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.
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 benefits will be limited to R150 000 per family member, per annum.
*Terms and conditions apply