Stratum Benefits is a South African company that provides medical gap cover insurance. It was established in 2005 and has experienced significant growth, expanding its office space and adding regional branches. The document provides details on Stratum Benefits' various gap cover insurance plans, including benefits covered and monthly premiums. It also outlines the company's history, leadership, underwriters, and national footprint across South Africa.

1. LOOK NO FURTHER.
WE HAVE YOU COVERED!

3. The Financial Services Board
certified that with effect from
25 April 2005 Stratum Benefits
(PTY) LTD is an accredited
Financial Services Provider in
terms of Section 8 of the Financial
AdvisoryandIntermediaryServices
Act,2002(ActNo.37of2002).
Stratum Benefits utilised a small
office space operating with a
handful of dedicated employees.
Stratum Benefits’ Head Office
opened its doors in Block B,
ground floor in January 2010. We
outgrew the space and moved to
Block C, where we occupy both
floors and subsequently took
additional space in Block D.
Our first regional office was
established in Cape Town in
February 2012.
OUR JOURNEY
2005 2007 2010 2012

4. Our regional branch in Durban &
satellite branches in Bloemfontein
& East London were opened in
March 2013 with the East
London office relocating to Port
Elizabeth in January 2014.
During the course of 2015 to
2016 Stratum Benefits voiced a
revolution by undertaking a
complete rebrand that
established One United Vision.
In 2016, Stratum Benefits
celebrated an incredible
achievement and major policy
acquisition milestone through
gaining over 100 000 policies
& having in excess of 200 000
insured lives which continues
to exponentially grow in 2017.
OUR JOURNEY CONTINUED
2013 2015 2017
The FIA not only recognised but
awarded us the prestigious
accolade of being the 2016 &
2017 Product Supplier of the
Year, in the category of Health
Insurance.
2016

5. THE VERY BEGINNING
Stratum Benefits is your forthright leading medical shortfall specialist that consistently delivers transparent quality and
remarkable value. We cover the gap that exists between what your medical scheme pays and the fee charged for private
healthcare. Our doors were opened in 2007 and we currently operate as a Non-Mandated Intermediary with binding
authority under FSP licence 2111.
Our products are designed to enhance benefits within the health care environment, providing cover to clients who are
and who are not members of a registered South African medical scheme. Due to the unwavering commitment from both
our clients and brokers, we have had inspiring growth in membership and currently provide cover to over 200 000
families nationwide.
OUR INSURERS
Stratum Benefits is underwritten by Constantia Insurance Company Limited FSP number 31111 and Lionheart Risk
Management (Pty) Ltd FSP number 22447.
NATIONAL FOOTPRINT
Stratum Benefits head office is located in Johannesburg, regional branches in Durban and Cape Town as well as satellite
branches in Port Elizabeth and Bloemfontein.
OUR MANAGING DIRECTOR
Marco Fonto is the Managing Director of Stratum Benefits, and has more than 15 years’ experience in the short term
insurance industry. He has built Stratum Benefits up to be a leading player in the gap insurance industry.
WHERE OUR JOURNEY BEGAN

6. Vereeniging
OUR NATIONAL FOOTPRINT
STRATEGICALLY SERVICING A NATION
Rest assured that we are the only leading
medical shortfall specialist with a strategic
national footprint, that ensures our speed
and delivery makes every second count and
every minute a memorable one.
Our Head Office is located in Johannesburg
with regional branches in Durban and Cape
Town, as well as satellite branches in Port
Elizabeth and Bloemfontein.

7. Our client growth has been exponentially
increasing each year since 2006, with now
over 100 000 policies & in excess of
200 000 insured lives which is testament to
our dedication to every broker, every client,
and everyone.
FINANCIAL PROFILE
OPERATIONAL HIGHLIGHTS
POLICIES SUMMARY
Accurate up until the 25th of January 2017

9. BASE
CO-EVOLUTION
ELITE
G-FORCE
HOSPITAL OPTIMISER
ACCESS OPTIMISER
DENTAL ASSURE
MEDICAL SHORTFALL SOLUTIONS FOR INDIVIDUALS
ESSENTIAL PRIMARY PLUS
GAP COVER PRODUCT RANGE
PRIMARY HEALTHCARE PRODUCT RANGE

10. BASE
BENEFIT LIMITS
500% GAP BENEFIT Subject to the OPL
Account shortfalls on Doctors or Specialists,
Basic Black & White X-rays, Pathology,
Physiotherapy, Disposable Items & Medication
Included in GAP BENEFIT
CASUALTY BENEFIT R 5 000 per policy per year, subject to the OPL
TRAUMA COUNSELLING BENEFIT R 5 000 per policy per year, subject to the OPL
CANCER DIAGNOSIS BENEFIT
R 5 000 once-off payment on first time
diagnosis of cancer, not subject to the OPL
ACCIDENTAL DEATH BENEFIT
R 5 000 on lives of principal insured or spouse,
not subject to the OPL
MONTHLY PREMIUM......................... R 180
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GAP COVER FOR INDIVIDUALS WITH AN
OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE

