GAP COVER

OUR PRODUCTS

WHEN CAN YOU CLAIM

GENERAL WAITING PERIOD

There is no general three (3) month waiting period.

10 MONTH CONDITION SPECIFIC WAITING PERIOD

No claims may be submitted within the first 10 months of membership for any Gap Cover policy if they relate to any of the following conditions:
• Head, neck and spinal procedures (including stimulators) e.g. Laminectomy
• All types of hernia procedures
• Endoscopic procedures e.g. Colonoscopy, Gastroscopy
• Oesophagitis, Gastroenteritis and Gastro-Intestinal Disorders
• Pregnancy and childbirth (including caesarean delivery)
• Gynaecological conditions e.g. Hysterectomy
• Male genital system (including prostatectomy / robotic prostatectomy)
• All robotic type surgery
• Joint replacement (including Arthroplasty, Arthroscopy, Metatarsal
Osteotomy) but excluding treatment due to accidental trauma.
• Inability to walk / move without pain
• Any Ear, Nose and Throat procedures (including nasal, sinus, tonsil
and adenoid procedures)
• Cardiac (relating to the heart)
• Dentistry (unless due to accidental trauma)
• Cataracts and / or eye laser surgery (including all eye and lens procedures)
• Neurological conditions and procedures (including stimulators)
• Organ transplants (including cochlear implants)
• Renal Failure
• Reconstructive surgery as a result of an incident or condition that
occurred prior to membership (including skin grafts)
• Mental health or psychiatric conditions (including depression)
• Varicose veins
• Diabetes and related complications

All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.

CANCER DIAGNOSIS WAITING PERIOD

If a Policyholder is diagnosed with any form of cancer prior to membership, all related claims will be subject to a nine (9) month waiting period. If a Policyholder has previously been diagnosed with cancer and is currently in remission, the Policyholder needs to advise the insurer by way of medical evidence that the remission period has been for two (2) or more consecutive years.

PRE-EXISTING MEDICAL CONDITION/S WAITING PERIOD

NO claims relating to any pre-existing condition/s that may lead to hospitalisation (excluding cancer: see above) will be covered within the first six (6) months of membership. The insurer reserves the right to request any clinical information from a Policyholder’s doctor should a claim in this period indicate, and/or relate to, a pre-existing condition. All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.

GENERAL WAITING PERIOD

There is no general three (3) month waiting period. The following waiting periods commence from the Join Date of the Gap Cover Policy:

10 MONTH CONDITION SPECIFIC WAITING PERIOD

No claims may be submitted within the first 10 months of membership for any Gap Cover policy if they relate to any of the following conditions:
• Head, neck and spinal procedures (including stimulators) e.g. Laminectomy
• All types of hernia procedures
• Endoscopic procedures e.g. Colonoscopy, Gastroscopy
• Oesophagitis, Gastroenteritis and Gastro-Intestinal Disorders
• Pregnancy and childbirth (including caesarean delivery)
• Gynaecological conditions e.g. Hysterectomy
• Male genital system (including prostatectomy / robotic prostatectomy)
• All robotic type surgery
• Joint replacement (including Arthroplasty, Arthroscopy, Metatarsal
Osteotomy) but excluding treatment due to accidental trauma.
• Inability to walk / move without pain
• Any Ear, Nose and Throat procedures (including nasal, sinus, tonsil
and adenoid procedures)
• Cardiac (relating to the heart)
• Dentistry (unless due to accidental trauma)
• Cataracts and / or eye laser surgery (including all eye and lens procedures)
• Neurological conditions and procedures (including stimulators)
• Organ transplants (including cochlear implants)
• Renal Failure
• Reconstructive surgery as a result of an incident or condition that
occurred prior to membership (including skin grafts)
• Mental health or psychiatric conditions (including depression)
• Varicose veins
• Diabetes and related complications

All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.

CANCER DIAGNOSIS WAITING PERIOD

If a Policyholder is diagnosed with any form of cancer prior to membership, all related claims will be subject to a nine (9) month waiting period. If a Policyholder has previously been diagnosed with cancer and is currently in remission, the Policyholder needs to advise the insurer by way of medical evidence that the remission period has been for two (2) or more consecutive years.

PRE-EXISTING MEDICAL CONDITION/S WAITING PERIOD

NO claims relating to any pre-existing condition/s that may lead to hospitalisation (excluding cancer: see above) will be covered within the first six (6) months of membership. The insurer reserves the right to request any clinical information from a Policyholder’s doctor should a claim in this period indicate, and/or relate to, a pre-existing condition. All claims for these conditions received within the waiting period will be reviewed by medical management to identify pre-existing conditions.