{"id":3061,"date":"2019-09-04T13:12:49","date_gmt":"2019-09-04T13:12:49","guid":{"rendered":"https:\/\/turnberry.co.za\/2023\/?page_id=3061"},"modified":"2026-09-30T13:39:55","modified_gmt":"2026-09-30T13:39:55","slug":"optimal","status":"publish","type":"page","link":"https:\/\/turnberry.co.za\/2027\/optimal\/","title":{"rendered":"Optimal"},"content":{"rendered":"

2026
\nMonthly premium: R558 per family for under 65yrs<\/strong><\/span>
\nMonthly premium: R806 per family for 65yrs+<\/strong><\/span><\/p>\n

Optimal provides a broad array of benefits \u2013 enhancing your medical aid by up to 500% of medical aid rates \u2013 all at a family-friendly price. By providing cover in the area of oncology, as well as several other value-adds, Optimal has become one of Turnberry\u2019s most-popular Gap Cover products. <\/span><\/strong><\/span><\/p>\n

Download Brochure 2026<\/a> | Comparison Table<\/a> | Product Summary<\/a><\/strong><\/p>\n<\/div>

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2027
\nMonthly premium: R600 per family for under 65yrs<\/strong><\/span>
\nMonthly premium: R870 per family for 65yrs+<\/strong><\/span><\/p>\n

Optimal provides a broad array of benefits \u2013 enhancing your medical aid by up to 500% of medical aid rates \u2013 all at a family-friendly price. By providing cover in the area of oncology, as well as several other value-adds, Optimal has become one of Turnberry\u2019s most-popular Gap Cover products. <\/span><\/strong><\/span><\/p>\n

Download Brochure 2027<\/a> | Comparison Table<\/a> | Product Summary<\/a><\/span><\/strong><\/p>\n<\/div>

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Increase in the OAL (Overall Annual Limit) \u2013 effective 1st April 2025<\/strong><\/span>
\nNational Treasury annually publishes new limits under the Demarcation Regulations. As of 1 April 2025, the limit for medical expense shortfall (Gap) policies has been increased from R210,580.06 to R219,845.96.\u00a0 Turnberry has increased the overall annual limit on all policies we administer with these benefits, with effect from 1 April 2025. Our clients automatically qualify for the adjusted overall annual limit.<\/span><\/p>\n<\/div>\n

