Click the SAVE button to save your progress if you have to rush off, but don’t forget to come back to us because your application will only reflect on our side if it’s fully completed and submitted.
Speak with your HR Representative or Broker about the Corporate Gap Cover and/or Corporate Health Insurance option available to you as an employee, as well as the waiting periods and terms and conditions of cover before submitting your application form.
Based on the discussion you've had with your HR Representative or Broker, please select the type of application relevant to your profile:
Let us know who the existing principal insured person is and we’ll swop your status from dependant to principal insured on your own policy.
And now... it's your turn.
One Gap Cover policy covers you, your spouse and all the dependants registered on both your and your spouse’s medical aid plans.
One Gap Cover policy covers you, your spouse and all the dependants registered on both your and your spouse's medical aid plans, subject to approval from your employer.
One Health Insurance policy covers you, your spouse and all your child dependants as long as you're their parent or legal guardian.
Children aged 20 years or younger pay child dependant premiums on a Health Insurance Policy only. Children aged 21 years or older pay adult dependant premiums if they are full-time students and proof of financial dependency is submitted every year. We accept proof from the educational facility or stamped copies of your child’s bank account statements of the past 3 months.
One Health Insurance policy covers you, your spouse and all your child dependants as long as you're their parent or legal guardian, subject to approval from your employer.
Children aged 20 years or younger pay child dependant premiums on a Health Insurance Policy only. Children aged 21 years or older pay adult dependant premiums if they are full-time students and proof of financial dependency is submitted every year. We accept proof from the educational facility or stamped copies of your child’s bank account statements of the past 3 months.
If you haven’t selected a Gap Cover product, ignore and click Next.
If you’re an individual aged 65 or older applying for cover just for yourself, we’ll cover you under a 65+ individual option. If you apply for cover as a family, and either you or one of your dependants is 65 years or older, you and your family will be covered under a 65+ family option.
We'll automatically adjust your policy premium if you've selected an incorrect policy premium category.
Waiting periods apply from the start date of your policy, from the effective option change date when you upgrade your policy, and from each person’s cover start date when they’re added after the policy’s start date. The Cover Letter you'll receive when your policy is activated will confirm the waiting periods that apply to each insured person.
3 MONTH GENERAL WAITING PERIOD
We don’t cover you during this period unless you claim for accidental events that occur after your cover start date.
EXCEPTION TO THE RULE
Out-Patient Specialist Consultation Cover offered on the ELITE option always receives a 3 Month General Waiting Period.
12 MONTH PRE-EXISTING CONDITION WAITING PERIOD
We don’t cover you during this period for investigations, medical procedures, surgeries or treatments related to any illness or medical condition that was diagnosed or that you received advice or treatment for within 12 months before your policy’s start date.
10 MONTH LIMITED PAYOUT BENEFIT
If you claim from our GAP COVER, CO-PAYMENT COVER, SUB-LIMIT COVER or ACCESS COVER in the first 10 months of cover for specific medical events, we'll cover only 20% of the approved claim amount subject to benefit limits where applicable.
If, however, your medical event is due to a medical condition that you received advice or treatment for within 12 months before the start date of your policy, your claim will be subject to a Pre-Existing Condition Waiting Period.
Accidental events don't form part of the 10 Month Limited Payout Benefit and aren't subject to any waiting periods.
As the main applicant, you’re responsible to answer this section for yourself and on behalf of your dependants, where applicable, and agree that you have the necessary knowledge and consent to do so.
12 MONTH PRE-EXISTING CONDITION WAITING PERIOD
We don’t cover you during this period for investigations, medical procedures, surgeries or treatments related to any illness or medical condition that was diagnosed or that you received advice or treatment for within 12 months before your policy’s start date.
Medical events claimed within the first 12 months of cover, that we view as pre-existing which you didn't disclose at the time of applying for cover, may be investigated and rejected on the basis of non-disclosure.
Please provide details of any illness or medical condition that's relevant to you and/or any dependants, including the diagnosis date where applicable.
By submitting this application, you acknowledge and accept that your policy will be subject to waiting periods and/or a limited benefit in the first 10 months of cover for specific medical events, unless otherwise specified in your Cover Letter.
As the Main Applicant completing this section or having it completed by your Broker, you understand that your current Gap Cover policy will be replaced with a Stratum Benefits policy and that certain aspects of the new policy will be different from the old policy.
DISCLOSURE
GENERAL WAITING PERIOD
Depending on your age, a General Waiting Period might apply. We don't cover you during this period unless you claim for accidental events that occur after your cover start date.
