This post was published on Jan 25, 2017 | Updated on Oct 1, 2025
Thousands of South Africans are surprised each year by sky-high hospital bills. That’s because medical schemes only pay up to their set tariffs and specialists, surgeons, or private hospitals often charge 200–500% more.
That’s where iWYZE Gap Cover steps in. It’s an add-on policy designed to protect you and your family from those unexpected out-of-pocket medical expenses. With iWYZE Gap Cover, you’re covered for medical shortfalls of up to R223,000 per year per insured person.
| Year | Cover amount |
| 2025 | R210 580 |
| 2026 | R223 00 |
The Overall Annual Limit (OAL) for claims is aggregated to a maximum of R223 000 from 1 April 2026 to 31 March 2027, unless specified, per beneficiary per annum. The current limit of R219 845 applies from 1 January 2026 to 31 March 2026.
What Exactly Is Gap Cover?
Gap Cover is not a medical aid, it’s an insurance product that works alongside your medical aid. Think of it as your financial shield against the shortfalls your scheme doesn’t cover.
For example:
- Hospital Surgery Bill: R80,000
- Medical Aid Pays: R30,000
- You Owe: R50,000
With Gap Cover, iWYZE pays that R50,000 shortfall* Without it, those costs could wipe out your savings.
*Subject to Ts&Cs and plan option
Key Benefits of iWYZE Gap Cover in 2026
Here’s a breakdown of what’s included in your iWYZE Gap Cover policy to help your family:
1. Tariff Shortfalls (In-Hospital & Out-of-Hospital)
- Covers up to 500% of medical scheme rates
- Applies to major surgeries, anaesthetist costs, and defined outpatient procedures (like scopes and endoscopies)
2. Co-payments & Deductibles
- Pays your fixed co-payments for MRIs, CT scans, PET scans, and defined surgical procedures
- No more worrying about R5,000+ co-payments eating into your budget
3. Oncology Support (Cancer Cover)
- Covers shortfalls on oncology treatments up to 500% of scheme rates
- Pays cancer-related co-payments and excess amounts over sub-limits
4. Childbirth Benefit
a) The joy of welcoming a baby can come with hefty bills. Many gynaes and specialists charge well above medical scheme rates. iWYZE Gap Cover pays up to R15,900 per childbirth event, so you can budget for nappies instead of shortfalls.
b) Family Booster for Premature Births If your baby arrives early (more than 41 days before the expected date), iWYZE pays a R15,000 lump sum to help cover the extra neonatal care costs.
5. Dental & Reconstruction
Kids have accidents. Whether it’s a chipped tooth on the soccer field or reconstructive dental surgery after trauma, iWYZE covers up to R40,000 per year for dental reconstruction. Wisdom teeth removals are also included under defined dental benefits.
6. Medical Aid Contribution Waiver
If the main member passes away or becomes permanently disabled, iWYZE pays your family’s medical aid contributions for up to 6 months (maximum R30,000). That means you won’t have to choose between healthcare and household bills.
7. Step-Down Facility Support
R5,000 once-off if the policyholder spends 10+ consecutive days in a sub-acute recovery facility
What’s Not Covered? Gap Cover is powerful but not unlimited.
Exclusions include:
- Prescribed Minimum Benefits (already covered by medical aids)
- Cosmetic & obesity-related surgeries
- Infertility treatments
- Outpatient dentistry (except accident-related)
- Claims your medical aid rejects
Tip: Always make sure your procedures are authorised by your medical aid first, as Gap Cover only pays once your scheme has contributed.
Waiting Periods to Know
To keep premiums affordable and fair, waiting periods apply:
- 3 months: General waiting period
- 12 months: Pre-existing conditions (like chronic illness or cancer)
- 12 months: Pregnancy-related conditions
#wyzemove: Sign up for Gap Cover now so you can get ahead of the waiting periods, meaning you’ll have full cover when you need it most.
Everyday Protection That Families Actually Use
Gap Cover isn’t only for major surgeries. Everyday family health needs are also protected:
- Hospital Shortfalls: Covers up to 500% of scheme rates for specialists, surgeons, and anaesthetists.
- Scans & Diagnostics: Pays your co-payments for costly scans (MRI, CT, PET).
- Oncology Protection: Includes shortfalls, co-payments, and sub-limits for cancer treatment because unfortunately, cancer can affect even young families.
- Emergency Casualty Cover: Pays up to R15,900 per year for emergency ward visits after accidents, provided you use a registered hospital casualty unit.
Real-Life Examples: Why You Need Gap Cover
Lebo, a 35-year-old teacher in Johannesburg, recently had spinal surgery. The bill came to R120,000. Her medical aid covered R60,000, leaving a R60,000 shortfall. Luckily, she had iWYZE Gap Cover. Instead of going into debt, her shortfall was fully covered giving her peace of mind during recovery.
The Naidoo family from Durban welcomed twins in 2025. Their medical aid covered part of the delivery and neonatal care, but the specialists billed nearly R40,000 above tariff rates. Without Gap Cover, those bills would have drained their emergency savings. Thanks to iWYZE, the entire shortfall was covered, and the family could focus on bringing their babies home not on hospital invoices.
Why Families Choose iWYZE Gap Cover
- Affordable monthly premiums designed for South African households
- Cover per insured person per year
- Family-first benefits like childbirth, premature birth, and contribution waiver
- Easy digital claims process with payouts in under 2 weeks • Trusted by South Africans: administered by Kaelo Risk, underwritten by GENRIC Insurance
Don’t let unexpected medical bills derail your yearly goals. Protect yourself and your family with iWYZE Gap Cover.
FAQs About iWYZE Gap Cover
Question: Does Gap Cover pay my entire hospital bill?
Answer: No. Your medical aid pays first. Gap Cover only pays the shortfall between what the medical aid covers and what providers charge.
Question: Who can I cover under one policy?
Answer: You can cover yourself, your spouse, and up to 7 dependants provided they are on the same medical aid
Question: How fast are claims paid?
Answer: Once you submit the required documents, claims are typically processed within 7–14 working days
Question: Can I use Gap Cover if I’m on a hospital plan?
Answer: Absolutely. In fact, hospital plan members often benefit the most, since these plans have stricter tariff limits.