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Benefits<\/h2><\/div>\n
\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
<\/td>\n<\/td>\nOptimal 2026<\/span><\/td>\nOptimal 2027<\/span><\/td>\n<\/tr>\n
<\/td>\n<\/td>\nMonthly premium: R510 per family for under 65yrs Monthly premium: R736 per family for 65yrs+<\/em><\/span><\/td>\nMonthly premium: R600 per family for under 65yrs Monthly premium: R870 per family for 65yrs+<\/em><\/span><\/td>\n<\/tr>\n
In-hospital benefits<\/span><\/td>\nMedical Expense Shortfall Cover<\/span><\/td>\nIncreases the Medical Aid rate up to 500%. Subject to OAL<\/span><\/td>\nIncreases the Medical Aid rate up to 500%. Subject to OAL<\/span><\/td>\n<\/tr>\n
Co-payment Cover<\/span><\/td>\nSubject to OAL<\/span><\/td>\nSubject to OAL<\/span><\/td>\n<\/tr>\n
Non-DSP Hospital Penalty Cover<\/span><\/td>\nR14700 per admission. Limited to 1 claim per family per annum. Subject to OAL<\/span><\/td>\nR16000 per admission. Limited to 1 claim per family per annum. Subject to OAL<\/span><\/td>\n<\/tr>\n
Sub-limit Cover<\/span><\/td>\nR36000 per insured. Limited to R75000 per family per annum. Subject to OAL<\/span><\/td>\nR39000 per admission per insured. Limited to R80000 per family per annum, including Robotic Surgeries. Subject to OAL<\/span><\/td>\n<\/tr>\n
In-hospital and out-of hospital benefits<\/span><\/td>\nTraditional Cancer Cover<\/span><\/td>\nCo-payment cover for traditional cancer treatment limited to 20% per admission. Subject to the OAL<\/span><\/td>\nCo-payment cover for traditional cancer treatment limited to 20% per admission. Subject to the OAL<\/span><\/td>\n<\/tr>\n
Biological Cancer Drug Cover<\/span><\/td>\nProvides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to a formulary and the OAL<\/span><\/td>\nProvides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to a formulary and the OAL<\/span><\/td>\n<\/tr>\n
Innovative Cancer Drug Cover<\/span><\/td>\nProvides cover for innovative cancer drugs. Limited to R13000 per claim. Subject to the OAL<\/span><\/td>\nProvides cover for innovative cancer drugs. Limited to R14000 per claim. Subject to the OAL<\/span><\/td>\n<\/tr>\n
Breast Cancer Prevention Cover<\/span><\/td>\nIncreases the Medical Aid rate up to 500% for a Prophylactic Mastectomy. Subject to OAL (Clinical Entry Criteria applies)<\/span><\/td>\nIncreases the Medical Aid rate up to 500% for a Prophylactic Mastectomy. Subject to OAL (Clinical Entry Criteria applies)<\/span><\/td>\n<\/tr>\n
Breast Cancer Reconstruction Cover<\/span><\/td>\nIncreases the medical aid rate up to 500% for a breast reconstruction post mastectomy due to Cancer for the affected breast. Reconstruction of the unaffected breast for the purposes of symmetry, where there is no benefit on the Insured person\u2019s Medical Scheme is limited to R24000 per insured person, per lifetime. Subject to OAL<\/span><\/td>\nIncreases the medical aid rate up to 500% for a breast reconstruction post mastectomy due to Cancer for the affected breast. Reconstruction of the unaffected breast for the purposes of symmetry, where there is no benefit on the Insured person\u2019s Medical Scheme is limited to R26000 per insured person, per lifetime. Subject to OAL<\/span><\/td>\n<\/tr>\n
MRI and CT scan Cover<\/span><\/td>\nProvides cover for MRI and CT scans when there is no benefit available on your Medical Scheme. Limited to R7500 per event and 2 claims per family per annum. Subject to OAL<\/span><\/td>\nProvides cover for MRI and CT scans when there is no benefit available on your Medical Scheme. Limited to R8000 per event and 2 claims per family per annum. Subject to OAL<\/span><\/td>\n<\/tr>\n
Investigative Treatment<\/span><\/td>\nScopes for Screening purposes will be limited to 1 every 5 years, per insured person and R7000. Subject to the Overall Annual Limit.<\/span><\/td>\nScopes for Screening purposes will be limited to 1 every 5 years, per insured person and R7500. Subject to the Overall Annual Limit.<\/span><\/td>\n<\/tr>\n
Trauma Care Cover<\/span><\/td>\nCovers the cost of trauma counselling consultations with a registered healthcare provider after a member has been diagnosed with a critical illness, a victim of a violent crime or experienced the death of an immediate family member. Limited to R3300 per consultation and R7500 per family per annum. Subject to OAL<\/span><\/td>\nCovers the cost of trauma counselling consultations with a registered healthcare provider after a member has been diagnosed with a critical illness, a victim of a violent crime or experienced the death of an immediate family member. Limited to R3600 per consultation and R8000 per family per annum. Subject to OAL<\/span><\/td>\n<\/tr>\n
Out-of-hospital benefits<\/span><\/td>\nCo-payments for MRI, CT and PET scans<\/span><\/td>\nSubject to OAL<\/span><\/td>\nSubject to OAL<\/span><\/td>\n<\/tr>\n
