Optimal
About this plan
Family-focused gap cover providing up to 500% medical aid tariff cover for specialist shortfalls, approved co-payments, oncology benefits, and selected out-of-hospital procedures.
Monthly premium
From
R590
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Optimal
Turnberry Optimal (🇿🇦 2025*)
💙 Overall, Turnberry Optimal Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Turnberry Optimal Gap Cover Plans start from R510 ZAR. Turnberry has a trust score of 4.3.| 🔎 Provider | 🥇 Turnberry Optimal |
| 🟥 Years in Operation | 22 years |
| 🟧 Underwriters | Lombard Insurance Company |
| 🟨 Market Share in South Africa | <5% |
| 🟩 Gap Cover Waiting Period | 3 – 12 months |
| 🟦 Do Exclusions Apply | ✅ Yes |
| 🟪 Average Monthly Premium | R510 |
| 🟥 Oncology Benefit | ✅ Yes |
| 🟧 In-Hospital Benefit | ✅ Yes |
| 🟨 Out-of-Hospital Cover | ✅ Yes |
Turnberry Optimal Gap Cover - 7 Key Point Quick Overview
- ✅ Turnberry Optimal Overview
- ✅ Turnberry Optimal Premiums
- ✅ Turnberry Optimal Benefits and Cover Breakdown
- ✅ Turnberry Optimal Exclusions and Waiting Periods
- ✅ Turnberry Optimal vs Other Gap Cover Plans
- ✅ Our Verdict on Turnberry Optimal
- ✅ Turnberry Optimal Frequently Asked Questions
Turnberry Optimal Overview
💙 The Turnberry Optimal is one of five plans that starts from R510 per month. The Turnberry Optimal Plan has benefits for in-hospital dental procedures, illness, oncology, innovative cancer drugs, trauma care, critical illness, travel, and more. https://youtu.be/zMSUi8WkN2I 👉 Turnberry Gap Cover has five plans to choose from ✅ Turnberry Synergy ✅ Turnberry Premier ✅ Turnberry Optimal ✅ Turnberry Med Extend ✅ Turnberry LaunchTurnberry Optimal Premiums
| 🅰️ Families under 65 years | 🅱️ Families that have members 65 years> |
| R510 | R736 |
Turnberry Optimal Benefits and Cover Breakdown
Turnberry Optimal In-Hospital Benefits
| 🟥 Medical Expense Shortfall Cover | Increases medical aid by 500%. Covers costs associated with GPs, Specialists, Anaesthetists, Radiology, Pathology, and Consumables. Subject to the Overall Annual Limit. |
| 🟧 Co-payment cover | Subject to the Overall Annual Limit. |
| 🟨 Non-DSP Hospital Penalty Cover | Limited to R13,500 per admission. Limited to 1 family claim per year. Subject to the Overall Annual Limit. |
| 🟩 Sub-Limit Cover | Limited to R33,000 per admission per insured. Limited to R72,000 per family per year. Subject to the Overall Annual Limit. |
Turnberry Optimal In-Hospital Dental Cover
| 🟥 Medical Expense Shortfall Cover | Increases medical aid by 500% for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery after an accident, and oral cancer diagnosed while on the policy. Subject to the Overall Annual Limit. |
| 🟧 Basic Dental Medical Expense Shortfall Cover for Children | Increases Medical Aid by 500% for basic dentistry for children under 12. Limited to R4,000 per family per year. |
| 🟨 Co-payment Cover | Subject to the Overall Annual Limit. |
| 🟩 Sub-limit and Co-payment Cover Dental Implants | Covers oral cancer and reconstructive maxillofacial surgery dental implants (diagnosed while on the policy). Limited to R24,000 per admission, R50,000 per family per year. Subject to the Overall Annual Limit. |
| 🟦 Sub-limit Cover | Limited to R24,000 per admission and R50,000 per family per year for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident while on the policy, and oral cancer (diagnosed while on the policy). Subject to the Overall Annual Limit. |
Turnberry Optimal Out-of-Hospital Benefits
| 🟥 Co-payments for MRI, CT, and PET scans | Subject to AOL |
| 🟧 Co-payments for scopes | Limited to R6,000 per event. Limited to 2 claims per insured yearly. Subject to the Overall Annual Limit. |
| 🟨 Sub-limit cover for MRI, CT, and PET scans | Limited to R33,000 per event per insured. Limited to R72,000 per family per year. Subject to the Overall Annual Limit. |
| 🟩 Casualty Benefits for Accidents | Limited to R12,000 per event per insured. Subject to the Overall Annual Limit. |
| 🟦 Casualty Benefit for Illness | Limited to R5,000 per event. Limited to 2 claims per family yearly. Subject to the Overall Annual Limit. Treatment is limited to 6 pm – 6 am, Mondays–Fridays, Saturdays–Sundays, and Public Holidays |
Turnberry Optimal In-Hospital and Out-of-Hospital Benefits
| 🟥 Traditional Cancer Cover | Traditional cancer treatment co-payments are limited to 20% per admission. Subject to the Overall Annual Limit. |
| 🟧 Biological Cancer Drug Cover | Covers Biological Cancer Drugs when the Medical Scheme has a sub-limit. Subject to the formulary and the Annual Maximum |
