CS
Casper S
1 reviews | Active since Aug 2020
09 Aug 2020, 20:24
Ambledown Gap cover is a ****
It is impossible to claim from Ambledown Gap cover. Normal GP visits, Dental, pediatric fees, radiology. Everything not paid by your medical aid while you are in self payment Gap. Have attempted to claim from Ambledown. They do not not pay for anything. Absolute ****.
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Replies (2)
Ambledown's replyOfficial
11 Aug 2020, 12:34Dear Mr Strydom,
I acknowledge receipt of the review.
Your concerns have been noted and we will respond to you privately.
Thanks & kind regards,
| Cebile Hadebe | Compliance Administrator | Tel: ***|
I acknowledge receipt of the review.
Your concerns have been noted and we will respond to you privately.
Thanks & kind regards,
| Cebile Hadebe | Compliance Administrator | Tel: ***|
Ambledown's reply11 Aug 2020, 12:34
Official
Dear Mr Strydom,
I acknowledge receipt of the review.
Your concerns have been noted and we will respond to you privately.
Thanks & kind regards,
| Cebile Hadebe | Compliance Administrator | Tel: ***|
I acknowledge receipt of the review.
Your concerns have been noted and we will respond to you privately.
Thanks & kind regards,
| Cebile Hadebe | Compliance Administrator | Tel: ***|
Ambledown's replyOfficial
12 Aug 2020, 09:39Dear Mr C Strydom,
In direct response to the concerns raised in your review we record that:
The gap cover product is not designed to pay for all forms of costs that are not covered by a medical aid scheme, nor designed to replace a medical aid scheme. It is not designed to cover costs that should be carried by a medical aid scheme, e.g. Medicines, materials, hospital expenses, PMB claims, day to day consultations, treatment and or procedures performed in doctor’s rooms. Generally treatment will be covered if it meets the defined event conditions below: DEFINED EVENTS In the event of an Insured Person suffering an insured incident (as defined) which necessitates the Insured Person: 1. Being confined to hospital and 3. The necessity for outpatient treatment for the following procedures: please refer to list in your policy document You have to be confined to hospital or would have received outpatient treatment as per the pre-defined list for one of the procedures outlined in your policy schedule. Gynae visits are regrettably not covered. The main policy benefit is extracted below as: Gap Cover - A benefit equal to actual cost limited to five (5) times the Medical Scheme Tariff less the higher of the Medical Scheme Tariff or Medical Scheme Option Reimbur*****t Rate for treatment received whilst as an in-patient and/or outpatient (as stated in the Defined Event). Should you need further clarity on policy functions and benefits, kindly do not hesitate to contact your broker.
Yours Sincerely
Paul Makwea
***
Risk and Compliance Department
In direct response to the concerns raised in your review we record that:
The gap cover product is not designed to pay for all forms of costs that are not covered by a medical aid scheme, nor designed to replace a medical aid scheme. It is not designed to cover costs that should be carried by a medical aid scheme, e.g. Medicines, materials, hospital expenses, PMB claims, day to day consultations, treatment and or procedures performed in doctor’s rooms. Generally treatment will be covered if it meets the defined event conditions below: DEFINED EVENTS In the event of an Insured Person suffering an insured incident (as defined) which necessitates the Insured Person: 1. Being confined to hospital and 3. The necessity for outpatient treatment for the following procedures: please refer to list in your policy document You have to be confined to hospital or would have received outpatient treatment as per the pre-defined list for one of the procedures outlined in your policy schedule. Gynae visits are regrettably not covered. The main policy benefit is extracted below as: Gap Cover - A benefit equal to actual cost limited to five (5) times the Medical Scheme Tariff less the higher of the Medical Scheme Tariff or Medical Scheme Option Reimbur*****t Rate for treatment received whilst as an in-patient and/or outpatient (as stated in the Defined Event). Should you need further clarity on policy functions and benefits, kindly do not hesitate to contact your broker.
Yours Sincerely
Paul Makwea
***
Risk and Compliance Department
Ambledown's reply12 Aug 2020, 09:39
Official
Dear Mr C Strydom,
In direct response to the concerns raised in your review we record that:
The gap cover product is not designed to pay for all forms of costs that are not covered by a medical aid scheme, nor designed to replace a medical aid scheme. It is not designed to cover costs that should be carried by a medical aid scheme, e.g. Medicines, materials, hospital expenses, PMB claims, day to day consultations, treatment and or procedures performed in doctor’s rooms. Generally treatment will be covered if it meets the defined event conditions below: DEFINED EVENTS In the event of an Insured Person suffering an insured incident (as defined) which necessitates the Insured Person: 1. Being confined to hospital and 3. The necessity for outpatient treatment for the following procedures: please refer to list in your policy document You have to be confined to hospital or would have received outpatient treatment as per the pre-defined list for one of the procedures outlined in your policy schedule. Gynae visits are regrettably not covered. The main policy benefit is extracted below as: Gap Cover - A benefit equal to actual cost limited to five (5) times the Medical Scheme Tariff less the higher of the Medical Scheme Tariff or Medical Scheme Option Reimbur*****t Rate for treatment received whilst as an in-patient and/or outpatient (as stated in the Defined Event). Should you need further clarity on policy functions and benefits, kindly do not hesitate to contact your broker.
Yours Sincerely
Paul Makwea
***
Risk and Compliance Department
In direct response to the concerns raised in your review we record that:
The gap cover product is not designed to pay for all forms of costs that are not covered by a medical aid scheme, nor designed to replace a medical aid scheme. It is not designed to cover costs that should be carried by a medical aid scheme, e.g. Medicines, materials, hospital expenses, PMB claims, day to day consultations, treatment and or procedures performed in doctor’s rooms. Generally treatment will be covered if it meets the defined event conditions below: DEFINED EVENTS In the event of an Insured Person suffering an insured incident (as defined) which necessitates the Insured Person: 1. Being confined to hospital and 3. The necessity for outpatient treatment for the following procedures: please refer to list in your policy document You have to be confined to hospital or would have received outpatient treatment as per the pre-defined list for one of the procedures outlined in your policy schedule. Gynae visits are regrettably not covered. The main policy benefit is extracted below as: Gap Cover - A benefit equal to actual cost limited to five (5) times the Medical Scheme Tariff less the higher of the Medical Scheme Tariff or Medical Scheme Option Reimbur*****t Rate for treatment received whilst as an in-patient and/or outpatient (as stated in the Defined Event). Should you need further clarity on policy functions and benefits, kindly do not hesitate to contact your broker.
Yours Sincerely
Paul Makwea
***
Risk and Compliance Department