Claims

Gap cover is important. Thousands of our clients use their gap cover benefits every year. To them it is the difference between getting healthy or getting trapped in a sickening debt-cycle because of a shortfall on their medical expenses.

In some cases, the gap is truly significant. The highest claim paid by Ambledown in 2020 was R153 850,27 for treatment of Angina Pectoris. The shortfall on this lifesaving medical procedure is only one of 28 648 claims we paid during the year.

Use Data to Find Big Value for Your Clients

With a variety of insurance products to meet your clients’ specific needs, you may find it difficult to advise them on the best value. Understanding both your client and the various benefits embedded in the Ambledown products is essential.

However, from our data, we can provide you with deeper insights. What really happens day to day? Which benefits are used the most often, and which benefits pay the highest amount? 

Most-Used Benefits

The vast majority of claims submitted to Ambledown are for Gap Cover and Major Medical Co-Payment Cover. In fact, of the 28 648 claims we paid, 20 618 claims were for the Gap Cover benefit, and 5 550 claims were for the Co-payment benefit.

Additionally, Casualty Cover saw 1275 claims, Cancer Co-payment paid out 707 claims, and the Sub-limitation Cover Benefit was used 246 times.

The data shows that ensuring your clients are covered for these five most-claimed events will protect their financial security in over 99% of the cases we see.

What is the largest Claim?

Gap Cover continually pays out the largest single claim of any of the Ambledown benefits with R153 850,27 in 2020 and R165 000,00 in 2021. And at R80 767,58 in 2020 and R58 166,61 in 2021, Sub-limitation Cover sees the second-largest single claims each year. 

With these benefit insights and Ambledown’s competitive and comprehensive insurance products , you can give your clients the protection they need when medical emergency strikes.

As a leader in product innovation, Ambledown understands medical and financial uncertainty can be extremely stressful. Time, and knowing where shortfalls may occur, is of the essence.

That is why Ambledown member claims are processed in 10 working days, upon receiving the necessary documents. We are continually analysing South Africa’s medical industry, its legal framework, and the medical schemes to build innovative solutions that safeguard your clients.

Find the most suitable Gap Cover for your client on the Ambledown website