gapcover Covers the excess not paid by your Medical Aid GapCore GapEssential GapXtra GapPremium bridging the gap

Transcription

1 gapcover bridging the gap GapCore GapEssential GapXtra GapPremium Covers the excess not paid by your Medical Aid

2 Most specialist doctors charge above medical aid rates. Can you afford to pay the shortfall? You may think that your and your family are fully covered by your Medical Aid, but this is not always the case. Medical Schemes pay claims at pre-determined scheme rates and when specialist doctors charge above this rate, the balance becomes your responsibility. The majority of surgeons, specialists and anaesthetists charge above recommended scheme rates and a number of standard Medical Scheme procedures such as MRI and CT scans are only partially covered by certain schemes. There may be times when up to 75% of your bill is not covered by your Medical Aid. What is Medcare Gap Cover? Medcare Gap Cover pays up to 500% of your Scheme rate. For example, if your Medical Scheme s fee for an anaesthetic procedure for a tonsillectomy is R1 200, but your Anaesthetist charges out of Scheme rates, Medcare Gap Cover will pay the shortfall up to R Medcare Gap Cover also extends to certain treatments, medical procedures and co-payments; depending on the various available options i.e. GapCore, GapEssential, GapXtra and GapPremium. How much cover do I get? R per family per year. What does it cost? Our Gap products are designed to complement your Medical Scheme option and suit your pocket. Cover starts from as little as R135 per family per month. Do I qualify for it? If you are under the age of 65 years and on a registered South African Medical Aid, you qualify for Medcare Gap Cover. Who is Medway? First established in 1990, Medway has consistently looked for ways to enhance the value proposition Financial Advisors offer their clients, in a meaningful and reliable way. Our credibility ensures that we are well positioned to interact and associate with various Medical Aids and Insurers, delivering product and service mechanisms that add real value when you need it most. Medway supports contracted Financial Advisors who ensure that our tailor-made solutions always fully address your medical cover requirements. How do I sign up? Simply complete the attached form and submit to your Medcare Broker for processing. With Medcare Gap Cover, you can rest easy, knowing that you and your family are covered for up to 500% of Medical Scheme rates.

3 medcare gap plan options Our Gap products are designed to give you cover that best suits your needs: LEVEL 1: GapCore R135 per month 3 GapCore ensures that you do not experience shortfalls when it comes to settling hospital accounts, paying up to 500% of your Medical Scheme rate 3 Covers your immediate family in respect of in-hospital associated services provided by specialist doctors that charge more than your Medical Scheme rate 3 Cover extends to treatment on an out-patient basis for chemotherapy, radiotherapy and kidney dialysis 3 Certain medical procedures performed in a doctors room are also covered 3 GapCore includes a reimbursement of up to R for in-hospital expenses incurred as a result of accidental injury GapCore may also be upgraded to one of the other Medcare options below: LEVEL 2: GapEssential R160 per month 3 GapCore PLUS 3 Cover for co-payments where your Medical Scheme has imposed a levy or deductible on specific procedures, including MRI and CT scans LEVEL 3: GapXtra R170 per month 3 GapCore plus 3 Extended cover for in-hospital sub-limits imposed by your Medical Scheme on certain procedures, which may result in a payment shortfall LEVEL 4: GapPremium R195 pm 3 GapCore plus 3 GapEssential plus 3 GapXtra plus 3 An additional reimbursement of up to R for accidental injury requiring treatment in a casualty ward For more information, please contact your broker or call Medway on or visit