Out-Patient Specialist Consultation Cover offered on the ELITE option always receives a 3 Month General Waiting Period.
PRE-EXISTING CONDITION WAITING PERIOD APPLICABLE TO LIKE-FOR-LIKE BENEFITS AND/OR ENHANCED BENEFITS
If your current Gap Cover policy has been active for less than 12 months and a Pre-Existing Condition Waiting Period applies, the balance of the waiting period will be carried over. If our Gap Cover policy offers enhanced benefits, these benefits will receive a 12 Month Pre-Existing Condition Waiting Period.
We don't cover you during this period for investigations, medical procedures, surgeries or treatments related to any illness or medical condition that was diagnosed or that you received advice or treatment for within 12 months before your policy's start date.
DISCLOSED PLANNED MEDICAL EVENTS
If you claim in the first 10 months of cover for a medical procedure, surgery, treatment or investigation that you informed us about when you applied to switch cover, we'll cover only 20% of the approved claim amount.
UNDISCLOSED MEDICAL EVENTS
If you claim in the first 12 months of cover for a medical procedure, surgery, treatment or an investigation, that we deem as pre-existing but that you didn’t tell us about when you applied to switch cover, may be investigated and rejected based on non-disclosure.
Click here to view our 2021 Gap Cover Transfer Process for Individuals to see which waiting periods could apply to you.
By submitting this application, you acknowledge and accept that your policy will be subject to waiting periods and/or a limited benefit in the first 10 months of cover for specific medical events, unless otherwise specified in your Cover Letter.
Your monthly premium is subject to the quote accepted by your employer. Speak with your HR Representative or Broker about premium details.
Please select the Corporate Gap Cover option that your employer offers.
Waiting periods may apply from the start date of your policy and from each person's cover start date when they're added after the policy's start date.
The waiting periods that apply to you are determined by the demographic profile of the employer group and the quote accepted by your employer. Waiting periods will be confirmed in the Cover Letter that you'll receive when your policy is activated.
3 MONTH GENERAL WAITING PERIOD
We don't cover you during this period unless you claim for accidental events that occur after your cover start date.
EXCEPTION TO THE RULE
Out-Patient Specialist Consultation Cover offered on the CORPORATE ELITE PLUS option always receives a 3 Month General Waiting Period.
12 MONTH PRE-EXISTING CONDITION WAITING PERIOD
We don't cover you during this period for investigations, medical procedures, surgeries or treatments related to any illness or medical condition that was diagnosed or that you received advice or treatment for within 12 months before your policy's start date.
10 MONTH LIMITED PAYOUT BENEFIT
If you claim from our GAP COVER, CO-PAYMENT COVER, SUB-LIMIT COVER or ACCESS COVER in the first 10 months of cover for specific medical events, we'll cover between 20% and 100% of the approved claim amount subject to the quote accepted by your employer.
If, however, your medical event is due to a medical condition that you received advice or treatment for within 12 months before the start date of your policy, your claim will be subject to a Pre-Existing Condition Waiting Period if this waiting period applies to the employer group.
Accidental events don't form part of the 10 Month Limited Payout Benefit and aren't subject to any waiting periods.
By submitting this application form, you acknowledge and accept that your policy may be subject to waiting periods and/or the 10 Month Limited Payout Benefit if you claim in the first 10 months of cover for specific medical events.
Speak with your HR Representative, Broker or refer to our product brochure for more information about the listed medical events.
As the main applicant, you’re responsible to answer this section for yourself and on behalf of your dependants, where applicable, and agree that you have the necessary knowledge and consent to do so.
Whether or not a Pre-Existing Condition Waiting Period will apply to you or your dependants, please answer the below questions.
As the Main Applicant completing, or having this section completed by your Broker, you understand that your current Gap Cover policy will be replaced with a Stratum Benefits policy and that certain aspects of the new policy will be different from the old policy.
DISCLOSURE
TRANSFER WAITING PERIODS
Your policy will be subject to underwriting, regardless of whether you're switching cover between the same insurer or from a different insurer. Waiting periods applicable to our Corporate Product Range are subject to the demographic profile of the employer group.
The below waiting periods are standard waiting periods that may apply to you as an employee switching cover from another Gap Cover provider, subject to the quote accepted by your employer.
EXCEPTION TO THE RULE
Out-Patient Specialist Consultation Cover offered on the CORPORATE ELITE PLUS option always receives a 3 Month General Waiting Period.
