Stratum Benefits Access Co pay Plus 300
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 Stratum Benefits Access Co pay Plus 300 Plan starts from R344 ZAR. Stratum Benefits has a trust score of 4.5.
| 🔎 Provider | 🥇 Stratum Benefits Access Co pay Plus 300 |
| 🟥 Years in Operation | 24 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 | R344 |
| 🟥 Oncology Benefit | ✅ Yes |
| 🟧 In-Hospital Benefit | ✅ Yes |
| 🟨 Out-of-Hospital Cover | ✅ Yes |
Stratum Benefits Access Co pay Plus 300 – 7 Key Point Quick Overview
- ✅ Stratum Benefits Access Co pay Plus 300 Overview
- ✅ Stratum Benefits Access Co pay Plus 300 Premiums
- ✅ Stratum Benefits Access Co pay Plus 300 Benefits and Cover Breakdown
- ✅ Stratum Benefits Access Co pay Plus 300 Exclusions and Waiting Periods
- ✅ Stratum Benefits Access Co pay Plus 300 vs Other Gap Cover Plans
- ✅ Our Verdict on Stratum Benefits Access Co pay Plus 300
- ✅ Stratum Benefits Access Co pay Plus 300 Frequently Asked Questions
Stratum Benefits Access Co pay Plus 300 Overview
The Stratum Benefits Access Co pay Plus 300 is one of eleven plans that starts from R344 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 eleven plans to choose from:
Stratum Benefits Access Co pay Plus 300 Premiums
| 🟥 Membership Type | 🟩 Monthly Contribution |
| 🟧 Individuals or Families <64 years | 🟦 R344 |
| 🟨 Individuals or Families>65 years | 🟪 R457 |
Stratum Benefits Access Co pay Plus 300 Benefits and Cover Breakdown
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 R 177,835 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.
Access Co pay Plus 300 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 | R50,000 |
| 🟨 Back / Neck Surgery | R50,000 |
| 🟩 Bunion Surgery | R14,000 |
| 🟦 The cochlear implant, auditory brain implant, and internal nerve stimulator surgery (Including the procedure, device, processor, and hearing aids) | R80,000 |
| 🟪 Dental Procedures for impacted teeth (children <18 years) | R14,000 |
| 🟥 Dental procedures – reconstructive surgery because of an accident | R80,000 |
| 🟧 Endoscopic Procedures | R5,000 |
| 🟨 Functional Nasal Surgery | R23,000 |
| 🟩 Joint replacement surgery (Including non-PMB joint replacements and internal prosthetic devices) | R50,000 |
| 🟦 Knee or shoulder surgery | R25,000 |
| 🟪 MRI or CT scan is required due to an accidental event | R10,000 |
| 🟥 Non-cancerous breast conditions (including breast reconstruction of a breast not affected by cancer) | R20,000 |
| 🟧 Esophageal reflux and hiatus hernia surgery | R55,000 |
| 🟨 Removal of varicose veins | R20,000 |
| 🟩 Skin disorders (including benign growths or lipomas) | R20,000 |
Access Co pay Plus 300 Benefits
| 🟥 Gap Benefit | Gap Benefit covers in and out-of-hospital expenses up to 300% with an annual Out-of-Pocket Limit (OPL) of R185,873 per insured person. |
| 🟧 Co-payment Benefit | Allows unlimited claims for co-payments and deductibles, as long as they don’t exceed R5,000 per policy per year. |
| 🟨 Dental Cover | Includes Gap Benefit cover of up to 300%, with limits ranging from R6,000 to R16,000 per policy per year, depending on the procedure.
Co-payment Benefit allows multiple claims for admission and procedure co-payments. |
| 🟩 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 R2,000 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. |
| 🟧 First-Time Cancer Diagnosis | Covers up to R15,000 per insured person in their lifetime. |
| 🟨 Lifestyle Benefits | Includes access to Boston Online Home Education for grades 8 to 12 high school students. It offers online CAPS and Cambridge International Curriculum content, educational webinars, career guidance, and short learning programs. Registration provides a unique voucher number to access the platform. |
Stratum Benefits Access Co pay Plus 300 Exclusions and Waiting Periods
Access Co pay Plus 300 Exclusions
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.
Access Co pay Plus 300 Waiting Periods
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.
Stratum Benefits Access Co pay Plus 300 vs Other Gap Cover Plans
| 🔎 Provider | 🥇 Stratum Benefits Access Co pay Plus 300 | 🥈 Sirago Gap Lite | 🥉 Standard Bank GapAssist Essential |
| 🟥 Years in Operation | 24 years | 30 years | 61 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 | R344 | R249 | R351 |
| 🟥 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 |
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Our Verdict on Stratum Benefits Access Co pay Plus 300
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. In addition, the plan offers benefits such as Gap Benefits, Co-payment Benefits, Dental Cover, Maternity Cover, Radiology Cover, 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.
Stratum Benefits Access Co pay Plus 300 Frequently Asked Questions
Can I apply for Stratum Benefits Access Co pay Plus 300 if I am under 65?
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.
Does Access Co pay Plus 300 provide cover for pre-existing conditions?
Yes, the plan covers pre-existing conditions after a 12-month waiting period.
What is the maximum limit for co-payments and deductibles under the Access Co-pay Plus 300 Co-payment Benefit?
The maximum limit for co-payments and deductibles under the Co-payment Benefit is R5,000 per policy per year.
Are there waiting periods for specific procedures or treatments on Access Co pay Plus 300?
Yes, there is a three-month waiting period for general claims, excluding accidental events, and a 12-month waiting period for pre-existing conditions.
Can I use the Access Cover for medical procedures already covered by my existing medical aid?
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.
