Do not take gap cover from Stratum Benefits they will find a reason not to pay

Item: Stratum Benefits (Pty) Ltd
Rating: 1
Author: Sonja R

I took out Stratum Gap Cover via my work. People save yourself money and DO NOT take out Gap Cover. With the plan I am on with my medical aid, I have a R 1 500 co-payment for my sons MRI scan. I had submitted all the paper work to Stratum. My claim was rejected as it was paid out of my day to day which was exhausted after the hospital visit. Rather save the money yourself if you can.

Helpful (0)

Replies (1)

Stratum Benefits (Pty) Ltd's replyOfficial

18 Aug 2021, 07:07

Hi Sonja

The way your medical aid processed the R 1 500 co-payment of the MRI scan, together with the actual cost of the scan, was paid from an insured day-to-day benefit which is seen as a risk benefit.

Co-payments are refunded when a client pays for it from their own pocket, or when their medical aid pays it from their medical savings account.

This was unfortunately not the case with the way your medical aid processed and paid the cost of the medical event, and that’s why we can’t refund you for a co-payment that your medical aid funded from a day-to-day benefit.

We’re sorry for not being able to assist with this claim.

Best regards,
The Stratum Benefits Team

Stratum Benefits (Pty) Ltd's reply18 Aug 2021, 07:07

Official

Hi Sonja

The way your medical aid processed the R 1 500 co-payment of the MRI scan, together with the actual cost of the scan, was paid from an insured day-to-day benefit which is seen as a risk benefit.

Co-payments are refunded when a client pays for it from their own pocket, or when their medical aid pays it from their medical savings account.

We’re sorry for not being able to assist with this claim.

Best regards,
The Stratum Benefits Team