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Old Mutual Medical Gap Cover
Fill in the gap between what your medical scheme pays and
what your medical specialists charge for in-hospital procedures.
So youve ensured youre covered by a medical
scheme, but have you given any thought as to
whether your bills will be covered should you end
up in hospital?
Its only after a stay in hospital that most medical scheme
members fnd out that the cover provided by their medical
scheme in hospital has fallen short of the amount charged by the
health professionals whove attended to them, leaving signifcant
shortfalls to pay what were simply not budgeted for.
Old Mutual Medical Gap Cover
This portion of the account that you need to pay for
is referred to as the gap between what your medical
scheme has paid out and the actual costs incurred. And
it arises for a very simple reason.
Did you know
The gap could be up to 75% of the total account.
This is why Old Mutual has introduced the
Old Mutual Medical Gap Cover.
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4 x MSR
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1 x MSR 3 x MSR
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What are you covered for?
Old Mutual Medical Gap Cover will cover the surgical and
consultation fees charged by the health professionals for you
and your immediate family (who are registered on your medical
scheme), up to a maximum amount of four times the Medical
Scheme Rates (MSR) in the event of:
in-hospital medical and surgical treatment, or
out-patient treatment for chemotherapy, radiotherapy or
renal dialysis.
MSR is Medical Scheme Rates
How much cover do you get?
Cover is provided for each calendar year for up to R100 000
per insured event, and subject to a maximum of R400 000 per
insured family.
What does it cost?
For just R110 per month you and your immediate family (who
are registered on your medical scheme membership) will be
provided with Old Mutual Medical Gap Cover. Premium rates
are annually reviewable, effective 1 January.
General rules
Anyone under 60 years of age (and on a medical scheme)
may join, and cover will cease upon attaining the age of 75.
A three-month general waiting period for benefts
will apply, which will be waived in the event that
hospitalisation is caused by an accident that occurred
after the commencement date of the cover.
A twelve-month condition-specifc waiting period for
benefts will apply on any birth and maternity related
events and any conditions for which any insured person
received treatment or advice, or could reasonably have
known about, in the twelve months prior to the start of
the policy.
The rules of the medical scheme will always apply,
and no payment will be made for excluded events, any
co-payments or penalties that may be levied, ex-gratia
payments made by your medical scheme, or for accounts
that arise as a result of participation in illegal activities.
Beneft op-
tion
Tariff costs
4 x Medical
Scheme Rates
The gap you
may face
Natural
childbirth
R4 300 R17 200 R12 900
Caesarean
section
childbirth
R6 900 R27 600 R20 700
Cruciate
ligament
knee repair
R7 300 R29 200 R21 900
Heart bypass
surgery
R26 700 R106 800 R80 100
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The above examples are an average of all health professional charges
for the selected in-hospital procedures, and assume that the medical
scheme is covering claims at Medical Scheme Rates, with the health
professional charge calculated at the maximum beneft level of four
times Medical Scheme Rates. 2009 Medical Scheme Rates, increased for
medical infation, have been used.
The rates used to calculate the maximum claim amounts will be the
relevant medical scheme rates applicable for the year in which the
insured event occurs.
The gap you face could be substantial
Old Mutual Medical Gap Cover is designed to fll the gap that
exists between what your medical scheme has paid and what
the attending health professionals have charged for in-hospital
surgical and consultation fees, up to a maximum total amount
of four times the Medical Scheme Rate (MSR). Most medical
schemes only cover you for one times the MSR, that is a major
boost to your in-hospital cover.
Here are some illustrations of the gap
that you may face.
For more information, contact your Old Mutual fnancial
adviser or broker, call 0860 101 233 or
visit www.oldmutual.co.za/healthsolutions
OLD MUTUAL MEDICAL GAP COVER
Designed to cover the gap between medical scheme payouts and
in-hospital health professional accounts.
This brochure is designed for easy reading and outlines the
main benefts and conditions of the product. While Old Mutual
has made every effort to refect the benefts and conditions as
accurately as possible, there could be other information that has
not been included. We therefore recommend that you consult a
fnancial adviser or broker for more detailed information.
Old Mutual Medical Gap Cover is underwritten by Old Mutual
Health Insurance Limited (reg no.1990/001350/06), a licensed
short-term insurer in terms of the Short-term Insurance Act.
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