Fusion Gap Cover – 2018 Benefits and Premiums

About

Kaelo Xelus offers a gap cover product, Fusion Gap, that we feel has excellent benefits and is well priced. Please read “How gap covers work” if you are unfamiliar with gap products. You can download the application here.

The benefits of Fusion Gap product are included with each 2018 plan that we show on this website, so you can immediately see the full benefit of the medical aid with the gap. Simply find your plan using our menu above, and see how this gap’s benefits fit in.

Gap details on each plan
Gap details on each plan

Cost

Family: R350pm (2018)
If any member of the policy is 60yrs+: R600pm (2018)
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Benefits

Shortfall benefit:

Fusion Gap will pay an additional 500% of the medical aid rate, covering shortfalls for all service providers like surgeons, radiologists, pathologists and physiotherapists for services rendered in a hospital, day clinic or where a medical aid pays for treatment in a specialist’s rooms out of risk (not out of savings).

    Oncology treatment benefit:
  • An additional 500% of medical aid rate to cover shortfall for oncologists, biological medication, chemotherapy, radiotherapy, radiology, specialised scans and pathology.
  • Full cover for the 20% co-payment for oncology services imposed by some medical aids.
  • Where a medical aid imposes an overall annual limit on oncology treatment, this gap cover will pay for full cover thereafter.
    Co-payment and Deductible benefit:
  • Full cover for all upfront co-payments (fixed Rand amount).
  • Cover of up to R12,000 once a year if you use a non-network hospital and have to pay a fixed Rand amount as a penalty.
Sublimit Enhancer:

Where a medical aid imposes a Rand limit on a benefit, there is an additional R40,000 per event (unlimited events per year). This usually applies to internal prosthetic devices, in-patient dentistry or specialised radiology.

Casualty/ER Benefit:

Covers costs not paid directly by medical aid for emergency treatment at a hospital casualty ward, up to R12,000 per event. These costs are covered even if the medical aid pays them out of your savings.

    Benefit Extenders:
  • Family Booster Benefit

    : For a premature birth, more than 6 weeks before the due date, a R12,000 lump sum payment.

  • Hospital Booster Benefit:

    You get a cash payout for each day spent in hospital as a result of accident or premature birth:

    • Day 1-13: R300 per day
    • Day 14-20: R600 per day
    • Day 21-30: R1,200 per day
  • Family Protector Benefit:

    A R12,000 payment on death or permanent disability. If the causue was accidental, the benefit doubles to R24,000.

  • Dental Reconstruction Benefit:

    If required as a result of trauma or oncology treatment, all related costs up to R40,000 per event will be covered. This benefit only applies to events occurring after commencement of cover.

  • Contribution Waiver Benefit:

    If the principal member of the medical aid passes away or becomes permanently disabled, the medical aid contribution will be covered for 6 months up to R4,400 per month. The gap policy premium will also be waived for the 6 months.

  • Road Accident Fund Benefit:

    In the event of injury in a vehicle accident where the policy holder was not at fault, RoadCover will provide all legal assistance needed to finalise the claim. The entire award from RAF will be paid out. All legal costs are covered.

The small print

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Medical Aid Bible helps South Africans choose the best medical aid plan for their needs. Quickly view the benefits on any open plan, and compare any two plans with a simple click.
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