PRE-EXISTING CONDITION WAITING PERIOD APPLICABLE TO LIKE-FOR-LIKE BENEFITS AND/OR ENHANCED BENEFITS
If your current Gap Cover policy has been active for less than 12 months and a Pre-Existing Condition Waiting Period applies, the balance of the applicable waiting period will be carried over. If our Gap Cover policy offers enhanced benefits, these benefits will receive a Pre-Existing Condition Waiting Period of up to 12 months.
We don't cover you during this period for investigations, medical procedures, surgeries or treatments related to any illness or medical condition that was diagnosed or that you received advice or treatment for within 12 months before your policy's start date.
By submitting this application, you acknowledge and accept that your policy may be subject to waiting periods.
If you haven’t selected a Health Insurance product, ignore and click Next.
Through a national network of providers who have contracted with Unity Health, our health insurance administrator, you have access to more than 3 000 GP’s, 2 700 optometrists and various pharmacies, pathologists and radiologists.
Need help in finding your nearest provider?
Visit www.unityhealth.co.za or contact us for assistance.
Our Essential Primary Plus product range offers healthcare solutions to individuals and families. Choose between our Day-to-Day Benefit Option, Emergency & Accident Benefit Option or our Day-to-Day, Emergency & Accident Benefit Option.
Our options complement your medical aid cover, or it can be taken as your primary health cover if you don’t have medical aid cover.
If you're 56 or older and apply for cover on the Day-to-Day Benefit Option or the Day-to-Day, Emergency and Accident Benefit Option, of if you're 61 or older applying for cover on the Emergency & Benefit Option, you'll pay a higher premium as indicated in the respective premium categories. If you can prove that you've been on medical aid or primary healthcare insurance cover for 15 or more consecutive years from the age of 35, the lower premium category will apply.
Children aged 20 years or younger pay child dependant premiums. Children aged 21 years or older pay adult dependant premiums if they are full-time students and proof of financial dependency is submitted every year.
We accept proof from the educational facility or stamped copies of your child’s bank account statements of the past 3 months.
If you select an incorrect policy premium that is not in line with the premium category on the Health Insurance option you’re applying for, your policy premium will be adjusted according to your age at entry.
Where would you like us to send your Health Insurance card to? Please give us the address if it's not the same as your physical address.
Allow +/- 21 working days for delivery depending on postal services.
Waiting periods apply from the start date of your policy, and from each person’s cover start date when they’re added after the policy’s start date. The Cover Letter you'll receive when your policy is activated will confirm the waiting periods that apply to each insured person.
2 MONTH GENERAL WAITING PERIOD
Cover does not apply to our Day-to-Day, Wellness Assessment and Preventative Care Benefits during the first 2 months of cover.
9 MONTH PRE-BIRTH CONSULTATION WAITING PERIOD
12 MONTH CHRONIC MEDICATION WAITING PERIOD
12 MONTH EYE CARE WAITING PERIOD
EXCEPTION TO THE RULE
Waiting periods do not apply to our Emergency and Accident Benefits and Essential Assistance Programme (EAP).
By submitting this application form, you acknowledge and accept that your policy will be subject to waiting periods for specific medical events.
DISCLOSURE
Waiting periods apply from the start date of the policy and from each insured person’s cover start date unless otherwise specified in your Cover Letter, which you will receive when your cover is activated.
Clients transferring cover must be informed of the following:
A change in monthly premium and/or special terms and conditions may apply as products are different in benefit and fee structure;
Our Policy Particulars provide more information about the general exclusions, terms and conditions of cover; and
STANDARD WAITING PERIODS
The below waiting periods are standard waiting periods that may or may not apply to a client’s policy when transferring.
2 MONTH GENERAL WAITING PERIOD
During the first 2 months of cover a general waiting period applies to our DAY-TO-DAY BENEFITS, WELLNESS ASSESSMENT BENEFIT and PREVENTATIVE CARE BENEFIT.
9 MONTH PRE-BIRTH CONSULTATION WAITING PERIOD
12 MONTH CHRONIC MEDICATION WAITING PERIOD
12 MONTH EYE CARE WAITING PERIOD
Waiting periods may apply when transferring cover from a medical aid to a health insurance benefit option that offers Day-to-Day Benefits.
Click here to view our 2021 Health Insurance Transfer Process for Individuals to see which waiting periods may apply to you.
By submitting this application form, you acknowledge and accept that your policy will be subject to waiting periods for specific medical events.
Please nominate 1 beneficiary to whom the benefit amount under our Accidental Death Benefit will be paid to in the event of your accidental death. If a beneficiary is not nominated the benefit amount will be paid to your estate.
