IN-HOSPITAL BENEFITS

In-Hospital benefits include cover for substantial tariff shortfalls, co-payments or sub-limits, co-payment and deductibles and shortfalls from sub-limits arising from defined in-hospital consultations and procedures.

TARIFF SHORTFALLS
  • Shortfalls are the difference between what specialists charge and what your medical scheme pays for these services. Benefit of up to 500% of the tariff fee to cover the shortfalls for defined medical and surgical treatment received when you are admitted in a hospital.
CO-PAYMENTS & DEDUCTIBLES

Your medical scheme 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 and scopes.

  • Includes MRI/CT/PET scans.
  • Limited to certain diagnostic and medical procedures.
PENALTY CO-PAYMENT

If you do not have iWYZE Gap Cover, you will have to pay a penalty co-payment or deductible for the voluntary use of a hospital that is not part of a hospital network.

  • Up to a maximum of one event per family per annum and a maximum compensation limit of R12 800 per event.
SHORTFALLS FROM SUB-LIMITS

Shortfalls from sub-limits occur when your medical scheme imposes a rand limit, known as a sub-limit, on certain treatment or prosthetic devices – without sufficient gap cover, you will need to pay in the difference.

  • Up to a maximum benefit of R44 000 per beneficiary per event.
  • Cover for services or devices which include, but are not limited to internal prostheses, MRI/CT/PET scans, cornea or lens transplants, pacemakers, cochlear implants.

COMPENSATION FOR ALL GAP COVER BENEFITS

The total maximum compensation limit payable for all benefits will be limited to R150 000 per family member, per annum.

*Terms and conditions apply





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