Co-payments for Scopes<\/span><\/td>\nR6500 per event. Limited to 2 claims per insured per annum. Subject to OAL.<\/span><\/td>\nR7000 per event. Limited to 2 claims per insured per annum. Subject to OAL.<\/span><\/td>\n<\/tr>\n
Sub-limit Cover for MRI, CT and PET scans<\/span><\/td>\nR36000 per event per insured. Subject to the OAL.<\/span><\/td>\nR39000 per event per insured. Limited to R75000 per family per annum. Subject to the OAL<\/span><\/td>\n<\/tr>\n
Casualty Benefit for Accidents<\/span><\/td>\nR13000 per event per insured. Subject to OAL<\/span><\/td>\nR14000 per event per insured. Subject to OAL<\/span><\/td>\n<\/tr>\n
Casualty Benefit for Illness<\/span><\/td>\nR5500 per event. Limited to 2 claims per family per annum. Subject to OAL. Treatment is restricted to between the hours of 6pm – 6am Mondays to Fridays, Saturdays, Sundays and Public Holidays<\/span><\/td>\nR6000 per event. Limited to 2 claims per family per annum. Subject to OAL. Treatment is restricted to between the hours of 6pm – 6am Mondays to Fridays, Saturdays, Sundays and Public Holidays<\/span><\/td>\n<\/tr>\n
Added benefits<\/span><\/td>\nMedical Scheme Contribution Waiver<\/span><\/td>\nUp to R8200 per month for 6 months; in the event of death or permanent and total disability as a result of an accident, of the Medical Scheme Contribution Payer<\/span><\/td>\nUp to R9000 per month for 6 months; in the event of death or permanent and total disability as a result of an accident, of the Medical Scheme Contribution Payer<\/span><\/td>\n<\/tr>\n
Gap Premium Waiver<\/span><\/td>\nPays the premium for your policy for 12 months in the event of death or permanent and total disability as a result of an accident, of the Contribution Payer<\/span><\/td>\nPays the premium for your policy for 12 months in the event of death or permanent and total disability as a result of an accident, of the Contribution Payer<\/span><\/td>\n<\/tr>\n
Personal Accident Benefit<\/span><\/td>\nR21000 per insured on the policy in the event of accidental death and permanent and total disability<\/span><\/td>\nR23000 per insured on the policy in the event of accidental death and permanent and total disability<\/span><\/td>\n<\/tr>\n
Critical Illness Benefit<\/span><\/td>\nR10500 per insured on the policy in the event of death due to a critical illness (excludes cancer)<\/span><\/td>\nR11500 per insured on the policy in the event of death due to a critical illness (excludes cancer)<\/span><\/td>\n<\/tr>\n
International Travel Cover<\/span><\/td>\nR5 million per insured (notification of travel required 48 hrs prior to departure)<\/span><\/td>\nR5 million per insured (notification of travel required 48 hrs prior to departure)<\/span><\/td>\n<\/tr>\n
In-Hospital Dental Cover<\/span><\/td>\nMedical Expense Shortfall Cover<\/span><\/td>\nIncrease the medical aid rate up to 500% for impacted wisdom teeth, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the OAL<\/span><\/td>\nIncrease the medical aid rate up to 500% for impacted wisdom teeth, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the OAL<\/span><\/td>\n<\/tr>\n
Basic Dental Medical Expense Shortfall Cover for Children<\/span><\/td>\nIncreases the Medical Aid rate up to 500% for basic dentistry for children up to and including 12 years old. Limited to R4400 per family per annum. Subject to the OAL<\/span><\/td>\nIncreases the Medical Aid rate up to 500% for basic dentistry for children up to and including 12 years old. Limited to R5000 per family per annum. Subject to the OAL<\/span><\/td>\n<\/tr>\n
Co-payment Cover<\/span><\/td>\nSubject to OAL<\/span><\/td>\nSubject to OAL<\/span><\/td>\n<\/tr>\n
Sub-limit and Co-payment Cover for dental implants<\/span><\/td>\nCovers the cost of dental implants for reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Limited to R26000 per admission and R50000 per family per annum. Subject to the OAL<\/span><\/td>\nCovers the cost of dental implants for reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Limited to R28500 per admission and R53000 per family per annum. Subject to the OAL<\/span><\/td>\n<\/tr>\n
Sub-limit Cover<\/span><\/td>\nR26000 per admission and R50000 per family for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the OAL<\/td>\nR28500 per admission and R53000 per family for impacted wisdom teeth, orthognathic surgery, reconstructive maxillofacial surgery due to an accident (which occurred while on the Policy) and oral cancer (which was diagnosed while on the Policy). Subject to the OAL<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div><\/div><\/div><\/div>
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<\/p>\n\t\t\t\t\n\t\t\t\t\t<\/sr7-adjuster>\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t