OLD MUTUAL MEDICAL GAP COVER

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Jewel Lewis
8 years ago
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1 UP TO R500K ANNUAL COVER* UP TO 4X THE COVER OLD MUTUAL MEDICAL GAP COVER Fill in the gap between what your medical scheme pays and what your health professionals charge for in-hospital and selected out-patient procedures. EIN-HOSPITAL TREATM NT COVER EOUT-PATIENT TREATM NT COVER WHOLE FAMILY COVER**

professionals charge for in-hospital and selected out-patient procedures.

2 OLD MUTUAL MEDICAL GAP COVER So you ve ensured you re 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? It s only after a stay in hospital that most medical scheme members find out that the cover provided by their medical scheme in hospital has fallen short of the amount charged by the health professionals who ve attended to them, leaving significant shortfalls to pay that were simply not budgeted for. 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.

It s only after a stay in hospital that most medical scheme members find out that the cover provided by their medical scheme in hospital has fallen short of the amount

3 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 What a health professional may charge What your medical scheme may pay The gap you are left to fill 0 4 x MSR 1 x MSR 3 x MSR *MSR is Medical Scheme Rates What are you covered for? Old Mutual Medical Gap Cover will pay the difference between what the health professional charges (capped at four times the medical scheme s tariff rate) and the amount paid by the medical scheme for: in-hospital medical and surgical treatment, or out-patient treatment by chemotherapy, radiotherapy or renal dialysis. How much cover do you get? Cover is provided for each calendar year for up to R per insured event, and subject to a maximum of R per insured family.

Old Mutual Medical Gap Cover will pay the difference between what the health professional charges (capped at four times the medical scheme s tariff rate) and the amount paid by the medical scheme

4 What does it cost? For just R130 per month you and your insured family will be provided with Old Mutual Medical Gap Cover. Premium rates are annually reviewable, effective 1 January. Who will be covered? You, the principal member on the medical scheme, your spouse registered as a spouse dependant on the medical scheme and your children who are registered as child dependants on your medical scheme and where child rates are being paid will be covered under the policy. No adult dependants are included. General rules Anyone under 60 years, who is the principal member of a medical scheme, may apply. The policy will end when the policyholder reaches the age of 75 years. A three-month general waiting period for benefits 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-specific waiting period for benefits 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 insured persons commencement of cover. 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. Terms and Conditions Apply.

You, the principal member on the medical scheme, your spouse registered as a spouse dependant on the medical scheme and your children who are registered as child dependants on your medical scheme and

5 THE GAP YOU FACE COULD BE SUBSTANTIAL Old Mutual Medical Gap Cover is designed to fill the gap that exists between what your medical scheme has paid and what the attending health professionals have charged for in-hospital and selected out of hospital surgical and consultation fees. This is up to a maximum total amount of four times the applicable medical scheme rate. Most medical schemes only cover you for one times the scheme s tariff rate (MSR). That is a major boost to your in-hospital cover. Here are some illustrations of the gap that you may face. Benefit option HEALTH PROFESSIONAL COST MEDICAL SCHEME TARRIF RATE THE GAP YOU MAY FACE Natural childbirth R R2 203 R6 609* Gastric bypass R R4 563 R5 583 Slipped disc R R R34 440* Laminectomy R R R *Health professional s payment capped by four times the MSR rate The above examples are average health professional charges for selected in-hospital procedures and medical schemes tariff rates. 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.

Most medical schemes only cover you for one times the scheme s tariff rate (MSR). That is a major boost to your in-hospital cover. Here are some illustrations of the gap that you may face.

6 OLD MUTUAL MEDICAL GAP COVER This brochure is designed for easy reading and outlines the main benefits and conditions of the product. While Old Mutual has made every effort to reflect the benefits and conditions as accurately as possible, there could be other information that has not been included. We therefore recommend that you consult a financial 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. For more information, contact your Old Mutual financial adviser or broker, call or visit Old Mutual is a Licensed Financial Services Provider

We therefore recommend that you consult a financial adviser or broker for more detailed information. Old Mutual Medical Gap Cover is underwritten by Old Mutual Health Insurance Limited (reg no.

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