Beware of the small print

I have been a customer of TRA since 2014 and have never had to make a claim previously. My wife gave birth recently. When I made contact with TRA to ask how the claims procedure works, I was shocked to be informed I wasn't covered due to the fact that my cover has an exclusion on PMBs (prescribed minimum benefits). Not being employed in the medical industry it is very easy to miss that giving birth is also a PMB (My understanding previously was that PMBs are only related to medical emergencies). I was literally told by one of the consultants that PMBs are supposed to be covered by your Medical Aid in full, and that I should go fight with my medical aid to pay the rest of the medical bill for the Gynaecologist. I was also told that it was my fault for not reading their promotional SMS/emails and changing my cover during the yearly window in January. Again, if you aren't a medical expert dealing with PMBs you wouldn't have known you needed to change. Pleas by me to allow me to change my cover outside their "change window" to remove the PMB exclusion was met with a "rules are rules" type response.

Looking now at the other Gap Cover companies, and now fully appreciating what a PMB exclusion entails, I have not yet found another Gap Cover company that has a PMB exclusion.

My expectation was that if you sign up for gap cover, you will be covered for the gap between what your Medical Aid pays and what the Doctors charge. I was not expecting to be so badly stung by the small print. I feel severely betrayed by TRA.