11. CO-EVOLUTION
BENEFIT LIMITS
500% GAP BENEFIT Subject to the OPL
Account shortfalls on Doctors or Specialists,
Basic Black & White X-rays, Pathology,
Physiotherapy, Disposable Items & Medication
CO-PAYMENT BENEFIT R 40 000 per policy per year, subject to the OPL
CASUALTY BENEFIT R 6 000 per policy per year, subject to the OPL
TRAUMA COUNSELLING BENEFIT R 6 000 per policy per year, subject to the OPL
CANCER DIAGNOSIS BENEFIT
R 5 000 once-off payment on first time
diagnosis of cancer, not subject to the OPL
ACCIDENTAL DEATH BENEFIT
R 6 000 on lives of principal insured or spouse,
not subject to the OPL
MONTHLY PREMIUM......................... R 225
Included in GAP BENEFIT
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GAP COVER FOR INDIVIDUALS WITH AN
OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE

12. MONTHLY PREMIUM......................... R 320ELITE
BENEFIT LIMITS
500% GAP BENEFIT Subject to the OPL
Account shortfalls on Doctors or Specialists,
Basic Black & White X-rays, Pathology,
Physiotherapy, Disposable Items & Medication
CO-PAYMENT BENEFIT
ONCOLOGY BENEFIT
In- and out-of-hospital medical procedure
related co-payments or deductibles &
1 non-DSP co-payment of R 8 250,
subject to the OPL
Covers service providers' account shortfalls
related to an approved oncology treatment
plan, subject to the OPL
ONCOLOGY OPTIMISER BENEFIT
R 100 000 per person per year, subject
to the OPL (when yearly limit is reached)
CANCER DIAGNOSIS BENEFIT
R 30 000 once-off payment on first time
diagnosis of cancer, not subject to the OPL
Included in GAP BENEFIT
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GAP COVER FOR INDIVIDUALS WITH AN
OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE

13. ELITE continued MONTHLY PREMIUM......................... R 320
BENEFIT LIMITS
SUB-LIMIT BENEFIT
R 30 000 per event / R 60 000 per person per year
for internal prosthesis and R 2 500 per MRI or CT scan limited
to 2 scans, subject to the OPL
CASUALTY BENEFIT R 10 000 per policy per year, subject to the OPL
TRAUMA COUNSELLING BENEFIT R 10 000 per policy per year, subject to the OPL
GAP POLICY PREMIUM WAIVER BENEFIT
12 Months on death, permanent disability or forced
retrenchment of the Stratum Benefits policy premium payer,
not subject to the OPL
MEDICAL SCHEME CONTRIBUTION WAIVER BENEFIT
6 Months limited to R 4 500 per month on death or permanent
disability of the medical scheme contribution payer, not subject
to the OPL
ACCIDENTAL DEATH BENEFIT
R 25 000 on lives of principal insured or spouse &
R 5 000 per dependant, not subject to the OPL
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UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE
GAP COVER FOR INDIVIDUALS WITH AN
OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR

14. BENEFIT
G-FORCE
BENEFIT LIMITS
500% GAP BENEFIT Subject to the OPL
Account shortfalls on Doctors or Specialists,
Basic Black & White X-rays, Pathology,
Physiotherapy, Disposable Items & Medication
CO-PAYMENT BENEFIT
ONCOLOGY BENEFIT
R 15 000 per policy per year, subject to
the OPL
R 100 000 per person per year, subject
to the OPL (covers service providers' account
shortfalls related to an approved oncology
treatment plan)
ONCOLOGY OPTIMISER BENEFIT
R 100 000 per person per year, subject
to the OPL (when yearly limit is reached)
CANCER DIAGNOSIS BENEFIT
R 5 000 once-off payment on first
diagnosis of cancer, not subject to the OPL
MONTHLY PREMIUM......................... R 240
Included in GAP BENEFIT
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GAP COVER EXCLUSIVELY TAILORED FOR GOVERNMENT EMPLOYEES WITH
AN OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE

15. SUB-LIMIT BENEFIT
CASUALTY BENEFIT
TRAUMA COUNSELLING BENEFIT
GAP POLICY PREMIUM WAIVER BENEFIT
MEDICAL SCHEME CONTRIBUTION WAIVER BENEFIT
ACCIDENTAL DEATH BENEFIT
G-FORCE continued
BENEFIT LIMITS
R 20 000 per event / R 60 000 per person per year for internal
prosthesis or non-PMB day procedures & R 2 500 per MRI or
CT scan limited to 2 scans, subject to the OPL
R 7 000 per policy per year, subject to the OPL
R 7 000 per policy per year, subject to the OPL
12 Months on death, permanent disability or forced
retrenchment of the Stratum Benefits policy premium payer,
not subject to the OPL
6 Months limited to R 4 500 per month on death or permanent
disability of the medical scheme contribution payer,
not subject to the OPL
R 15 000 on lives of principal insured or spouse &
R 5 000 per dependant, not subject to the OPL
MONTHLY PREMIUM......................... R 240
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GAP COVER EXCLUSIVELY TAILORED FOR GOVERNMENT EMPLOYEES WITH
AN OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE

