KN
Karen N
1 reviews | Active since Jun 2026
22 Jun 2026, 21:37
This is not gap cover!
Stay away, this is not gap cover - absolute ****. The procedure they will cover is yet to be invented, and then they will amend their policy wording to exclude their liability for that procedure. Their policy excludes the procedures most people will generally go to hospital for. 2 year's worth of gap cover premiums wasted!
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GapRisk Administrators's replyOfficial
23 Jun 2026, 13:34Dear Mrs. Noeth
Thank you for your communication. Every interaction, good or bad, helps us to review and improve our services and product offering.
Thank you for your communication. Every interaction, good or bad, helps us to review and improve our services and product offering.
Upon investigation of your concerns, and discussions with our claims team, the following:
"Mrs. Noeth went in for a planned C-section 02/01/26.
As there was a clinical reason for the confinement (O34.2 Maternal care due to uterine scar from previous surgery) it was considered PMB and subsequently repudiated under the policies PMB exclusion.
Herewith the policy wording in terms of the PMB and PMB confinement exclusions:
GapCover Excludes:
27. Prescribed Minimum Benefits (PMB): A set of benefits as defined in the Medical Schemes Act 131 of 1998 with Regulations, which ensures all Scheme members have access to certain minimum health benefits, regardless of their Medical Scheme option. This includes a requirement for Medical Schemes to pay the full cost of diagnosis and treatments of a list of 270 medical conditions, provided that you follow the Scheme Rules and make use of your Designated Service Provider (DSP). Excludes all costs for treatment related to Prescribed Minimum Benefit’s (Both Elective and Emergency Events). 29. All claims related to Pregnancy and Prescribed Minimum Benefits (PMB) confinements.
27. Prescribed Minimum Benefits (PMB): A set of benefits as defined in the Medical Schemes Act 131 of 1998 with Regulations, which ensures all Scheme members have access to certain minimum health benefits, regardless of their Medical Scheme option. This includes a requirement for Medical Schemes to pay the full cost of diagnosis and treatments of a list of 270 medical conditions, provided that you follow the Scheme Rules and make use of your Designated Service Provider (DSP). Excludes all costs for treatment related to Prescribed Minimum Benefit’s (Both Elective and Emergency Events). 29. All claims related to Pregnancy and Prescribed Minimum Benefits (PMB) confinements.
The 2026 Policy documents were issued to the principal member during annual review. The communication was sent 19/11/25 to the principle member ***.
Take note that in the body of the annual communication the following is noted:
EXCLUSIONS
EXCLUSIONS
It is important to note that pregnancy and PMB confinements are excluded as part of the PMB exclusion"
As always, we urge our clients to read the policy wordings thoroughly. If there are sections that are unclear, please contact us for clarification.
Our general enquiries line is Tel: +***7 , or on email at ***.
Congratulations on the birth of your baby.
Wishing you all the best.
Kind regards,
The GapCover Team
GapRisk Administrators's reply23 Jun 2026, 13:34
Official
Dear Mrs. Noeth
Thank you for your communication. Every interaction, good or bad, helps us to review and improve our services and product offering.
Thank you for your communication. Every interaction, good or bad, helps us to review and improve our services and product offering.
Upon investigation of your concerns, and discussions with our claims team, the following:
"Mrs. Noeth went in for a planned C-section 02/01/26.
As there was a clinical reason for the confinement (O34.2 Maternal care due to uterine scar from previous surgery) it was considered PMB and subsequently repudiated under the policies PMB exclusion.
Herewith the policy wording in terms of the PMB and PMB confinement exclusions:
GapCover Excludes:
27. Prescribed Minimum Benefits (PMB): A set of benefits as defined in the Medical Schemes Act 131 of 1998 with Regulations, which ensures all Scheme members have access to certain minimum health benefits, regardless of their Medical Scheme option. This includes a requirement for Medical Schemes to pay the full cost of diagnosis and treatments of a list of 270 medical conditions, provided that you follow the Scheme Rules and make use of your Designated Service Provider (DSP). Excludes all costs for treatment related to Prescribed Minimum Benefit’s (Both Elective and Emergency Events). 29. All claims related to Pregnancy and Prescribed Minimum Benefits (PMB) confinements.
27. Prescribed Minimum Benefits (PMB): A set of benefits as defined in the Medical Schemes Act 131 of 1998 with Regulations, which ensures all Scheme members have access to certain minimum health benefits, regardless of their Medical Scheme option. This includes a requirement for Medical Schemes to pay the full cost of diagnosis and treatments of a list of 270 medical conditions, provided that you follow the Scheme Rules and make use of your Designated Service Provider (DSP). Excludes all costs for treatment related to Prescribed Minimum Benefit’s (Both Elective and Emergency Events). 29. All claims related to Pregnancy and Prescribed Minimum Benefits (PMB) confinements.
The 2026 Policy documents were issued to the principal member during annual review. The communication was sent 19/11/25 to the principle member ***.
Take note that in the body of the annual communication the following is noted:
EXCLUSIONS
EXCLUSIONS
It is important to note that pregnancy and PMB confinements are excluded as part of the PMB exclusion"
As always, we urge our clients to read the policy wordings thoroughly. If there are sections that are unclear, please contact us for clarification.
Our general enquiries line is Tel: +***7 , or on email at ***.
Congratulations on the birth of your baby.
Wishing you all the best.
Kind regards,
The GapCover Team