KaeloXelus is SACA’s gap and co-payment insurance cover utilised for its members. SACA funds the full monthly KaeloXelus premium for all its members and their dependents.
Click here to download the KaeloXelus brochure
KaeloXelus gap and co-payment cover is a short-term insurance policy that compliments your medical aid and allows you to access private and high-quality healthcare without having to consider the cost. It therefore provides the security to not have to worry about your medical aid bills not being fully covered if you stick to the guidelines of your Medical Aid.
Co-payment is a fixed, upfront fee that is payable on certain procedures. These usually apply to defined surgical procedures, basic in-patient dentistry and diagnostic services such as MRI/CT/PET scans and scopes.
There is normally a shortfall between what your medical aid will cover and the actual cost of your procedure or treatment as service providers can charge above the medical aid rate. Without gap cover, this shortfall will be at your own expense. Being a professional sportsman/ women you want the security of being able to see the best practitioners without having to be concerned about the shortfall incurred.
Players have to settle the medical account first and then claim the money back from KaeloXelus by following the steps below:
Download a copy of the KaeloXelusisClaim Form
Download a copy of the KaeloXelus Claim Form
Complete form and send to Tess du Plessis firstname.lastname@example.org at SACA along with a copy of your medical aid statement, hospital bill and receipts if you have made payment upfront.
Players will have 4 months from the date of the medical procedure to submit the claim
If all claim related documentation has been correctly submitted, a claim should pay out within three (3) weeks of submission. KaeloXelusis claims are paid into a player’s nominated account and never to the service provider
• Day-to-day claims, unless specified
• Claims not approved by, or excluded by or paid as an ex-gratia by your medical aid
• A co-payment that is not a fixed Rand amount, except in the case of oncology co-payments
• Any penalty co-payment, deductible or limitation applied to your medical aid benefits for non-adherence to rules or authorisation procedures (unless otherwise specified)
• Specialised Dentistry such as implants, crowns, bridges, orthognathic surgery, etc (this does not include basic in-hospital dentistry such as wisdom extractions or fillings for young children)
• Claims older than four months