16. HOSPITAL OPTIMISER
YOUR MEDICAL
SCHEME’S OVERALL
ANNUAL HOSPITAL
LIMIT (OAL)
HOSPITAL
OPTIMISER
BENEFIT
WILL COVER
HOSPITAL
OPTIMISER
BENEFIT INCREASES
YOUR OAL
R 150 000 R 300 000
R 150 000
per person per year
limited to a maximum
of R 2 000 000
per policy per year
R 300 000 R 450 000
R 800 000 R 950 000
R 1 000 000 R 1 150 000
MONTHLY PREMIUM......................... R 85
GAP COVER FOR INDIVIDUALS WITH AN OVERALL POLICY LIMIT (OPL)
OF R 150 000 PER POLICY PER YEAR, LIMITED TO A MAXIMUM OF
R 2 000 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE
Your claim will be assessed in line with your medical scheme rules and the applicable rate your medical
scheme pays, therefore when your service providers charge a rate considerably more than the medical
scheme rate, cover is not applicable.

17. MONTHLY PREMIUM......................... R 180
ADD OUR GAP COVER........................ R 40ACCESS OPTIMISER
MEDICAL PROCEDURE NOT
COVERED BY YOUR MEDICAL SCHEME
ACCESS OPTIMISER
BENEFIT WILL COVER
Dental procedures for impacted teeth for child
dependants under 18 years of age
Dental procedures for reconstructive plastic
surgery due to an accident
Functional nasal surgery
Oesophageal reflux and hiatus hernia surgery
Back and neck surgery R 80 000
R 55 000
R 50 000
R 80 000
R 14 000
R 80 000
R 23 000
R 14 000
R 80 000
R 20 000
Joint replacement surgery
Cochlear implant, auditory brain implant and internal
nerve stimulator surgery including the device
and processor
Bunion surgery
Arthroscopic surgery
Varicose veins surgery
GAP COVER FOR INDIVIDUALS WITH AN OVERALL POLICY LIMIT (OPL)
OF R 100 000 PER POLICY PER YEAR OR WHEN ADDING OUR
GAP BENEFIT INCREASES TO R 150 000 PER POLICY PER YEAR

18. MONTHLY PREMIUM......................... R 180
ADD OUR GAP COVER........................ R 40ACCESS OPTIMISER
ACCIDENTAL DEATH BENEFIT
R 5 000 on lives of principal insured or spouse,
not subject to the OPL
BENEFIT LIMITS
500% GAP BENEFIT Subject to the OPL
Account shortfalls on Doctors or Specialists,
Basic Black & White X-rays, Pathology, Physiotherapy,
Disposable Items & Medication
Included in GAP BENEFIT
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GAP COVER FOR INDIVIDUALS WITH AN OVERALL POLICY LIMIT (OPL)
OF R 100 000 PER POLICY PER YEAR OR WHEN ADDING OUR
GAP BENEFIT INCREASES TO R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE

19. DENTAL ASSURE
OPTIONS
MAXIMUM
ENTRY AGE
PRINCIPAL
INSURED
SPOUSE
CHILD
DEPENDANT
SOLUTION A R 32 R 28
65SOLUTION B R 225 R 170
SOLUTION C R 260 R 220
R 24
R 110
R 150
Our DENTAL ASSURE option has been cleverly arranged to
provide you with essential cover whether you belong to a medical
scheme or not. From basic and affordable dental benefits to
specialised dentistry and eye care, you can rest assured that
your leading medical shortfall specialist has you covered.
MONTHLY PREMIUM

20. BASIC DENTISTRY
Within the first 3 months of cover a general waiting period will apply, where no claims can be submitted.
BENEFIT DESCRIPTION
CONSULTATIONS
R 295 per consultation /
limited to 2 consultations
R 590 per person per year
R 295 per consultation /
limited to 4 consultations
R 1 180 per person per year
R 280 per consultation /
limited to 2 consultations
R 560 per person per year
FILLINGS
R 300 per filling /
limited to 2 fillings
R 600 per person per year
R 400 per filling /
limited to 4 fillings
R 1 600 per person per year
R 300 per filling /
limited to 2 fillings
R 600 per person per year
X-RAYS
R 75 per x-ray /
limited to 2 x-rays
R 150 per person per year
R 85 per x-ray /
limited to 5 x-rays
R 425 per person per year
R 65 per x-ray /
limited to 2 x-rays
R 130 per person per year
EXTRACTIONS
R 180 per extraction /
limited to 2 extractions
R 360 per person per year
R 200 per extraction /
limited to 3 extractions
R 600 per person per year
BITE PLATE
Limited to 1 bite plate /
R 800 per person per year
MOUTH GUARD
Limited to 1 mouth guard /
R 400 per person, every 2 years
R 150 per extraction /
limited to 2 extractions
R 300 per person per year
EMERGENCY ROOT CANAL
R 190 per extraction /
limited to 2 emergency
root canal treatments
R 380 per person per year
R 270 per extraction /
limited to 3 emergency
root canal treatments
R 810 per person per year
R 190 per extraction /
limited to 2 emergency
root canal treatments
R 380 per person per year
SOLUTION A SOLUTION B SOLUTION C
DENTAL ASSURE

