Agility Combined Cover

 

Frequently asked questions:

01

What does the Agility Combined product include?

 

The Agility Combined cover product includes the following 3 components:

 

  • Gap cover: Gap cover provides financial protection against the difference between your Medical Scheme Rate and private rates charged by a Registered Medical Professional for in-hospital treatment. Gap cover will settle up to a maximum of 500% of your Medical Scheme Rate in these instances.

 

  • Co-pay cover: This product will cover your co-payments for procedures performed in-hospital as well as some specified out-patient procedures. This includes MRI, CT and ultrasound scans. An incident limit of R12 000 applies per claim which means that your co-payment will be covered up to a maximum amount of R12 000 per insured per incident. Utilisation per beneficiary is limited to no more than 3 claims per annum with an overall annual limit of R120 000 per family.

 

  • Out-patient cover: This product covers the difference between your Medical Scheme Rate and private rates charged by a registered medical professional. The policy will cover you for out-patient surgical procedures that would normally be performed as an in-patient. An incident limit of R3 000 applies per claim which means that your specified out-patient treatment will be covered up to a maximum amount of R3 000 per insured per incident. Utilisation per beneficiary is limited to no more than 3 claims per year with an overall annual limit of R15 000 per family. 

 

The list of out-patient procedures includes:

 

  • General surgery

  • Urology

  • Opthalmology

  • ENT surgery

  • Orthopaedic

  • Paediatric surgery

  • Hepatobiliary surgery

  • Cardiothoracic surgery

  • General medical cardiology

  • Neurology

  • Immunology

  • Gastroenterology

  • Radiology

02

Why would I need this product?

 

The Agility Combined product is near essential to anyone who belongs to a medical scheme. All major in-hospital admission shortfalls, like registered medical professional fees, co-payments and admission fees, are covered.

 

03

What are my cover options?

 

The Agility Combined basket includes 4 products, each of which is perfectly suited to the varying healthcare needs, and pockets, of our diverse client base:

 

  • Agility Combined 200: For R129,12 per family per month, this basket will cover in-hospital and in-room procedures up to 200% over and above your medical scheme rate as well as provide protection against in-hospital procedural co-payments.

 

  • Agility Combined 350: For R183,60 per family per month, this basket will cover in-hospital and in-room procedures up to 350% over and above your medical scheme rate as well as provide protection against in-hospital procedural co-payments.

 

  • Agility Combined 500: For R260,26 per family per month, this basket will cover in-hospital and in-room procedures up to 500% over and above your medical scheme rate but include added benefits such as:

- An unlimited number of claims for in-hospital procedural co-payments.

- R25 000 cover if you want to use a surgeon of your choice instead of your medical scheme’s network     provider for Prescribed Minimum Benefit (PMB) conditions

- A useful Emergency Room Benefit of R6 000 per annum

 

  • Agility Ultra: For only R383,33 per family per month this exceptional product can boost your Agility Combined 500 cover with additional benefits for those instances where: 

- Your medical scheme benefits are depleted

- You need additional in-hospital cover

- You need added cover (R35 000 per annum) to use a surgeon of your choice instead of your medical     scheme’s network provider for Prescribed Minimum Benefit (PMB) conditions

- You need to cover any penalty co-payments

- You want to include dental and ophthalmology cover

- You need out of hospital cover for specialist consultations

- You need an unlimited number of claims for procedural co-payments

 

04

Are there any waiting periods?

 

There is a 3 month general waiting period and a minimum of 12 months on pre-existing conditions.

 

05

How do I claim?

 

  • Step 1: Submit a completed claim form. Ensure that all sections are completed in full and that you have signed the claim form.  

  • Step 2: All provider accounts relating to the procedure must be attached and submitted at the same time, including the hospital, surgeon and anaesthetist accounts.

  • Step 3: Attach a copy of the medical scheme statement indicating scheme payment towards the claim.

  • Step 4: Submit your claim to: gapco@agilityinsurance.co.za

06

What about dentistry and optometry care?

 

The Agility Value Added Product (VAP) provides extensive in-hospital cover for dental and optometry gap claim shortfalls at an affordable rate of R25 per family per month. Should you not take the VAP additional cover, these in-hospital dental and optometry gap claim shortfalls will be excluded.

 

Need extra cover for dental and optometry care?
 

Add our Value Add Product (VAP) for just R25 p/m and include dental and ophthalmology as part of your Agility Gap & CoPay cover.

Agility Insurance Administrators (PTY) ltd is an authorised financial services provider (FSP44024). 

Products are underwritten by GENRIC Insurance Company Ltd (FSP 43638). GENRIC Insurance Company Ltd is an Authorised Financial Services Provider.

Call us: 011 801 2168   |    info@agilityinsurance.co.za