| 🟨 Innovative Cancer Drug Cover | Cover for new and innovative cancer drugs. Each claim is limited to R12,000. Subject to the Overall Annual Limit. |
| 🟩 MRI and CT Scan Cover | Covers MRI and CT scans without Medical Scheme cover. R7,000 per event and 1 claim per family per year. |
| 🟦 Trauma Care Cover | Covers trauma counseling with a registered healthcare provider after a member is diagnosed with a critical illness, is a victim of a violent crime, or loses an immediate family member. Limited to R3,000 per insured and R7,000 per family annually. Subject to the Overall Annual Limit |
| 🟪 Breast Cancer Prevention Cover | Increases the Medical Aid rate for a Prophylactic Mastectomy by up to 500%. Subject to clinical entry criteria and the Annual Maximum. |
| 🟥 Breast Cancer Reconstruction Cover | Increases the Medical Aid rate for breast reconstruction after a mastectomy due to cancer for the affected breast by up to 500%. When there is no benefit on the insured person’s Medical Scheme, reconstruction of the unaffected breast for symmetry is limited to R22,000 per insured person per lifetime. Subject to the Overall Annual Limit. |
Turnberry Optimal Added Benefits
| 🟥 Medical Scheme Contribution Waiver | Limited to R7,500 per month for six months if the Medical Scheme Contribution Payer dies or becomes permanently disabled in an accident. |
| 🟧 Gap Premium Waiver | Pays your Optimal Policy premium for 12 months if the Contribution Payer dies or becomes permanently disabled in an accident. |
| 🟨 Personal Accident Benefit | Limited to R19,500 per insured registered on the policy if there is accidental death or permanent total disability. |
| 🟩 Critical Illness Benefit | The policy is limited to R9,500 per insured if death or critical illness occurs (excluding cancer). |
| 🟦 International Travel Cover | R5 million per insured, but a 48-hour travel notice is required. |
Turnberry Optimal Exclusions and Waiting Periods
Turnberry Optimal Exclusions
💙 Turnberry Optimal excludes Hospitalization, bodily injury, sickness, or disease caused by:- ✅ Nuclear weapons, nuclear material, or ionizing radiation.
- ✅ Suicide, attempted suicide, or intentional self-injury.
- ✅ Taking drugs or narcotics not prescribed by a Medical Practitioner.
- ✅ Alcohol-related illness or exceeding the legal alcohol limit.
- ✅ Artificial insemination, hormone treatment, or surgery.
- ✅ Fraudulent claim submissions.
- ✅ Medical or surgical treatment not occurring during hospital confinement.
- ✅ No benefits for transport charges or services during emergency transportation.
- ✅ No ward fee benefits for additional costs during private ward confinement.
- ✅ Treatment for not following doctor’s orders.
- ✅ Casualty Illness Benefit treatment not received during specified hours.
- ✅ Injuries from professional sports or dangerous recreational activities.
Turnberry Optimal Waiting Periods
💙 There is a general waiting period of three months for all benefits except accidents on the policy and a waiting period of 10 months for pregnancy/childbirth. Furthermore, there is a waiting period of 12 months for the following treatments:- ✅ Investigations
- ✅ Treatment or surgery related to hysterectomy
- ✅ Hysteroscopies
- ✅ Endometriosis
- ✅ Ovarian cysts and fibroids
- ✅ Musculoskeletal conditions
- ✅ Tonsillectomy
- ✅ Myringotomy
- ✅ Grommets
Turnberry Optimal vs Other Gap Cover Plans
| 🔎 Provider | 🥇 Turnberry Optimal | 🥈 Sirago Exact Cover with Gap and Co-Pay | 🥉 Netcare Plus Gap Cover |
| 🟥 Years in Operation | 23 years | 31 years | 28 years |
| 🟧 Underwriters | Lombard Insurance Company | GENRIC Insurance Company Limited (FSP: 43638) | The Hollard Insurance Company Limited |
| 🟨 Market Share in South Africa | <5% | >10% | <5% |
| 🟩 Gap Cover Waiting Period | 3 – 12 months | From 3 months (up to 12) | 3 – 12 months |
| 🟦 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Monthly Premium from. | R510 | R413 | R315 |
| 🟥 Oncology Benefit | ✅ Yes | None | ✅ Yes |
| 🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟨 Out-of-Hospital Cover | ✅ Yes | None | ✅ Yes |
| 🟩 Maternity Benefit | None | None | ✅ Yes |
| 🟦 Scopes and Scans | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Co-payment Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟥 Emergency Room | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟧 Accidental Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟨 Trauma Counseling | ✅ Yes | None | ✅ Yes |
| 🟩 Premium Waiver | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟦 Non-DSP Co-Payment | ✅ Yes | None | ✅ Yes |
| 🟪 Prostheses | None | ✅ Yes | ✅ Yes |
| 🟥 Travel Cover Extender | ✅ Yes | None | None |
| 🟧 Accidental Death/ Permanent Disability | ✅ Yes | ✅ Yes | ✅ Yes |
