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.

Download brochure 2021

Benefits

Optimal 2021 Optimal 2022
Monthly premium: R345 per family for under 65yrs
Monthly premium: R506 per family for 65yrs+
Monthly premium: R365 per family for under 65yrs
Monthly premium: R517 per family for 65yrs+
In-hospital benefits Medical Expense Shortfall Cover Increases the Medical Aid rate up to 500%. Subject to OAL Increases the Medical Aid rate up to 500%. Subject to OAL
Co-payment Cover Subject to OAL Subject to OAL
Non-DSP Hospital Penalty Cover R9 000 per admission. Limited to 1 claim per family per annum. Subject to OAL R10 000 per admission. Limited to 1 claim per family per annum. Subject to OAL
Sub-limit Cover R25 000 per insured. Limited to R60 000 per family per annum. Subject to OAL R25 000 per insured. Limited to R60 000 per family per annum. Subject to OAL
In-hospital and out-of hospital benefits Traditional Cancer Cover Co-payment cover for traditional cancer treatment limited to 20% per admission. Subject to the OAL Co-payment cover for traditional cancer treatment limited to 20% per admission. Subject to the OAL
Biological Cancer Drug Cover Provides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to a formulary and the OAL Provides cover for Biological Cancer Drugs when the Medical Scheme imposes a sub-limit. Subject to a formulary and the OAL
Innovative Cancer Drug Cover Provides cover for innovative cancer drugs. Limited to R10 000 per claim. Subject to the OAL
Breast Cancer Prevention Cover Increases the Medical Aid rate up to 500% for a Prophylactic Mastectomy. Subject to OAL (Clinical Entry Criteria applies) Increases the Medical Aid rate up to 500% for a Prophylactic Mastectomy. Subject to OAL (Clinical Entry Criteria applies)
Breast Cancer Reconstruction Cover Increases 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’s Medical Scheme is limited to R15 000 per insured person, per lifetime Subject to OAL Increases 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’s Medical Scheme is limited to R15 000 per insured person, per lifetime Subject to OAL
MRI and CT scan Cover Provides cover for MRI and CT scans when there is no benefit available on your Medical Scheme. Limited to R4 500 per event and 2 claims per family per annum. Subject to OAL Provides cover for MRI and CT scans when there is no benefit available on your Medical Scheme. Limited to R5 000 per event and 2 claims per family per annum. Subject to OAL
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, a victim of a violent crime or experienced the death of an immediate family member. Limited to R1 000 per consultation and R7 000 per family per annum. Subject to OAL Covers 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 R1 500 per consultation and R7 000 per family per annum. Subject to OAL
Out-of-hospital benefits Co-payments for MRI, CT and PET scans Subject to OAL Subject to OAL
Co-payments for Scopes R3 000 per event. Limited to 2 claims per insured per annum. Subject to OAL. R3 500 per event. Limited to 2 claims per insured per annum. Subject to OAL.
Sub-limit Cover for MRI, CT and PET scans R25 000 per event per insured. Subject to the OAL. R25 000 per event per insured. Subject to the OAL
Casualty Benefit for Accidents R9 000 per event per insured. Subject to OAL R9 500 per event per insured. Subject to OAL
Casualty Benefit for Illness R2 500 per event. Limited to 2 claims per family per annum. Subject to OAL. Treatment is restricted to between the hours of 7pm – 6am Mondays to Fridays, Saturdays, Sundays and Public Holidays R3 000 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
Added benefits 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 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 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 Pays 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
Personal Accident Benefit R15 000 per insured on the policy in the event of accidental death and permanent and total disability R15 000 per insured on the policy in the event of accidental death and 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) 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) R5 million per insured (notification of travel required 48 hrs prior to departure)
In-Hospital Dental Cover Medical Expense Shortfall Cover Increase 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 Increase 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
Basic Dental Medical Expense Shortfall Cover for Children Increases the Medical Aid rate up to 500% for basic dentistry for children up to and including 12 years old. Limited to R2 000 per family per annum. Subject to the OAL
Co-payment Cover Subject to OAL Subject to OAL
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 50 000 per family per annum. Subject to the OAL 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 50 000 per family per annum. Subject to the OAL
Sub-limit Cover R20 000 per admission and R50 000 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 R20 000 per admission and R50 000 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

Overall Annual Limit (OAL) – R177 800 per insured per annum (2022 year)

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
Turnberry Optimal Cover