GENERAL POLICY EXCLUSIONS
Unless specifically mentioned in the policy wording, no benefit will be provided or claims assessed for any condition, disease, injury, illness , consequence of treatment resulting from or associated with:
• Any claim that must be paid in terms of any other act such as the Compensation for Occupational Injuries Act 90 of 1993,
the Road Accident Fund Act 56 of 1996.
• Any psychiatric or psychological condition or disorder.
• Suicide, attempted-suicide or injury as a result of self-harm.
• Medication, drugs, prescriptions, consumables and equipment used. Devices, such as artificial joints, braces, crutches,
dental implants, orthodontic, prosthodontic and all cosmetic dentistry including all forms of internal and external
prosthesis as defined, unless specified as part of the benefit entitlement of the policy.
• Cosmetic surgery unless specified under any benefit in this policy.
• Any illness, injury or condition resulting from or directly associated with professional sport
the Road Accident Fund Act 56 of 1996.
• Any psychiatric or psychological condition or disorder.
• Suicide, attempted-suicide or injury as a result of self-harm.
• Medication, drugs, prescriptions, consumables and equipment used. Devices, such as artificial joints, braces, crutches,
dental implants, orthodontic, prosthodontic and all cosmetic dentistry including all forms of internal and external
prosthesis as defined, unless specified as part of the benefit entitlement of the policy.
• Cosmetic surgery unless specified under any benefit in this policy.
• Any illness, injury or condition resulting from or directly associated with professional sport
POLICY SPECIFIC EXCLUSIONS
No benefit will be provided or claims assessed in case of the following:
• The first 100% of the medical scheme tariff.
• Any claims rejected or not authorised by your medical scheme unless defined as a stated benefit under the policy wording.
• Claims that exceed benefit limits or the Overall Annual Limit as stated in the policy wording.
• Experimental treatments and medications.
• Any claims rejected or not authorised by your medical scheme unless defined as a stated benefit under the policy wording.
• Claims that exceed benefit limits or the Overall Annual Limit as stated in the policy wording.
• Experimental treatments and medications.
POLICY SPECIFIC WAITING PERIODS
The following list of conditions is subject to a 10 month waiting period with 50% of benefit accessible from month 7 to 10:
• Myringotomy and Grommets
• Adenoidectomy
• Tonsillectomy
• Hysterectomy where not malignant.
• Spinal, back, neck and joint related procedures where not due to an accident.
• Adenoidectomy
• Tonsillectomy
• Hysterectomy where not malignant.
• Spinal, back, neck and joint related procedures where not due to an accident.
GENERAL WAITING PERIODS
Applicable to new policies who have not been covered on a Gap Cover policy with similair benefits within the past 90 days for a period of 12 months or longer.
• A 3 month general waiting period.
• A 10 month waiting period on pre-existing conditions, diseases or illnesses.
• In the event of an option upgrade, a 3 month general waiting period on the additional benefit or limits.
• 10 month waiting period for pregnancy and confinement.
• 12 month waiting period on all pre-existing cancer treatments.
• A 10 month waiting period on pre-existing conditions, diseases or illnesses.
• In the event of an option upgrade, a 3 month general waiting period on the additional benefit or limits.
• 10 month waiting period for pregnancy and confinement.
• 12 month waiting period on all pre-existing cancer treatments.
WAITING PERIOD