21. DENTAL ASSURE
Solution B and C require a compulsory Panoramic Scan for all insured persons older than 18, before any dental benefits will be authorised.
Within the first 6 months of cover a general waiting period will apply, where no claims can be submitted.
BENEFIT DESCRIPTION
POLICY RAND AMOUNT LIMIT
Limited to R 1 160
per person per year
Limited to R 20 000
per person per year
Limited to R 10 000
per person per year
TEMPORARY CROWNS
R 450 per crown / limited to
2 temporary crowns
R 900 per person per year
WISDOM TEETH
R 580 per extraction /
limited to 2 wisdom teeth
extractions / R 1 160
per person per year
CROWN AND BRIDGE WORK
DENTAL IMPLANTS
R 4 000 per treatment /
limited to 2 crown and
bridge work treatments
R 8 000 per person per year
R 450 per crown / limited to
2 temporary crowns
R 900 per person per year
R 7 000 per implant /
limited to 2 dental implants
R 14 000 per person per year
R 4 000 per treatment /
limited to 1 crown and
bridge work treatment
R 4 000 per person per year
R 6 000 per implant /
limited to 1 dental implant
R 6 000 per person per year
SOLUTION A SOLUTION B SOLUTION C
SPECIALISED DENTISTRY

22. SPECIALISED DENTISTRY
Solution B and C require a compulsory Panoramic Scan for all insured persons older than 18, before any dental benefits will be authorised.
Within the first 6 months of cover a general waiting period will apply, where no claims can be submitted.
BENEFIT DESCRIPTION
DENTURES
ORTHODONTIC
TREATMENT
OUT-OF-HOSPITAL
WISDOM TEETH
EXTRACTIONS
IN-HOSPITAL WISDOM
TEETH EXTRACTIONS
Limited to 1 full set of
dentures per person every
5 years / R 3 500 per person
per event
Limited to 1 full set of
dentures per person every
5 years / R 3 500 per person
per event
Limited to 1 orthodontic
treatment plan per person
per lifetime / R 17 000
per person per lifetime
R 1 000 per extraction /
limited to 4 wisdom teeth
extractions / R 4 000
per person per year
R 1 000 per extraction /
limited to 4 wisdom teeth
extractions / R 4 000
per person per year
R 3 500 per extraction /
limited to 2 wisdom teeth
extractions / R 7 000
per person per year
R 3 500 per extraction /
limited to 2 wisdom teeth
extractions / R 7 000
per person per year
ROOT CANAL
TREATMENT
R 1 500 per treatment /
limited to 2 root canal
treatments / R 3 000
per person per year
R 1 500 per treatment /
limited to 2 root canal
treatments / R 3 000
per person per year
SOLUTION A SOLUTION B SOLUTION CBENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C

23. EYE CARE BENEFITS
EYE TEST
LENSES, FRAMES &
CONTACT LENSES
R 423 per eye test
per person less R 100
excess payable by you /
limited to 1 eye test
per person every 2 years
Limited to R 320 per clear
plastic single vision lenses
and R 550 per frame
per person, every 2 years
OR
Limited to a maximum of
R 950 per clear plastic
bifocal / multifocal lenses
and R 550 per frame per
person, every 2 years
OR
Limited to R 720 per set of
contact lenses per person,
every 2 years. R 100 excess
payable by you per claim
BENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C
DENTAL ASSURE

24. EYE CARE BENEFITS
DENTAL ASSURE
Within the first 6 months of cover a general waiting period will apply, where no claims can be submitted.
EYECARE SPECIALIST
CONSULTATION
PERSONAL ACCIDENT
EYECOVER (NO GENERAL
WAITING PERIOD
APPLIES TO THIS
SPECIFIC BENEFIT)
ALL RISK INSURANCE
R 800 per consultation
per person, less R 100
excess payable by you /
limited to 1 specialist
consultation every 2 years
Limited to R 25 000
per person per event
Limited to R 1 500 per
replacement or repair
claim of either your lenses
or your frame, less R 100
excess payable by you
BENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C

