No. It will only cover in-hospital procedures, and certain day admission procedures in day-clinics (as defined), provided none of these are as a result of any of the exceptions listed.
Outpatient procedures are only covered when accompanied by your medical scheme’s authorisation and also included in the “Outpatient Table” which is available under the Gap Benefits.
Cover for all medical scheme shortfalls is limited to a maximum of R198 000 per person per annum.
For the first three years following inception of a contract, there is a limit of R30 000 (per person) in respect of the combined shortfall claims for hip and knee replacements or procedures from the sub-limit and gap benefit.
