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Optimal 20202019-09-09T03:44:35+00:00

Optimal provides a broad array of benefits – enhancing your medical aid by up to 500% of medical aid rates – 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’s most-popular Gap Cover products.

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Overall annual limit 2020 Gap Cover Policies by Turnberry

Benefits

Medical Expense Shortfall Cover

Increases the Medical Aid rate up to 500% (e.g. Specialists, GPs, Anaesthetists, Radiology, Pathology, Consumables, etc.). Subject to the Overall Annual Limit

Co-payment Cover

Subject to the Overall Annual Limit

Non-DSP Hospital Penalty Cover

R8 500 per admission. Limited to 1 claim per family per annum. Subject to the Overall Annual Limit

Sub-limit  Cover

R20 000 per admission per insured. Limited to R50 000 per family per annum. Subject to the Overall Annual Limit

Co-payments for MRI, CT and PET scans

Subject to the Overall Annual Limit

Co-payments for Scopes

R2 000 per admission. Limited to 2 claims per insured per annum. Subject to the Overall Annual Limit

Sub-limit Cover for MRI, CT and PET Scans

R20 000 per admission per insured. Limited to R50 000 per family per annum. Subject to the Overall Annual Limit

Casualty Benefit for Accidents

R8 500 per event per insured. Subject to the Overall Annual Limit

Casualty Benefit for Illness

R2 000 per event. Limited to 2 claims per family per annum. Subject to the Overall Annual Limit. Treatment is restricted to between the hours of 7pm – 6am Mondays – Fridays, Saturdays, Sundays and Public Holidays

Traditional Cancer Cover

Co-payment cover for traditional cancer treatment limited to 20% per admission. Subject to the Overall Annual Limit

Biological Cancer Drug Cover

Provides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to the formulary and the Overall Annual Limit

MRI and CT Scan Cover

Covers the cost of MRI and CT scans when there is no benefit available on your Medical Scheme. Limited to  R4 000 per event and 2 claims per family per annum. Subject to the Overall Annual Limit

Trauma Care Cover

Covers the cost of trauma counselling consultations with a registered healthcare provider after a member has been diagnosed with a critical illness, has been a victim of a violent crime or experienced the death of an immediate family member. Limited to R800 per consultation and R6 000 per family per annum. Subject to the Overall Annual Limit

Medical Scheme Contribution Waiver

Up to R6 000 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

Gap Premium Waiver

Pays the premium of your Optimal Policy for 12 months in the event of death or permanent and total disability as a result of an accident of the Contribution Payer

Personal Accident Benefit

R10 000 per insured on the Policy in the event of accidental death or permanent and total disability

Critical Illness Benefit

R7 500 per insured on the Policy in the event of death due to a critical illness (excludes cancer)

International Travel Cover

R5 million per insured (notification of travel required 48 hrs prior to departure)

Medical Expense Shortfall Cover

Increases 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 Overall Annual Limit

Co-payment Cover

Subject to the Overall Annual Limit

Sub-limit and Co-payment Cover for dental implants

Covers 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 R20 000 per admission and R50 000 per family per annum. Subject to the Overall Annual Limit

Sub-limit Cover

R20 000 per admission and R50 000 per family per annum 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 Overall Annual Limit

Additional Information

Biological Cancer Drugs

Click the button below to view the lists of the Biological Cancer Drugs covered under Optimal.

List of Drugs

Waiting Periods

Click the button to review the Waiting Periods and Exceptions

Waiting Periods
Exceptions
2020 Gap Cover Policies by Turnberry