25. ADDITIONAL BENEFITS
DENTAL ASSURE
DENTAL TRAUMA &
EMERGENCY BENEFIT
R 25 000 per person per year
/ limited to 1 dental event
per person per year
R 16 000 per person per year
/ limited to 1 dental event
per person per year
R 25 000 per person per year
/ limited to 1 dental event
per person per year
BENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C
BENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C
Limited to a 3 month period
in the event of:
The forced retrenchment
of the premium payer /
limited to 1 occurrence
per policy every 5 years
AND / OR
The death of the premium
payer / limited to 1
occurrence per lifetime of
the policy
Limited to a 3 month period
in the event of:
The forced retrenchment
of the premium payer /
limited to 1 occurrence
per policy every 5 years
AND / OR
The death of the premium
payer / limited to 1
occurrence per lifetime of
the policy
Limited to a 3 month period
in the event of:
The forced retrenchment
of the premium payer /
limited to 1 occurrence
per policy every 5 years
AND / OR
The death of the premium
payer / limited to 1
occurrence per lifetime of
the policy
Within the first 6 months of cover a general waiting period will apply, where no claims can be submitted.
Within the first month of cover a general waiting period will apply, where no claims can be submitted.
POLICY PREMIUM WAIVER

27. MONTHLY PREMIUM
ESSENTIAL PRIMARY PLUS
DAY-TO-DAY
BENEFITS ONLY
55
R 285
R 370
R 205 per family
R 190
R 265
R 75
R 95
60
EMERGENCY
& ACCIDENTAL
BENEFITS ONLY
DAY-TO-DAY
AND EMERGENCY
& ACCIDENTAL
BENEFITS
OPTIONS SPOUSE
MAXIMUM
ENTRY AGE
PRINCIPAL
INSURED
CHILD
DEPENDANT

28. DAY-TO-DAY BENEFITS
ESSENTIAL PRIMARY PLUS
No limit on the number of times that you may visit
your general practitioner
R 3 000 per person per year
DOCTORS VISITS
BASIC MEDICAL PROCEDURES
MEDICATION
BASIC BLOOD AND OTHER BASIC TESTS
BASIC X-RAYS
BASIC DENTISTRY R 800 per person per year
ADDITIONAL DENTISTRY
Limited to Diabetes Type 1, Hypertension and HIV / AIDSCHRONIC MEDICATION
1 Eye test & 1 pair of monofocal / bifocal lenses and
a standard frame per person every 2 years
BASIC EYE CARE
R 2 500 per policy per year.
Includes 2 maternity check-ups and ultrasound scans
MATERNITY CARE
BENEFIT
DESCRIPTION
UNIQUE FEATURES

29. When you are admitted into a private facility for a planned medical procedure such as giving birth, cover is not applicable.
EMERGENCY & ACCIDENTAL BENEFITS
ESSENTIAL PRIMARY PLUS
24 HOUR MEDICAL EMERGENCY SERVICES
Access to contact centre / Emergency transport services /
Ambulance transfers / Repatriation / Telephonic medical advice
BENEFIT DESCRIPTION UNIQUE FEATURES
POLICY RAND AMOUNT LIMIT R 1 000 000 per policy per year
HOSPITALISATION DUE TO AN EMERGENCY R 16 500 per person per event
HOSPITALISATION DUE TO AN ACCIDENT R 1 000 000 per person per event
CASUALTY FACILITY R 5 000 per person per event

31. CORPORATE ELITE
CORPORATE ACCESS
CORPORATE ASSURE
MEDICAL SHORTFALL SOLUTIONS FOR EMPLOYER GROUPS
CORPORATE ESSENTIAL
GAP COVER PRODUCT RANGE
PRIMARY HEALTHCARE PRODUCT RANGE

32. CORPORATE ELITE
BENEFIT LIMITS
500% GAP BENEFIT Subject to the OPL
Account shortfalls on Doctors or Specialists,
Basic Black & White X-rays, Pathology,
Physiotherapy, Disposable Items & Medication
CO-PAYMENT BENEFIT
ONCOLOGY BENEFIT
In- and out-of-hospital medical procedure
related co-payments or deductibles &
1 non-DSP co-payment of R 8 250,
subject to the OPL
Covers service providers' account shortfalls
related to an approved oncology treatment
plan, subject to the OPL
ONCOLOGY OPTIMISER BENEFIT
R 100 000 per person per year, subject
to the OPL (when yearly limit is reached)
CANCER DIAGNOSIS BENEFIT
R 30 000 once-off payment on first time
diagnosis of cancer, not subject to the OPL
Included in GAP BENEFIT
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GAP COVER EXCLUSIVELY TAILORED FOR EMPLOYER GROUPS WITH
AN OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE
PREMIUM & WAITING PERIODS SUBJECT
TO EMPLOYER GROUP PROPOSAL

