For the Comprehensive Individual Plan: R223 000 per insured person.

For the Comprehensive Family Plan: R223 000 per insured family.

We pay up to an additional 500% for shortfalls on doctors' procedures performed in hospital. Additionally, we provide up to an extra 500% for doctors' procedures conducted outside the hospital if classified as in-hospital by the medical scheme and paid from risk. Subject to the overall annual limit.

We pay the full defined co-payment/deductible amount that medical aid schemes have specified on listed procedures. Proper Gap Comprehensive will reimburse the defined amount whether stated as a fixed Rand amount or percentage. Subject to the overall annual limit.

Medical Scheme options often place limits on certain procedures/events, e.g. internal prostheses, MRI/CT scan etc. Proper Gap Comprehensive will enhance your cover for defined sub-limits. Subject to the overall annual limit.

We pay when you have accidental trauma-related or crime-related injuries which require treatment in a hospital outpatient facility or casualty unit. The limit is R23 000 per event.

Illness-related emergencies for infants and children under the age of 8 will be covered at any time of the day or night. Illness-related emergencies for members 8 years and older will be covered between 6pm and 8am.

All illness-related emergencies are limited to R4 500 per event and R13 000 per family per annum.

Most medical schemes place limits on their payment of cancer treatment such as Chemotherapy, Radiation & Cancer Biological drugs. Proper Gap Comprehensive will enhance this limit whether stated as a fixed co-payment or sublimit in accordance with the scheme’s limitations. Subject to the overall annual limit.

Cover for root canal and surgical extractions [excluding consultations] in dentists’ rooms. This is limited to clients whose medical schemes do not cover in-hospital dentistry or list it as a procedural exclusion. The combined overall annual limit is R8 000 per annum per policy.

Proper Gap Comprehensive offers MRI/CT scan cover for clients whose medical schemes options exclude specialised scans. Limited to R6 500 per event and R15 000 per policy per annum.

We pay for any shortfalls your medical aid scheme does not cover for your consultation with a specialist in their private rooms.

Annual limit R7 000, limited to R2 500 per consultation, 3 consultations per annum.

The medical aid scheme must pay a portion of your specialist’s consultation fee from a hospital, risk, day-to-day benefit or from your medical savings account.

A Non-DSP benefit has been added for any penalty fee that the medical scheme may impose should you choose to voluntarily use a hospital or day clinic outside the medical scheme’s designated network. Limited to R25 000 per annum.