Gap Cover for Medical Expense Shortfall

WHY DO YOU NEED GAP COVER?

The Council for Medical Schemes recommends an annual medical aid rate – this is the base rate that can be charged by all medical practitioners for medical procedures. Most medical aids agree to pay up to a certain percentage of this rate – in most cases up to 300% of this rate. However, medical practitioners are free to charge whatever they want for their services, and should your provider charge more, it will be your responsibility to cover the shortfall.

For example: Let’s say your medical aid covers up to 300% of the medical aid rate. If a medical practitioner charges 500% of medical aid rates, your medical aid will cover the first 300% and you will have to pay the additional 200%.Medical practitioners may also request certain tests and procedures which would also require co-payments from your pocket.

Medical procedures are expensive, and this can mean an instant bill of tens of thousands of Rands, if not more. Gap Cover is important, additional insurance you buy in conjunction with your medical aid to cover this shortfall. iWYZE Gap Cover is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.

MIND THE GAP

The table below is an illustrative example of how iWYZE Gap Cover could help you to cover those medical expense shortfalls:

Shortfall covered for various Treatments, according to patient age:

Endometriosis

47yrs old - R28 502

Hip Replacement

51yrs old - R24 617

Wisdom Extraction

24yrs old - R9 387

Spinal Surgery

46yrs old - R42 760

Cancer

32yrs old - R43 298

C-section

33yrs old - R11 885

Tonsillectomy

6yrs old - R5 826

Ovarian Cyst

47yrs old - R16 082

HEALTHY BENEFITS TO PROTECT YOU AGAINST SHORTFALLS

iWYZE Gap Cover offers excellent In-Hospital, In- and Out-of Hospital Oncology and Out-of-Hospital benefits to cover extensive medical expense shortfalls for tariffs, oncology, sub-limits, co-payments and deductibles, plus a Benefit Extender in addition to the core benefits.

iWYZE Gap Cover:

pays up to five times (or 500%) the medical aid rate;
covers your immediate family, even as it grows, without increasing your premium; and
covers members from different medical aids on a single iWYZE Gap Cover policy.

Covered events

Hospitalisation for accidental harm, illness or other health incidents.
Oncology treatment, including chemotherapy, radiotherapy or other drug regimen.
Kidney dialysis.
Accidental harm resulting in emergency medical treatment at the outpatient casualty or trauma ward of a hospital.

GAP COVER BENEFITS:

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 in-hospital consultations, procedures.

IN- AND OUT-OF-HOSPITAL ONCOLOGY BENEFITS

In- and -Out-of-Hospital benefits include cover for shortfalls on oncology treatment. These shortfalls can be significant and can occur as oncology tariff shortfalls, co-payments or sub-limits.

OUT-OF-HOSPITAL BENEFITS

Out-of-Hospital Benefits provide cover tariff shortfalls on defined out-patient surgical procedures, treatments and medical expense shortfalls received as an out-patient, as well as cover for accidental casualty.

BENEFIT EXTENDER

The Benefit Extender was designed to assist with additional benefits (over and above the core benefits) for certain medical events, resulting in additional non-medical expenses that will not be covered by your medical scheme. These benefits can be used at own discretion.

COMPENSATION

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

*Terms and conditions apply

MAKE THE WISE INSURANCE CHOICE
for affordable, reliable gap insurance you can trust.

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