33. CORPORATE ELITE
BENEFIT LIMITS
SUB-LIMIT BENEFIT
R 30 000 per event / R 60 000 per person per year
for internal prosthesis, subject to the OPL
R 2 500 per MRI or CT scan limited to 2 scans, subject
to the OPL
CASUALTY BENEFIT R 10 000 per policy per year, subject to the OPL
TRAUMA COUNSELLING BENEFIT R 10 000 per policy per year, subject to the OPL
GAP POLICY PREMIUM WAIVER BENEFIT
12 Months on death, permanent disability or forced
retrenchment of the Stratum Benefits policy premium payer,
not subject to the OPL
MEDICAL SCHEME CONTRIBUTION WAIVER BENEFIT
6 Months limited to R 4 500 per month on death or permanent
disability of the medical scheme contribution payer, not subject
to the OPL
ACCIDENTAL DEATH BENEFIT
R 25 000 on lives of principal insured or spouse &
R 5 000 per dependant, not subject to the OPL
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PREMIUM & WAITING PERIODS SUBJECT
TO EMPLOYER GROUP PROPOSAL
GAP COVER EXCLUSIVELY TAILORED FOR EMPLOYER GROUPS WITH
AN OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE

34. CORPORATE ACCESS
MEDICAL PROCEDURE NOT
COVERED BY YOUR MEDICAL SCHEME
ACCESS OPTIMISER
BENEFIT WILL COVER
Dental procedures for impacted teeth for child
dependants under 18 years of age
Dental procedures for reconstructive plastic
surgery due to an accident
Functional nasal surgery
Oesophageal reflux and hiatus hernia surgery
Back and neck surgery R 80 000
R 55 000
R 50 000
R 80 000
R 14 000
R 80 000
R 23 000
R 14 000
R 80 000
R 20 000
Joint replacement surgery
Cochlear implant, auditory brain implant and internal
nerve stimulator surgery including the device
and processor
Bunion surgery
Arthroscopic surgery
Varicose veins surgery
GAP COVER EXCLUSIVELY TAILORED FOR EMPLOYER GROUPS WITH
AN OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
PREMIUM & WAITING PERIODS SUBJECT
TO EMPLOYER GROUP PROPOSAL

35. CORPORATE ACCESS
ACCIDENTAL DEATH BENEFIT
R 5 000 on lives of principal insured or spouse,
not subject to the OPL
BENEFIT LIMITS
500% GAP BENEFIT Subject to the OPL
Account shortfalls on Doctors or Specialists,
Basic Black & White X-rays, Pathology, Physiotherapy,
Disposable Items & Medication
Included in GAP BENEFIT
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GAP COVER EXCLUSIVELY TAILORED FOR EMPLOYER GROUPS WITH
AN OVERALL POLICY LIMIT (OPL) OF R 150 000 PER POLICY PER YEAR
UNDERWRITTEN BY CONSTANTIA INSURANCE COMPANY LIMITED AS A NON-MEDICAL SCHEME PRODUCT, PROVIDING BENEFITS THAT CANNOT BE
COMPARED TO OR SUBSTITUTED FOR MEDICAL SCHEME MEMBERSHIP. T'S & C'S APPLY | E&OE
PREMIUM & WAITING PERIODS SUBJECT
TO EMPLOYER GROUP PROPOSAL

36. CORPORATE ASSURE
Our CORPORATE ASSURE option has been cleverly arranged to
provide you with essential cover whether you belong to a medical
scheme or not. From basic and affordable dental benefits to
specialised dentistry and eye care, you can rest assured that
your leading medical shortfall specialist has you covered.
PREMIUM & WAITING PERIODS SUBJECT TO EMPLOYER
GROUP PROPOSAL

37. BASIC DENTISTRY
CORPORATE ASSURE
Within the first 3 months of cover a general waiting period will apply, where no claims can be submitted.
BENEFIT DESCRIPTION
CONSULTATIONS
R 295 per consultation /
limited to 2 consultations
R 590 per person per year
R 295 per consultation /
limited to 4 consultations
R 1 180 per person per year
R 280 per consultation /
limited to 2 consultations
R 560 per person per year
FILLINGS
R 300 per filling /
limited to 2 fillings
R 600 per person per year
R 400 per filling /
limited to 4 fillings
R 1 600 per person per year
R 300 per filling /
limited to 2 fillings
R 600 per person per year
X-RAYS
R 75 per x-ray /
limited to 2 x-rays
R 150 per person per year
R 85 per x-ray /
limited to 5 x-rays
R 425 per person per year
R 65 per x-ray /
limited to 2 x-rays
R 130 per person per year
EXTRACTIONS
R 180 per extraction /
limited to 2 extractions
R 360 per person per year
R 200 per extraction /
limited to 3 extractions
R 600 per person per year
BITE PLATE
Limited to 1 bite plate /
R 800 per person per year
MOUTH GUARD
Limited to 1 mouth guard /
R 400 per person, every 2 years
R 150 per extraction /
limited to 2 extractions
R 300 per person per year
EMERGENCY ROOT CANAL
R 190 per extraction /
limited to 2 emergency
root canal treatments
R 380 per person per year
R 270 per extraction /
limited to 3 emergency
root canal treatments
R 810 per person per year
R 190 per extraction /
limited to 2 emergency
root canal treatments
R 380 per person per year
SOLUTION A SOLUTION B SOLUTION C

