iWyze Gap Cover for Medical Expense Shortfall

December 14, 2021

How does iWyze Gap Cover work?

  • It covers you for medical aid shortfalls
  • You receive in-hospital benefits
  • The company pays for certain out-of-hospital fees
  • You can choose a benefit-extender to help pay for extras not covered by the core benefits
  • Each family member has an annual limit for cover of R150 000.


Having a medical scheme is no longer  enough to cover out of the ordinary medical expenses. Whenever a healthcare practitioner charges out of contract rates, YOU pay the shortfall. This is not so bad if you are visiting your doctor when the shortfall is probably a small amount.

It is not uncommon for this shortfall to be thousands of rand when you are in the hospital, though and these medical bills become a problem.

EveryiWyze Gap Cover year the government publishes the standard medical tariffs. These are based on average medical costs across the whole country and are a recommendation as to a medical practitioner should charge you.

However, the healthcare professionals are allowed to charge as much as 500% of these tariffs. What this means for you is that you might come out of the hospital and have to face a staggering array of bills, even when your medical scheme pays what they promise.

Most medical schemes pay 100% of the standard medical tariffs and this can result in a significant shortfall that you are responsible for.

What Gap Cover Is

Insurance such as iWyze gap cover bridges that gap for you. It kicks in after your medical scheme has done its bit so that you don’t have to come up with all of that cash.

What Gap Cover Is Not

What it is not is something that can replace your medical aid completely – the amount paid out by the insurance will depend on how much your scheme has already paid out.

iWYZE Gap Cover

iWYZE, from Old Mutual, offers a plan that can assist with both in-hospital and out-of-hospital benefits. iWYZE pays out for shortfalls related to:

  • Tariff differences
  • Sub-limits being reached
  • Deductibles and co-payments
  • Oncology
  • There are some benefit extender options as well.


What Cover You Get

iWYZE pays out:

  • Illness and accidents
  • Treatment for cancer
  • Trauma
  • Dialysis


In-Hospital Benefits

Shortfalls in terms of sub-limits, tariffs, etc., when you have been admitted to hospital and where the costs have arisen as a result of consultations in the hospital. are included. The oncology benefit extends to out-patient treatments as well.

Out-of-Hospital Benefits

These include shortfalls as discussed above for surgical procedures. In addition, cover extends to some treatments that you have incurred as an out-patient. It also includes casualty fees for accidental injury and penalty co-payments.

Benefit Extender

What about items that don’t fall under core benefits? You can choose the benefit extended to cover some non-medical expenses that do not fall under your medical scheme’s purview.

Limits for the Policy

The total limit paid out per annum is R150 000 for each family member.

iWYZE gap cover offers you an alternative way to secure your financial future. It will be there for you when you need it most. The last thing that you want to do when you have to go into hospital is to worry about medical expenses.

Your medical scheme and iWYZE, together cover you for those serious medical emergencies that cost so much more.


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All info was correct at time of publishing