Universal Medical Gap Cover from Zestlife
December 15, 2021
What is Universal Gap Cover at Zestlife?
- This is Zestlife’s premier gap cover product.
- It covers you for up to 500% of the medical scheme tariff amount.
- Your medical aid pays out according to its predetermined medical scheme tariffs.
- Doctors and specialists often charge a lot more than these rates.
- The gap cover is mostly for in-hospital expenses but some out-patient expenses are also covered.
When you join a medical aid, you might think that your medical aid will pay out 100% of your costs for your hospital stay. You could find yourself in for a nasty surprise, though. Medical aids have their own predetermined rates that they pay for procedures.
Doctors, surgeons and specialists are not under any obligation to charge these same rates, however. And, in many cases, their charges far exceed these rates.
Let’s take a simple example, let’s say you needed to go in for an appendectomy. It’s a simple surgery and should be routine. Now, let’s say that the bill for the surgeon and the anaesthetist together come to R21 000.
Not a problem, right? After all, your medical aid has you covered. Wrong, because, according to the standard medical tariffs as laid out by your medical aid, they are only liable for R10 000 of the total bill. That means that the remaining R11 000 is for your account. Your portion is actually higher than the medical aids.
And, yes, it is perfectly legal.
What Can You Do?
You can always hope that you never need to go into hospital. Let’s be realistic here, though, you have very little control over that, don’t you?
What you can do instead is to protect yourself by taking out gap cover. With Zestlife, you have two options when it comes to gap cover – Essential and Universal.
Common Elements of Universal and Essential Gap Cover
- Available to anyone who is a member of a registered medical aid.
- Cover applies to main member and any family members listed as dependents on the main member’s medical aid.
- Single members who join when under the age of 55 will qualify for a monthly premium discount.
- Should the main member or any dependents being covered be over the age of 65, the monthly premium will increase.
- There is no maximum age for entry.
2019 Zestlife Universal Gap Cover Information
- Overall regulatory maximum for medical expense shortfall cover increased from R150 000 to R160 000.
- Cancer lump sum increased from R25 000 to R30 000.
- Casualty benefit increased from R10 000 to R20 000. Casualty visit must be within 48 hours of the accident.
- Medical Aid and Gap Cover Premium Waiver maximum increased from R6 500 toR7 300.
- Medical Aid and Gap Cover Premium Waiver limited to accidental only, but the payment period increased from 3 to 12 months. This change was due to legal requirements.
- Accidental dentistry maximum increased from R15 750 to R19 250 and amount per tooth increased from R2 250 to R2 750.
- Non-Designated Service Provider co-payment increased from R8 600 to R9 300.
- Oncology co-payment maximum increased from 20% to 25%.
- Cover for robotic procedures up to R30 000.
- Cover for procedures in day clinics.
- New Oncology Benefit to cover 20% of treatment cost when oncology limit is exceeded.
- Varicose veins have been added as an out-of-hospital procedure that is covered.
2022 Zestlife Premiums
You will also receive enhanced cancer coverage.
Next step: complete and submit the form on this page to sign up for a Zestlife gap cover plan
All info was correct at time of publishing