38. SPECIALISED DENTISTRY
CORPORATE ASSURE
PREMIUM & WAITING PERIODS SUBJECT
TO EMPLOYER GROUP PROPOSAL
Solution B and C require a compulsory Panoramic Scan for all insured persons older than 18, before any dental benefits will be authorised.
Within the first 6 months of cover a general waiting period will apply, where no claims can be submitted.
BENEFIT DESCRIPTION
POLICY RAND AMOUNT LIMIT
Limited to R 1 160
per person per year
Limited to R 20 000
per person per year
Limited to R 10 000
per person per year
TEMPORARY CROWNS
R 450 per crown / limited to
2 temporary crowns
R 900 per person per year
WISDOM TEETH
R 580 per extraction /
limited to 2 wisdom teeth
extractions / R 1 160
per person per year
CROWN AND BRIDGE WORK
DENTAL IMPLANTS
R 4 000 per treatment /
limited to 2 crown and
bridge work treatments
R 8 000 per person per year
R 450 per crown / limited to
2 temporary crowns
R 900 per person per year
R 7 000 per implant /
limited to 2 dental implants
R 14 000 per person per year
R 4 000 per treatment /
limited to 1 crown and
bridge work treatment
R 4 000 per person per year
R 6 000 per implant /
limited to 1 dental implant
R 6 000 per person per year
SOLUTION A SOLUTION B SOLUTION C

39. SPECIALISED DENTISTRY
Solution B and C require a compulsory Panoramic Scan for all insured persons older than 18, before any dental benefits will be authorised.
Within the first 6 months of cover a general waiting period will apply, where no claims can be submitted.
BENEFIT DESCRIPTION
DENTURES
ORTHODONTIC
TREATMENT
OUT-OF-HOSPITAL
WISDOM TEETH
EXTRACTIONS
IN-HOSPITAL WISDOM
TEETH EXTRACTIONS
Limited to 1 full set of
dentures per person every
5 years / R 3 500 per person
per event
Limited to 1 full set of
dentures per person every
5 years / R 3 500 per person
per event
Limited to 1 orthodontic
treatment plan per person
per lifetime / R 17 000
per person per lifetime
R 1 000 per extraction /
limited to 4 wisdom teeth
extractions / R 4 000
per person per year
R 1 000 per extraction /
limited to 4 wisdom teeth
extractions / R 4 000
per person per year
R 3 500 per extraction /
limited to 2 wisdom teeth
extractions / R 7 000
per person per year
R 3 500 per extraction /
limited to 2 wisdom teeth
extractions / R 7 000
per person per year
ROOT CANAL
TREATMENT
R 1 500 per treatment /
limited to 2 root canal
treatments / R 3 000
per person per year
R 1 500 per treatment /
limited to 2 root canal
treatments / R 3 000
per person per year
SOLUTION A SOLUTION B SOLUTION CBENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C

40. EYE CARE BENEFITS
CORPORATE ASSURE
EYE TEST
LENSES, FRAMES &
CONTACT LENSES
R 423 per eye test
per person less R 100
excess payable by you /
limited to 1 eye test
per person every 2 years
Limited to R 320 per clear
plastic single vision lenses
and R 550 per frame
per person, every 2 years
OR
Limited to a maximum of
R 950 per clear plastic
bifocal / multifocal lenses
and R 550 per frame per
person, every 2 years
OR
Limited to R 800 per set of
contact lenses per person,
every 2 years. R 100 excess
payable by you per claim
BENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C

41. EYE CARE BENEFITS
CORPORATE ASSURE
Within the first 6 months of cover a general waiting period will apply, where no claims can be submitted.
EYECARE SPECIALIST
CONSULTATION
PERSONAL ACCIDENT
EYECOVER (NO GENERAL
WAITING PERIOD
APPLIES TO THIS
SPECIFIC BENEFIT)
ALL RISK INSURANCE
R 800 per consultation
per person, less R 100
excess payable by you /
limited to 1 specialist
consultation every 2 years
Limited to R 25 000
per person per event
Limited to R 1 500 per
replacement or repair
claim of either your lenses
or your frame, less R 100
excess payable by you
BENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C

