One Gap Cover Policy per Family from Zestlife

    Medical specialist rates are commonly much higher than Medical Aid rates. This also results in an amount (often large) left for the medical aid member to fund out of their own pockets. Fortunately one gap cover policy per family from Zestlife covers the self-payment gap.

    Medical aid members often do not understand that the Medical Aids may say they cover 100% of the costs involved but that, in fact, refers to, the 100% of the Medical Scheme Tariff (MST) rates which are much lower than doctors and specialist charges. Zestlife with their experience in the Medical Industry also has become experts in creating “Gap” insurance policies. So read more to find out more about Zestlife’s one gap cover policy per family.

    Growth in Gap funds required – One Gap Cover Policy per Family

    one gap cover policy per familyStatistics show that there is also an alarming growing gap, year on year, between what the medical aid pays and what the doctors/specialists charge.

    2006 – Average gap payment was approx R 100 per consultation.

    2016 – Average gap payment is approx +R400.00 per consultation.

    2020- Expected to rise to +700 per consultation.

    We cover all medical schemes at Zestlife – One Gap Cover Policy per Family

    Zestlife have created three different Gap insurance options: Universal/Standard and Core. Premiums are per month, per family, with no restrictions on the number of children.

    CORE OPTION:  – R 219.00

    Covers:

    1. In Hospital Payments – Covers up to 500% MST rate – no minimum
    2. Out Patient Payments -Covers up to 500% MST rates -no minimum –most procedures.
    3. Co-Payments – Upfront payments are required for hospital admissions and certain surgical procedures.
    4. Non-DSP (Designated Service Provider) hospital co-payment of a Max R 8000.00 per policy per year -once only may be paid.

     

    Standard Option – R262.00

    Covers:

    1. In Hospital Payments.
    2. Out Patient Payments. 
    3. Co-Payments.
    4. Non DSP (Designated Service Provider )
    5. Cancer Cover – Lump sum upfront amount of R25 000. Co-payments that need to be made to Medical Aid after normal funds. Per individual up to R25 000 per year/Breast reconstruction surgical costs up to R 20 000 one claim per year.
    6. Internal Prosthesis – Cover up to R30 0000 on shortfalls per year on the internal prosthesis.

    Universal Option – R 281.00

    Covers:

    • In Hospital Payments.
    • Out Patient Payments 
    • Co-Payments
    • Non-DSP(Designated Service Provider)
    • Cancer Cover
    • Internal Prosthesis
    • Casualty Ward – covers expenses when being attended in a Casualty Room. Up to R5000 per policy per year.
    • Accidental Dentistry – R14 000 per person per year or flat rate R2000 per tooth.
    • Accidental Death and Disability – Lump sum R25 000 /Emergency transportation Max R 25 000 /Life support Equipment R 25000 to cost of hire./Trauma counselling R 750 per visit maximum R 25 000.All these resulting ONLY from the accident.
    • Medical premium Waiver-Paid if death or permanent disability of policyholder. We will pay up to R5 600 for three months for either Gap cover or Medical insurance.

    More options – One Gap Cover Policy per Family

    There are also options available covering extended Cancer and Dentistry gap cover. Contact Zestlife for further details. There are also some general exclusions to persons i.e. suicide/speed racing/nuclear explosions etc. Please contact Zestlife for an up to date list. ZESTLIFE contact: 021 180 4220.

    Fill in and submit the form on this page to get your one free gap cover quote