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.
The table below is an illustrative example of how iWYZE Gap Cover could help you to cover those medical expense shortfalls:
47yrs old - R28 502
51yrs old - R24 617
24yrs old - R9 387
46yrs old - R42 760
32yrs old - R43 298
33yrs old - R11 885
6yrs old - R5 826
47yrs old - R16 082
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.
The total maximum compensation limit payable for all benefits will be limited to R150 000 per family member, per annum.
*Terms and conditions apply