42. ADDITIONAL BENEFITS
CORPORATE ASSURE
DENTAL TRAUMA &
EMERGENCY BENEFIT
R 25 000 per person per year
/ limited to 1 dental event
per person per year
R 16 000 per person per year
/ limited to 1 dental event
per person per year
R 25 000 per person per year
/ limited to 1 dental event
per person per year
BENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C
BENEFIT DESCRIPTION SOLUTION A SOLUTION B SOLUTION C
Limited to a 3 month period
in the event of:
The forced retrenchment
of the premium payer /
limited to 1 occurrence
per policy every 5 years
AND / OR
The death of the premium
payer / limited to 1
occurrence per lifetime of
the policy
Limited to a 3 month period
in the event of:
The forced retrenchment
of the premium payer /
limited to 1 occurrence
per policy every 5 years
AND / OR
The death of the premium
payer / limited to 1
occurrence per lifetime of
the policy
Limited to a 3 month period
in the event of:
The forced retrenchment
of the premium payer /
limited to 1 occurrence
per policy every 5 years
AND / OR
The death of the premium
payer / limited to 1
occurrence per lifetime of
the policy
Within the first 6 months of cover a general waiting period will apply, where no claims can be submitted.
Within the first month of cover a general waiting period will apply, where no claims can be submitted.
POLICY PREMIUM WAIVER

44. CORPORATE ESSENTIAL
DAY-TO-DAY BENEFITS
No limit on the number of times that you may visit
your general practitioner
R 5 000 per person per year
DOCTORS VISITS
BASIC MEDICAL PROCEDURES
MEDICATION
BASIC BLOOD AND OTHER BASIC TESTS
BASIC X-RAYS
BASIC DENTISTRY R 1 000 per person per year
ADDITIONAL DENTISTRY
Limited to 27 chronic medical conditionsCHRONIC MEDICATION
1 Eye test & 1 pair of monofocal / bifocal lenses and
a standard frame per person every 2 years
BASIC EYE CARE
R 2 500 per policy per year.
Includes 2 maternity check-ups and ultrasound scans
MATERNITY CARE
BENEFIT
DESCRIPTION
UNIQUE FEATURES
PREMIUM & WAITING PERIODS SUBJECT
TO EMPLOYER GROUP PROPOSAL

45. CORPORATE ESSENTIAL
When you are admitted into a private facility for a planned medical procedure such as giving birth, cover is not applicable.
EMERGENCY & ACCIDENTAL BENEFITS
24 HOUR MEDICAL EMERGENCY SERVICES
Access to contact centre / Emergency transport services /
Ambulance transfers / Repatriation / Telephonic medical advice
BENEFIT DESCRIPTION UNIQUE FEATURES
POLICY RAND AMOUNT LIMIT R 1 000 000 per policy per year
HOSPITALISATION DUE TO AN EMERGENCY R 16 500 per person per event
HOSPITALISATION DUE TO AN ACCIDENT R 1 000 000 per person per event
CASUALTY FACILITY R 5 000 per person per event
PREMIUM & WAITING PERIODS SUBJECT
TO EMPLOYER GROUP PROPOSAL

46. 3 MONTH GENERAL WAITING PERIOD
6 MONTH PRE-EXISTING CONDITION WAITING PERIOD
10 MONTH SPECIFIC WAITING PERIOD
1 YEAR PRE-EXISTING CANCER WAITING PERIOD
YOUR WAITING PERIODS
EXCEPTIONS TO THE RULE
REFER TO OUR BROCHURE
AND THE GENERAL EXCLUSIONS
FOR WHAT OUR BENEFITS
DO NOT COVER
IMPORTANT NOTE
• Our Access Optimiser option is subject to a 3 month general
waiting period and a 12 month pre-existing condition waiting
period where no claims can be submitted for any of the listed
medical procedures for which you have received advice or treat-
ment 12 months prior to your cover start date
• Our Essential Primary Plus option is subject to a 2 month
general waiting period, 10 month waiting period on MATERNITY
CARE as well as a 12 month waiting period on BASIC EYE CARE
and CHRONIC MEDICATION
• Our Dental Assure option is subject to a 3 month general
waiting period on BASIC DENTISTRY and a 6 month general
waiting period on SPECIALISED DENTISTRY, EYE CARE
BENEFITS & ADDITIONAL BENEFITS
• Waiting periods applicable to our Corporate Product Range
are subject to the demographic profile of the employer group

47. IMPORTANT TO KNOW
• We cover your client and their spouse, even if they do not
belong to the same medical scheme or medical scheme option
as well as all dependants registered on the medical scheme
option of either the principal insured or spouse (applicable to
our Gap Cover Product Range but excluding DENTAL ASSURE)
• Waiting periods are applied to a policy, except on our
ESSENTIAL PRIMARY PLUS & DENTAL ASSURE options
where waiting periods are applied to each insured person’s
cover start date
• Our options do not have maximum entry ages, except on our
ESSENTIAL PRIMARY PLUS & DENTAL ASSURE options where
different entry ages apply
• Existing clients can upgrade anytime during the year and
will receive a 6 Month Pre-Existing Condition Waiting Period
on enhanced benefits on their upgraded option