4 Gap Cover application 1. PRINCIPAL MEMBERS DETAILS (Please attach a copy of your ID - Maximum entry age = 65) Surname Date of Birth Full First Name(s) ID Number Marital Status Single Married Divorced Gender Male Female Postal Address Postal Code Telephone (H) Cell Number Telephone (W) Fax Number Address 2. Select your plan Product select cost per Month Product select cost per Month GapCore R135 pm GapXtra R170 pm GapEssential R160 pm GapPremium R195 pm Commencement Date Signature 3. Dependant Details (Immediate family members only i.e. spouse and own children) First name(s) surname date of Birth / ID No relationship 4. debit order details Account Holder Branch / Branch Code Bank Name Bank Account No Type of Account Savings Cheque Date of Debit Order Declaration (to be signed by account holder only) I authorize Medway to draw against my bank account all amounts due in terms of the policy contract. I understand that either Medway or myself can terminate this request in writing to the other party at any time, but that termination will have no effect on any withdrawals already made by the bank and credited to Medway. I understand and undertake that Medway will receive all premiums as per this request, without prejudice to its rights. Should the bank reclaim from Medway for any reason, any amounts paid as per this request, I agree to refund such amounts to Medway. I agree to advise Medway of any changes to the above banking details. Authorised Signatory (Premium Payer) Date

5 5. DECLARATION BY PRINCIPAL MEMBER 1. I hereby apply for the Medway Medcare policy, in accordance with the provisions and conditions as contained in the policy contract. 2. I acknowledge that the level of cover and the rate at which contributions increase are not guaranteed and can be reviewed in the event of unforeseen circumstances, which materially affect the cost of providing cover. 3. I understand and agree that, subject to the waiting periods, the Insurer will only be at risk once the Insurer accepts this application and the first contribution is received. 4. Medway will send me the Medway Medcare policy schedule and policy wordings pertaining to my product selection for me to examine. If the plan does not suit my needs, I must cancel it within 30 days of receipt, by providing written notification to Medway, in order to qualify for a refund. 5. I warrant that all information given in this Medway Medcare policy application form, whether in my handwriting or not, is true and complete. I understand that any misrepresentation or non-disclosure or provision of false information can lead to cancellation of these benefits, in which case, all monies paid to Medway will be forfeited. 7. I have confirmed to my Intermediary (who has explained the possible disadvantages of replacing existing insurance policies) that I am not replacing an existing insurance policy with the Medway Medcare policy. 8. I hereby confirm that I wish to receive the Policy Documents via Have you, or any of your dependents sought any advice, been diagnosed with, or treated for any of the following conditions in the past 12 months: Tuberculosis, Cancer, Heart Disease, HIV/Aids, Diabetes? Yes No 10. Are you aware of any condition that may require medical treatment in the next 12 months for either you or any of your dependents? Yes No If Yes please give details 6. I undertake to keep Medway informed of changes to any banking details and my address to enable them to communicate with me. Signature (Principal Member) Date 6. Declaration by the Intermediary who submitted this application Name of FSP Agent/Representative FSP Number Rep. Number Cell Number 1. I have explained the meaning of the replacement of an insurance policy to the applicant Policy Owner. 2. I am a representative of an Authorised Financial Services Provider in terms of the Financial Advisory and Intermediary Services Act, 37 of 2002 and confirm that the Applicant Policy Holder has been provided with all information required in terms of the Act. 3. I declare that I am accredited to sell the Medway Medcare Policy, that I did conduct a financial needs analysis and that this product is designed to fulfil the applicant s needs. 4. I further declare that all the information contained in this application was obtained from the applicant and was completed and signed in his/her presence. Signature of Intermediary Date YOU MAY ALSO BE INTERESTED IN THESE INNOVATIVE MEDCARE PRODUCTS: AngelCover Covers a maximum of 4 children for up to R for the treatment of chronic conditions and dread disease. DomestiCover Provides Accidental Injury, Disability, Income Protection and Funeral Cover to your domestic worker. BiologiCare Provides a lump sum payment of R on diagnosis of cancer and will cover your Biological Cancer Treatment expenses up to R in instances where your Medical Scheme cover is insufficient. Health & Accident Provides key private healthcare cover in the event of an accident, death or disability. CashXtenda (in partnership with Amazing Vouchers) Extend your cash with vouchers for almost anything under the sun, for only R49 per month. For more information, please contact Medway on or visit our website

