Elixi Gap Cover | Learn More About Our Afforable Plans

Everything you need to know
Your gap cover questions answered

FREQUENTLY ASKED QUESTIONS

Stay informed with Elixi Gap Cover. Find the answers to all your gap cover questions below:

Does this cover my whole family?

Yes, the family policies covers your eligible spouse and eligible children only as defined in your master policy document. This cover is extended to 26 years should the child be financially dependent on main member, unmarried and a dependent on the main member’s Medical Aid. There is no age limit for children whom are mentally incapacitated or physically disabled and are wholly dependent on the main member.

 

Can I obtain cover for my parents or relatives?

No, this product only covers immediate family which includes the spouse of the main member and children. Your parents may however take out their own policy.

 

My grandchild is covered by my medical aid. Will he/she also be covered by my Elixi Gap Cover?

Cover for the grandchild is subject to the child being legally adopted or fostered. Then the eligible child conditions will be applicable.

 

Can I continue with cover for my 26 year old child who is still financially dependent on me?

An adult child registered as a dependant on your medical scheme will have to take out his/her own gap cover policy. However, if the child is 26 years old or more is mentally or physically handicapped and is financially dependent on you, they can be covered under your policy. Proof of disability will be required.

 

Will the Elixi Gap Cover policy cover me if I only have a hospital cash plan and do not belong to a registered Medical Scheme?

No, the Elixi Gap Cover Range augments (assists, increases) the benefit offered by a Medical Scheme. Regrettably without a recognised registered Medical Aid Plan in place as the Principal member or dependent you cannot have gap cover.

 

What is the maximum entry age?

The maximum age of Single and Family plans is 65 years old. The entry-level age for the Senior plans is 65 years old.

 

Will Elixi Gap Cover policy cover a client that goes overseas?

No, Elixi Gap policy covers the SADC areas only, namely Angola, Botswana, Democratic Republic of Congo (DRC), Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, United Republic of Tanzania, Zambia and Zimbabwe.

 

Does Elixi Gap Cover only cover for in-hospital procedures?

No. Elixi Gap Cover covers you mainly for the shortfall on the doctor’s charges for in-hospital procedures or outpatient procedures as listed in the policy documents.

 

Is the co-payment benefit under Gap cover the same as “self-payment Gap?

The hospital self-payment refers to a deductible or self-payment that some clients need to pay out of pocket before their medical aid benefits become available for hospitalisation. Co-payments refer to an upfront cost that some customers have to pay for certain outpatient procedures and hospitalisation, and the Elixi Gap Cover co-payment benefit only reimburses those costs if they are deemed to be a co-payment as per the customer’s medical aid rules.

 

Will the policy premium be adjusted, and how frequently will it be adjusted?

The Gap Cover is rated annually with adjustments taking effect on 1 January every year. Adjustments are based on various factors, including but not limited to, medical inflation, provider disposition (the likelihood of a medical practitioner to increase charges) as well as a study of the various Medical Scheme options and the impact on our product benefits. We do reserve the right to adjust the premium with 30 days written notice.

 

How do I claim?

Please refer to our Gap Claims Process page.

 

What are the notable exclusions of the policy?

    1. Any procedure not covered or declined by the Medical Scheme.
    2. Pre-existing conditions (Unless Waived).
    3. Depression, Insanity or mental stress or psychotic/psychoneurotic disorders.

It is recommended that a full list of exclusions be provided to the individual as per the policy wording.

 

How and when do I submit a claim?

A claim form can be obtained from client.services@talksuresa.co.za or www.ambledown.co.za. It must be completed in full and emailed to claims@ambledown.co.za with all supporting documentation within 6 months of the first day of treatment/hospitalisation.

 

To whom will the benefit be paid?

The principal member needs to provide his her own banking details for payment to be made. Payments are not made to the service provider.

 

How long will the claims process take?

The claim is assessed within a reasonable time frame from receipt of all supporting documentation. Our service levels require that a claims assessment be completed within 2 weeks of receipt of all supporting documentation.

 

Are my Gap Cover premium payments paid, Income Tax deductible?

No. Section 18 (1) of the Income Tax Act allows a deduction for contributions to a Medical Scheme registered in terms of the Medical Schemes Act of 1998. The Gap Cover Series is defined as Accident and Health products in the Short-Term Insurance Act.

 

How do I cancel membership?

Contact Talksure Trading via email at client.services@talksuresa.co.za or telephonically on 0860 33 3343. We will assist you to determine the necessity of the Gap Cover product and will submit your cancellation request after consultation. Immediate attention will be given to your cancellation request, subject to any contractual obligations that may exist.

 

The details provided are only for marketing purposes. The Master Policy issued is the source of all benefits, rights, and obligations and exclusions. To determine your individual needs, we suggest that you contact us for more information.

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