Employees who are currently on a medical aid and without gap cover, have an opportunity to join Ambledown gap cover at the UCT corporate rate.
What is Gap Cover?
Gap cover is designed to assist members by covering the shortfalls that arise during hospitalization for a medical or surgical procedure, where the doctors and specialists charge a higher rate than what your medical scheme pays, or when you are required to make a co-payment or carry an up-front cost for the procedure. Although gap cover does not cover out-of-hospital procedures, in some cases certain listed procedures performed in the doctor’s rooms are covered. The above-mentioned benefits may differ from your option selected.
Tariff shortfalls and co-payments equates to an average of 94% of all gap cover claims and below is examples of frequent claims and accidental casualty claims paid by gap cover:
|
Frequent Claims |
What was paid by Gap |
Accidental Casualty Claims |
What was paid by Gap |
|
|
Scope |
R 29 471,50 |
Unspecified injury of head |
R 5 695,20 |
|
|
Other Dentistry |
R 21 042,48 |
Multiple open wounds of head |
R 3 871,48 |
|
|
Tonsilectomy |
R 17 816,00 |
Fracture of clavicle |
R 3 056,70 |
|
|
Wisdom Tooth Extraction |
R 11 575,72 |
Other injury of unspecified body region |
R 3 023,36 |
|
|
Natural birth |
R 13 164,70 |
Dislocation of elbow, unspecified |
R 2 679,10 |
|
|
Caesarean |
R 29 861,69 |
Member support
UCT has appointed PSG Employee Benefits as the preferred healthcare broker to provide end-to-end service to UCT employees on their UCT Discovery Health medical aid and gap cover benefits.
If you require assistance as to which option will be suitable or how to join, please contact:
Dianne Wilson via e-mail dianne.wilson@psg.co.za, or the
PSG Support Unit on 0860 105 158 or email psgsupport@psg.co.za
| Application form |
- 2024 Ambledown - PSG - UCT Staff Gap Cover Series 2024 Brochure
- 2024 Ambledown - PSG - UCT Staff Application form
- 2024 Ambledown - PSG - UCT Staff Continuation form
- 2024 Ambledown - PSG - UCT 2024 Gap Cover Option Change form
Supporting documents to include with the application
- ID copy of main member and debit order account holder
- Medical aid membership certificates for main member and dependants
| Claims |
| Contacts | ||
| Appointed broker for Ambledown Gap Cover | UCT Healthcare Office | |
| For applications, advice on product selection, benefits, or claims assistance. |
For applications and claims process information. |
|
|
Dianne Wilson PSG Employee Benefits PSG Support Tel: 0860 105 158 |
Gaynor Pekeur Benefits Admin Assistant |
Debra De Gouveia-Meyer Healthcare Specialist Tel: (021) 650-4001 |
Page last updated: 20 June 2024