In the event of your spouse's accidental death, the benefit amount will be paid to the principal insured person on the policy.
Please refer to your policy documentation for full terms and conditions.
As the main applicant, you understand that the beneficiary nominated will receive proceeds from the benefit payable under our Accidental Death Benefit, subject to the terms and conditions of your policy and/or limitations imposed by law at the time of your claimable event.
You also understand that:
Through a national network of providers who have contracted with Unity Health, our health insurance administrator, you have access to more than 3000 GP’s, 3000 optometrists and various pharmacies, pathologists and radiologists.
Need help in finding your nearest provider? Visit www.unityhealth.co.za or contact us for assistance.
Your monthly premium is subject to the quote accepted by your employer. Speak with your HR Representative or Broker about premium details.
Please select the Corporate Health Insurance option that your employer offers:
Waiting periods apply from the start date of your policy and from each insured person’s cover start date.
Waiting periods don’t apply to employer groups when 20 or more employees join on a compulsory basis.
When 20 or less employees join or when it’s voluntary for employees to join, the below waiting periods will apply.
The waiting periods that apply to you are determined by the demographic profile of the employer group and the quote accepted by your employer. Waiting periods will be confirmed in the Cover Letter that you’ll receive when your policy is activated.
1 MONTH GENERAL WAITING PERIOD
Cover doesn’t apply to the Day-to-Day, Employee Wellness Assessment or Preventative Care Benefits during the first month of cover.
9 MONTH PRE-BIRTH CONSULTATION WAITING PERIOD
12 MONTH CHRONIC MEDICATION WAITING PERIOD
12 MONTH EYE CARE WAITING PERIOD
EXCEPTION TO THE RULE
Waiting periods don’t apply to the Emergency and Accident Benefit and Essential Assistance Programme (EAP).
By submitting this application form, you acknowledge and accept that your policy may be subject to waiting periods for specific medical events.
Waiting periods apply from the start date of the policy and from each insured person’s cover start date unless otherwise specified in your Cover Letter, which you will receive when your cover is activated.
Clients transferring cover must be informed of the following:
DISCLOSURE
A change in monthly premium and/or special terms and conditions may apply as products are different in benefit and fee structure;
Our Policy Particulars provide more information about the general exclusions, terms and conditions of cover; and
STANDARD WAITING PERIODS
The below waiting periods are standard waiting periods that may or may not apply to a client’s policy when transferring.
2 MONTH GENERAL WAITING PERIOD
During the first 2 months of cover a general waiting period applies to our DAY-TO-DAY BENEFITS, WELLNESS ASSESSMENT BENEFIT and PREVENTATIVE CARE BENEFIT.
9 MONTH PRE-BIRTH CONSULTATION WAITING PERIOD
12 MONTH CHRONIC MEDICATION WAITING PERIOD
12 MONTH EYE CARE WAITING PERIOD
Waiting periods may apply when transferring cover from a medical aid to a health insurance benefit option that offers Day-to-Day Benefits.
By submitting this application form, you acknowledge and accept that your policy will be subject to waiting periods for specific medical events.
Please nominate 1 beneficiary to whom the benefit amount under our Accidental Death Benefit will be paid to in the event of your accidental death. If a beneficiary is not nominated the benefit amount will be paid to your estate.
In the event of your spouse's accidental death, the benefit amount will be paid to the principal insured person on the policy.
Please refer to your policy documentation for full terms and conditions.
As the main applicant, you understand that the beneficiary nominated will receive proceeds from the benefit payable under our Accidental Death Benefit, subject to the terms and conditions of your policy and/or limitations imposed by law at the time of your claimable event.
You also understand that:
By accepting this section and upon acceptance of your application, you:
You’ll receive an invoice for the premiums due from your cover start date up until December 2021. A new invoice will be sent to you for the new benefit year once your chosen Gap Cover option’s premium increase is confirmed.
By accepting this section and upon acceptance of your application, you:
As the main applicant applying for insurance cover, I understand and acknowledge that the Corporate Gap Cover and/or Corporate Health Insurance Option I'm applying for is not a medical aid, doesn't provide similar cover as that of a medical aid and can't be substituted for medical aid membership.
I hereby declare and accept that:
As the main applicant applying for insurance cover, I understand and acknowledge that the Gap Cover/Health Insurance Option I'm applying for is not a medical aid, doesn't provide similar cover as that of a medical aid and can't be substituted for medical aid membership.
I hereby declare and accept that:
E&OE