Shortfalls are the difference between what specialists charge and what your medical scheme pays for these services.
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.
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.
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.
The total maximum Compensation Limit payable for all Core Benefits and Benefit Extender will be limited to R164 500 (one hundred and sixty-four thousand, five hundred rand) per family member, per annum.
* Cover benefits, limits and maximum compensation limit applicable from 1 January 2020.
Terms & Conditions apply.