Why do you need GAP Cover?

As a member of a medical scheme, you might find yourself having to pay some medical practitioners from your own pocket. Sometimes health professionals can charge up 5 times more than what the medical scheme rate is. In an instance like that, you would have to cover the shortfall from your own pocket. We all know that these could sometimes run in to thousands of rands which you might not afford to pay. That’s why you should take up this cover so you don’t end up worrying about unplanned medical bills, while you should only be focusing on recovering and restoring your health!

Take advantage of this opportunity and be sure that you will be covered for when you need it.

Old Mutual Insurance 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.

HEALTHY BENEFITS TO PROTECT YOU AGAINST SHORTFALLS

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

Old Mutual Insurance Gap Cover:

  • Available to members of a registered medical scheme.
  • Pays up to five times (500%) the medical scheme tariff fee if designated service providers are used.
  • Pays up to one time (100%) the medical scheme tariff fee for shortfalls on:
    - maxillofacial and back and spinal surgery OR for shortfalls where a non-designated service provider was used on a group network option and.
  • Cover applies to the member, spouse and children (up to 26 years of age).
  • Members on multiple medical schemes can be covered under a single iWYZE Gap Cover policy.
  • A spouse, who is a dependent on their partner’s medical scheme, can take up an iWYZE Gap Cover policy and the family will be covered.

Covered events

  • Hospitalisation for accidental harm, illness, or other health incidents.
  • Oncology treatment, including chemotherapy, radiotherapy or other drug regimen.
  • Kidney dialysis for the treatment of acute or chronic renal failure.
  • Accidental harm resulting in emergency medical treatment at the out-patient 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 defined in-hospital consultations and procedures.

IN- AND OUT-OF-HOSPITAL ONCOLOGY BENEFITS

In- and Out-of-Hospital Oncology 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 for tariff shortfalls on 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.


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