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A. If you have been on your existing Gap Cover policy for 3 months or longer and have not had a break in membership then reduced waiting periods will apply. Upon acceptance of your application a policy document will be sent to you, which will advise you of your reduced waiting periods.
A 3-month general waiting period applies to all benefits, with exception of benefits providing cover up to 600% should the commencement of the Policy be in line with the commencement date of the Medical Scheme
A 10-month waiting period on pregnancy/childbirth
A 12-month waiting period on / investigations, treatment or surgery for:
hysterectomy, hysteroscopies, endometriosis, ovarian cysts and fibroids (myomectomy), muscular-skeletal (except in the event of a motor vehicle collision), tonsillectomy, myringotomy, grommets, adenoids, wisdom teeth, hernia, cataracts, gastroscopies, colonoscopies, cancer, nasal and sinus
Please note that the products displayed in this brochure are not a medical scheme and the cover is not equivalent to that of a medical scheme. Medical scheme cover is a prerequisite for this cover. These products are complementary to a medical aid scheme and are not a substitute for medical scheme membership.
Disclaimer: This document is a summary for information purposes only and does not supersede the policy terms and conditions. In the event of any discrepancy, the policy, terms and conditions will prevail. Underwritten by Lombard Insurance Company Limited.
A. No. A claim may only be submitted after the procedure has been performed.
A. No. Legislation does not permit us to pay Medical Service Providers. Further, it is advisable for you not to tell your Medical Service Provider that you have a Gap Cover policy. We have incidences where providers have charged higher rates than they would otherwise have, which will have a detrimental effect on future premium rates. There are some providers that ask the question on their forms, again you are not required to disclose this information. A Gap Cover contract is between you, the client, and the insurer. No other person or institution has a right to know whether you have a contract or not.
A. You have 6 months to provide written notice from the date of treatment of a pending claim. All documentation must me provided within 12 months to avoid your claim prescribing.
A. When the payment will reflect in your account generally depends on with whom you bank. The time varies from 1 to 3 working days. In addition, Turnberry will send you a claim statement, which will provide details of your claim and the amount that will be paid into your account.
A. Upon receipt of all the required documentation it will take, 5 to 9 working days for the claim to be finalised.
A. You can obtain a claim form by clicking on this link, under document downloads on our website or you can contact us on 0861 000 509.
A. You will be required to submit the following documents –
- Turnberry’s claim form.
- Medical Aid statement reflecting the transactions processed by the Medical Service Provider for which you are claiming, as well as the transactions your Medical Aid has processed from your hospital account.
- Invoices from the Medical Service Providers for whom you are claiming.
- Hospital account for the period you were hospitalised.
A: A signed debit order authorisation form must be completed and returned to us. We will also accept a written instruction from the client giving us the new banking details.
A: A debit order authorisation form would need to be completed. The available debit order dates are the 1st, 7th, 15th and 25th. Should the collection date selected fall on a weekend or public holiday, a debit will be processed against your account on the first working day following the weekend or public holiday.
A: No, the change in membership will not affect your policy benefits. Either spouse may be the owner on the policy.
We will however require the new medical aid details in order to update our records. (Please speak to your financial advisor to ensure your policy is still appropriate for your medical aid option).
A. No. The policy terms and conditions require that premiums are paid by the due date. Turnberry will likely reject your application for reinstatement and then you will need to apply for a new policy, which will be subject to all the contractual waiting periods. If Turnberry do decide to accept your application for reinstatement it will be on condition that no benefits will be paid for any hospitalisation during the period of non-payment and any other terms and conditions Turnberry may decide to impose.
A: A reinstatement application form must be completed and the request for reinstatement will be underwritten. Once our underwriters have agreed to the reinstatement the policy owner will be notified and proof of payment of the arrear premiums will be required. Cover will only recommence on written acceptance and the payment of the arrear premiums.
If the policy has been in a state of lapse or cancelled for more than three months a new application form will generally be requested.
A: The principle insured person would be required to complete an upgrade form. Existing benefits will not be affected and will not have any new waiting periods. Any new benefits will be subject to waiting periods. Please discuss any material changes that could affect your cover with your financial advisor.
A: The baby will be covered from date of birth under the Gap Cover policy. To initiate the cover for the baby the principle insured person needs to complete a dependent addition form. Please note, A newborn must be added onto the Policy within 90 days, from the date of birth, in order to avoid waiting periods.
If an older child or adult dependent is added, the addition of the new member will be subject to waiting periods.
Once the baby or new dependent is added, an amended Policy Document will be issued as confirmation of the change.
A. The standard policy offers travel cover of R5 000 000 per insured for emergency medical expenses and does not cover pre–existing medical conditions. Should you require travel cover for pre-existing medical conditions we do offer top-up cover for an additional rate.
A. The MSO contact number is available on all Travel Insurance policies. You need to contact them in the event of any emergency (other than a general GP visit). They will take care of all necessary arrangements to ensure you receive the best treatment possible.
A. For short business trips the free travel cover is the ideal product to have when travelling. It is however important to note that the aim of the product is to provide free leisure travel insurance. The terms and conditions of the policy excludes manual labour as well as things such as off-shore drilling, being part of an airline crew and specialised sports events on a professional level. Please refer to the TIC policy terms and conditions appendix for more information. You may contact Lizelle to obtain a travel quote or policy specifically suited to your needs.
A. The maximum length of your free International Travel cover is 90 days. You may purchase an additional leisure travel insurance policy from TIC in order to extend your cover until you return to South Africa. Should you require cover for more than 90 days, please email firstname.lastname@example.org or phone 0861 000 509 in order to obtain a quote.
A. You will have cover for each trip outside of South Africa provided that you have completed the application form and have been issued a travel insurance policy for the particular trip.
A. The turnaround time for Travel Certificates to be issued is 2 working days.
A. Prior to each trip outside of the borders of South Africa, a Travel Insurance Application form needs to be completed and sent to email@example.com or 0861 000 509 in order for a certificate of travel to be issued. This has to be done for each and every trip.
- In the dynamic healthcare environment the alignment to Lombard will provide Turnberry with a competitive pricing structure going forward.
- Lombard will provide both operational and strategic synergies to assist in the growth of Turnberry’s business and development of exciting new benefits.
- Turnberry will be the Medical Gap Insurance Specialists for Lombard and will not be competing for Gap Cover business with other Lombard providers.