The FNB Gap Cover is an insurance policy that covers medical expenses not covered by medical aid, with monthly premiums starting at R240.00. The FNB Gap Cover is only available to people over the age of 18 who are members of a medical aid scheme.
A spouse on a medical aid scheme may also be covered by the gap insurance. A spouse can be covered for the same benefits as the primary policyholder.
Children on medical aid can also be covered under the plan until the age of 26. Children over the age of 21 must demonstrate financial dependence on the main member in order to be covered.
The FNB Gap Cover can cover special needs children for the rest of their lives, provided that the child is unable to support themselves financially due to mental or physical disability.
The plan also covers special dependents, which include dependents who are not the plan holder’s children. However, special dependents can only be accepted at the discretion of FNB.
As the FNB Gap Cover provides coverage for the main member’s immediate family, it also offers a range of gap cover plans to choose from. The cover options are discussed in detail below.
FNB Gap Cover Options
Customers can choose from three FNB Gap Cover plans: essential, comprehensive, and elite.
The Essential plan provides 300% of the medical scheme rate in excess medical expense coverage. The plan also includes a casualty benefit, and policyholders receive R4,000.00 in cover per year.
Cancer is also covered by the plan, with an additional 300% coverage of the medical scheme rate for oncology treatment shortfalls, less what the medical scheme pays.
For policyholders under the age of 30, the Essential plan provides more limited gap cover starting at R240.00 per month. An additional dependent can be added to the policy for an additional R25.00 premium.
Policyholders aged 30 to 54 pay a monthly family premium of R265.00 on the plan. If the policyholder wants to add a dependent, he or she must pay an additional premium of R27.00.
A special rate is available for policyholders aged 55 to 59, who pay a monthly family premium of R308.00. A dependent can be added for a monthly premium of R30.00.
Policyholders aged 60 to 64 pay a monthly family premium of R365 and an additional dependent premium fee of R37. Members who are 65 and over pay R485 for the family benefit and R50 for the dependent premium.
The Comprehensive gap cover offers family coverage for a monthly premium starting at R350.00. The plan includes a medical expense shortfall benefit that pays up to 500% of the medical scheme rate.
Medical expense shortfall coverage is also available for service providers’ oncology treatment shortfalls. The medical shortfall for oncology treatment provides an additional 500% cover.
A copayment benefit is also provided by the gap cover. A special copayment for cancer treatment is available if the costs exceed the limits set by the medical scheme for oncology treatment. The benefit can only cover up to 25% of the cost.
The Elite plan is the most comprehensive plan available from FNB Gap cover, with monthly premiums starting at R415.00.
Under this plan, medical expense shortfalls are unlimited, including shortfalls resulting from various medical expenses and oncology treatments. A copayment benefit is also provided, covering up to 25% of the cost if the costs of cancer treatment exceed the limits set by the medical scheme for oncology treatment.
The plan covers the difference in treatment costs and what the medical scheme pays up to a maximum of R50,000.00. The plan pays a maximum of 25% of the difference between oncology treatment and what the medical scheme pays for oncology treatments. The plan also covers casualty ward services up to a maximum of R20,000.00.
The cost of the Elite Gap Cover is higher than that of the Essential and Comprehensive plans. The following are the costs associated with maintaining the FNB Elite Gap Cover:
Advantages of FNB Gap Cover
- There are various gap cover plans to choose from, and the cost of gap insurance is fixed.
- Children who are financially dependent on the policyholder can be added to the plan.
- Each plan covers medical shortfalls and copayments, and cancer treatments have their own set of rates.
- Non-network coverage is included in all plans.
Disadvantages of FNB Gap Cover
The policy can only cover up to 5 people, and the plan does not offer cash back on premiums like other FNB insurance products.
FNB Gap Cover Application
To apply for FNB Gap Cover, you must be 18 years or older and have a valid South African ID book or smart card. You must also have a valid FNB transactional account, and all lives covered under the FNB Gap Cover must be covered on a medical aid.
Customers can choose from three FNB Gap Cover plans, and the pricing is very straightforward, including the benefits that each plan provides. A plan can be chosen based on affordability and desired benefits. However, the cover lacks a bespoke plan that can be easily customized.