6 IMPORTANT INFORMATION Medway Medcare Plan is a combination of insured benefits underwritten by Guardrisk. Administration is provided by Manage Plus Fund Administrators on behalf of the insurer. It is important for the policy owner to read this information and store in a safe place. PRODUCT INSURER ADDRESS Gap; Personal Accident; XtraCare; Co Payment; Casualty Cover Guardrisk Insurance Company Limited 2 nd Floor, Alexander Forbes Place 115 West Street Sandton CONTACT TELEPHONE NUMBER REG. NO. 1992/001639/06 FSP NO CONTACT DETAILS FOR ALL ADMINISTRATIVE QUERIES COMPLAINTS PROCEDURE COMPLIANCE OFFICERS Manage Plus Fund Administrators (Pty) Ltd (M.P.F.A), FSP No , Reg No 1994/00187/07 Tel: Fax: Box 5466 Cape Town 8000 If you have a complaint regarding this product or service, please contact the Compliance Department of the Insurer at the address listed above. If you believe that any legislation or regulatory considerations have been contravened, you may contact the Compliance Officer of the Insurer at the address listed above. CLAIMS NOTIFICATION In the event of a claim, please contact MPFA on OMBUD DETAILS Short-term Insurance Ombud PO Box 32334, Braamfontein, 2017 Tel: Fax: info@osti.co.za FAIS Ombud PO Box 74571, Lynnwood Ridge, 0040 Tel: Fax: info@faisombud.co.za COOLING OFF REPLACEMENT OF POLICIES NAME, CLASS AND TYPE OF POLICY BENEFITS COMMENCEMENT DURATION OF COVER PREMIUM OBLIGATIONS NON-PAYMENT OF PREMUIMS ADMINISTRATION CHARGES COMMISSIONS EXCLUSIONS AND WAITING PERIODS RESTRICTIONS The issued policy may be cancelled within 30 days from the date of commencement. You may cancel the policy by written notice to Box 5466 Cape Town 8000 Or Customercare@medway.co.za Replacement of any insurance is generally to the disadvantage of the policy owner, due to the duplication of initial existing costs. However, in the case of Medcare, there are no initial costs. Gap Cover: A top-up cash benefit paid to the member after hospitalisation. Personal Accident Hospital Expenses Cover: A cash benefit paid to the member after hospitalisation due to an accident. XtraCARE: An additional cash benefit paid to the member after (defined) treatments when medical scheme benefits are inadequate. Co-payment Cover: A cash benefit paid to the member for co-payments and deductable charges imposed due to hospitalisation. Casualty Cover: A cash benefit paid to the member for Casualty expenses due to accidental injury The benefits provided by this policy, depending on selection, are described within the policy wording. The policy will commence on the acceptance of the application and receipt of the first premium. The commencement date of the policy is indicated on the Policy Schedule. Cover continues for as long as premiums are paid in accordance with the policy conditions, but cover will cease on the death of the Principal Member. The premium payable for this policy is shown in the application form and will be confirmed in the policy pack. Premiums are paid monthly and may be reviewed from time to time. Should premiums not be paid according to policy conditions, the policy will lapse and all premiums and benefits will be forfeited. Fees are paid to the administrator in the amount of 20% of gross premium payable. Commission is paid to an intermediary in the amount of 20% of gross premium payable. A summary of claims exclusions and waiting periods are more fully described in the individual policy wordings. Principal Member may not be covered by more than one Medway Medcare Plan Principal Member must be a paid up member of an approved registered medical scheme check with your intermediary. Medway Medcare Plan includes various short term insurance policies for which (in terms of the Short Term Insurance Act) the member may not benefit from duplicate cover. Check with your intermediary to confirm you do not have duplicate cover Medway Marketing (Pty) Ltd is a licensed Financial Services Provider FSP # 15624