Gap/Top Up cover that pays in-hospital shortfalls and procedure co-payments

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Have you ever had hospital bills short-paid?
Or a co-payment charged for a specific treatment or procedure?

Private doctors and specialists can charge what they want, often up to 5 times what your medical aid pays!
Medical aids are increasingly charging co-payment for expensive procedures.
Procedures like knee replacement surgery, colonoscopies, or using hospitals outside of your medical aid’s network.

The only way to address the threat of you having to pay these high medical expenses is to join a Gap and CoPay plan today.

Many medical aid members have already done this and are stress-free medical aid members.

The Agility Gap & CoPay Cover gives you:

• More in-hospital medical cover (up to 500% of medical aid rate payments), without needing to upgrade your current medical aid.
• Pays the penalty if you use non-network hospitals
• Unlimited cover for procedural co-payments across all the options
• Extensive medical emergency cover
• Maternity cover
• PMB cover
• Gap and medical scheme premium waiver benefits
• A Hospital Booster Benefit (which covers private room upgrades, in-hospital sub-limits & robotic-assisted surgery)

Through a variety of cover levels, Agility offers you a choice of options to best suit your needs and budget.

There are 2 main options:

1. The Agility Gap Range of comprehensive, highly specialised gap cover, suitable for all budgets.
Guaranteed to cover the difference between your medical scheme rate and what your doctor or hospital charges for an in-hospital procedure.
There is a choice of 200% to 500% cover for in-hospital specialist fee shortfalls, exceeding your medical aid’s limits.

2. The Agility Combined Range of integrated Gap and CoPay benefits.
Covers benefit shortfalls, where your doctor or hospital charges more for an in-hospital procedure than what your medical scheme will cover, as well as any out-of-pocket contributions that you may need to pay towards an in-hospital procedure.

They include full cover for in-hospital professional fee short payments, co-payments related to MRI & CT scans, as well as procedural admissions to hospital across a range of 200%, 400% & 500% of medical aid rates.

The Combined 400, Combined 500 and Ultra options include cover for in-hospital sub-limits, robotic-assisted shortfalls and private room upgrades.

Other benefits are:

• Oncology Shortfall Benefit
• Premature Birth Cover
• Extensive out-patient cover including emergency room benefits, physiotherapy consultations and more
• Procedures performed as an in-patient or as an out-patient (specified list of procedures), as well as MRI, CT, and Ultrasound scans.
  Outpatient Benefits - Comprehensive cover for out-of-hospital in-room procedures, consultations, including GP, Specialist, Dentist, Physio & Psychology Consultations
• Maternity benefits during pregnancy - Lump-sum benefit activated after first trimester, 2D, 3D, 4D Scans (in-and-out of hospital)
• Emergency Room Benefit - covers all beneficiaries on the policy without age limitations or reasons for emergency visits. All treatments and consultations for Trauma, Accident & Illness will be covered up to the annual benefit per policy, regardless of any payment by the medical aid.
• Trauma Counselling Benefit - Cover in the event of an unplanned traumatic incident, including accidents or events of violence leading to physical injury or psychological trauma. This benefit provides consultations with registered psychologists, psychiatrists, or counsellors.

No medical aid member can afford to be withoutb Gap/Top up cover.

Agility Gap Application

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The plan works with any medical aid!
Enhance your cover without having to change from your medical scheme!

You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.

083 655 2164

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Last update: January 18, 2025