At KaeloXelus we understand that your health cover is very important to you and that you want to have access to the best medical care for you and your family.

The rising cost of healthcare, coupled with reducing medical aid benefits, means that it is vital to purchase gap cover, ensuring that you are not left with large shortfalls on medical bills.

Fusion™ is specifically designed for such purposes, offering you the best gap cover benefits in the market today!

Make the smart choice - Fusion™

Core benefitsTariff ShortfallsSurgeons or anaesthetists charge considerably more than what your medical aid is willing to pay for these services, often resulting in large shortfalls.

Fusion™ will provide you with an additional benefit of 500% of tariff to cover these shortfalls. This applies when you have treatment in a hospital or day clinic or when your medical aid pays for treatment in a specialists’ rooms from the hospital benefit.

Fusion™ covers all procedures – including prescribed minimum benefits - and all practitioners used during the procedure are covered, eg surgeons, radiologists, pathologists, physiotherapists, etc. There is no Rand limit on this cover.

CancerFusion™ offers the most comprehensive oncology cover on the market, giving you and your family complete financial security.

Shortfalls on oncology treatment can occur in 3 different ways. We explain these shortfalls below and how Fusion™ covers you for all these costs, including prescribed minimum benefits:

• Oncology involves simultaneous treatment from different doctors and they charge more than what your medical aid is willing to pay, often creating large shortfalls. This can be for oncologists, biological medicines, chemotherapy, radiotherapy, radiology, specialised scans and pathology.

We provide an additional benefit of 500% of tariff to cover these shortfalls and there is no rand limit.

• The second way in which shortfalls occur is when your medical aid imposes co-payments on your benefits, after your oncology treatment costs exceed a certain rand threshold.

Fusion™ provides cover for these co-payments, up to an additional R 325,000 per beneficiary per treatment cycle. There is no annual limit on this cover, so if you have more than one treatment cycle per annum, you will have R 325,000 cover for each treatment cycle.

• The last way in which oncology shortfalls occur, is when your medical aid imposes an overall annual limit on oncology treatment.

We will provide an additional R 220,000 cover per annum per beneficiary, once your medical aid benefit is exhausted.

Co-Payments & DeductiblesYour medical aid requires you to pay a fixed, upfront fee, called a co-payment or deductible, on certain procedures. This usually applies to defined surgical procedures, basic in-patient dentistry and diagnostic services, such as MRI/CT/PET scans and scopes.

Fusion™ will provide you with unlimited cover for these upfront payments.

If you make voluntary use of a non-designated hospital or day clinic, then we will cover you once per annum, up to a maximum of R 12,000.

For new business enquiries please contact the KaeloXelus team atenquiries@KaeloXelus.co.za

Gap Cover

C-section 33 Cancer 32Hip Replacement 51 Ovarian cyst 37 Spinal Surgery 46 Endometriosis 47 Tonsillectomy 6 Wisdom Extraction 24

R 11,885R 43,298R 24,617R 16,082R 42,760R 28,502R 5,826R 9,387

Shortfall Covered

Treatment & Patient Age

Fusion™

Actual Claims

Kaelo Consulting (Pty) Ltd is a registered company and Xelus (Pty) Ltd is an authorised financial services provider FSP: 36931, underwritten by Centriq Insurance Company Limited.

Sub-Limit EnhancerWhen your medical aid imposes a rand limit, known as a sub-limit, on certain treatment or prosthetic devices, you will need to pay in the difference.

We will provide you with additional cover up to R 40,000 per beneficiary per event. There is no annual limit and we will cover you for services or devices such as internal prostheses, MRI/CT/PET scans, cornea or lens transplants, pacemakers, cochlear implants, etc.

Casualty BenefitIf you have an accident and need emergency treatment at a hospital casualty ward, your medical aid will not pay for these costs from the hospital benefit.

We will provide you with cover up to R 12,000 per incident. There is no annual limit and cover applies to all services delivered in the casualty ward, even if the costs are paid from your medical savings account.

FusionX combines the comprehensive Fusion™ benefits with an Employee Assistance Programme (EAP) ensuring employees have cover for both physical and mental wellness.

FusionX is available to employer groups of 20+ employees only on a compulsory participation basis. Refer to the EAP brochure for further detail.

Benefit ExtenderWe understand that certain medical events result in additional non-medical expenses that will not be covered by your medical aid.

Our Benefit Extender was designed to assist you with additional benefits for exactly such events.These benefits are paid over and above the core benefits and can be used entirely at your discretion.

Family Booster – for a premature birth more than 6 weeks before due date, Fusion™ will pay you R12,000.

Hospital Booster - Fusion™ will pay a lump sum related to the length of stay in hospital:From day 7 to 13 we will pay R600 per dayFrom day 14 to 20 we will pay R1,200 per dayFrom day 21 to 30 we will pay R1,800 per day

If the hospitalisation was trauma related or for a premature birth more than 6 weeks before due date, we will pay the benefit from day 1 instead of day 7.

Family Protector – should you or any beneficiary die or become permanently disabled, we will pay a lump sum of R12,000. If the cause was accidental, the benefit doubles to R24,000.

Dental Reconstruction Benefit – if a beneficiary requires dental reconstruction as a result of trauma or oncology treatment, we will cover such costs up to R30,000 per event. This benefit only applies to events occurring after commencement of cover.

Contribution Waiver – if the principal member of the medical scheme dies or becomes permanently disabled, Fusion™ will cover the medical scheme contributions for 6 months up to a maximum of R4,000 per month. The Fusion™ premium will also be waived entirely for 6 months.

Road Accident Fund (RAF) – if you are injured in a vehicle accident that wasn’t your fault, our partners – Road Cover – will provide you with all the legal assistance to finalise your claim. The entire award from the RAF will be paid out to you – we cover all the legal costs for free.

ExclusionsIn order to ensure the long term sustainability of Fusion™, certain exclusions apply. We list the main exclusions below – if you want full details, please refer to your policy document or contact us for a copy thereof:

• Day-to-day claims, unless specified

• Claims not approved by, or excluded by or paid as an ex-gratia by your medical aid

• Co-payment/deductible that is not a fixed rand amount (excludes 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 specified in these benefits)

• Specialised Dentistry such as implants, crowns, bridges, orthognathic surgery, etc (does not apply to basic in-hospital dentistry, eg wisdom extractions or fillings for young children)

• Claims that are older than four months.

Terms & Conditions• Maximum entry age is 60 for individuals and groups less than 20. Increases

to 65 for groups of 20 or more

• Waiting periods may apply to your cover. Check your member schedule or contact us to confirm

• Cover only applies to the member, spouse & children (up to 26)

• Families covered on 2 medical aids will be covered by a single Fusion™

policy

• A spouse, who is a dependant on their partner’s medical aid, can take out a Fusion™ policy and the family will be covered

• This brochure is a summary of the cover – please refer to your policy document for all conditions of cover or contact us for clarification.

Fusion X

Focused on you

Kaelo Consulting (Pty) Ltd is a registered company and Xelus (Pty) Ltd is an authorised financial services provider FSP: 36931, underwritten by Centriq Insurance Company Limited.