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Out-of-Hospital Benefits
Out-of-hospital benefits
Out-of-Hospital Benefits
Out-of-Hospital Benefits provide cover for tariff shortfalls on defined out-patient surgical procedures, treatments and medical expense received as an out-patient.
- Up to a maximum compensation limit of five times the Medical Scheme rate to cover defined surgical procedures/treatment and medical expense shortfalls received as an out-patient.
- Driven by a designated service provider group network.
- Limited to certain diagnostic and medical procedures/treatment.
Co-payments and Deductibles
- Includes MRI, CT and PET scans.
- Limited to certain diagnostic and medical procedures/treatment such as gastroscopies and colonoscopies.
Accidental Casualty Benefit
- Up to a maximum compensation limit of R15 900 per policy, per annum.
- Covers the actual cost of the services delivered in the casualty ward, less any amount paid by your Medical Scheme from risk pool benefits (i.e. not from medical savings).
External Appliance Benefit
- Covers the purchase of external appliances up to a maximum of R2 120 per policy per annum.
- Limited to crutches, knee braces, arm slings and moon boots.
Maximum compensation for all Gap Cover benefits*
The total maximum Compensation Limit payable for all Core Benefits and Benefit Extender will be limited to R210 580 (two hundred and ten thousand five hundred and eighty rand) per insured person, per annum.
*Cover benefits, limits and maximum compensation limit applicable from 1 January 2025.
Terms & Conditions apply.
Important note
- During the first 12 months of membership, a pre-existing condition waiting period applies.
- During the first 3 months of membership, a general waiting period applies.
- During the first 12 months of membership, a pregnancy waiting period applies.
Please note the 3 months general waiting period, 12 months pre-existing condition waiting period and 12 months pregnancy waiting period apply to an insured person from the time that such person's cover commences under the policy (to run concurrently if two or more waiting periods are applicable to an insured person).
What do our customers say?
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Nontokozo K
Thank you iWYZE for your affordable comprehensive insurance cover. After all these years no one has managed to beat the iWYZE premium that I am getting.
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