |
| 🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟨 Out-of-Hospital Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟩 Maternity Benefit | ✅ Yes | ✅ Yes | None |
| 🟦 Scopes and Scans | ✅ Yes | None | ✅ Yes |
| 🟪 Co-payment Cover | ✅ Yes | ✅ Yes | None |
| 🟥 Emergency Room | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟧 Accidental Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟨 Trauma Counseling | None | None | ✅ Yes |
| 🟩 Premium Waiver | None | None | ✅ Yes |
| 🟦 Non-DSP Co-payment | None | ✅ Yes | None |
| 🟪 Prostheses | ✅ Yes | None | None |
| 🟥 Travel Cover Extender | None | None | None |
| 🟧 Accidental Death/ Permanent Disability | ✅ Yes | None | ✅ Yes |
👉🏿 Discover more about Preventative Care?
💙 In our experience, Stratum Benefits Access Co-pay Plus 300 is a comprehensive gap cover plan offered by Stratum Benefits in South Africa. Co-pay Plus 300 covers medical expenses not covered by existing medical aid plans. The plan also offers benefits such as Gap Benefits, Co-payment Benefits, Dental Coverage, Maternity Coverage, Radiology Coverage, and more.
💙 However, according to our research, there is a three-month period for general claims and a 12-month waiting period for pre-existing conditions.
No, Stratum Benefits Access Co pay Plus 300 is specifically designed for individuals aged 65 and above and families with at least one member aged 65 or above.
Yes, the plan covers pre-existing conditions after a 12-month waiting period.
The maximum limit for co-payments and deductibles under the Co-payment Benefit is R6,500 per policy per year.
Yes, there is a three-month waiting period for general claims, excluding accidental events, and a 12-month waiting period for pre-existing conditions.
No, the Access Cover is specifically designed to provide cover for procedures not typically covered by your existing medical aid, filling the gaps in your cover.
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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