Zestlife Claim Form
Here is the link to the Zestlife claim form when you have hospital shortfalls to cover.
Some Possible Exclusions
However, any medical expense unrelated to a hospital stay. And your Zestlife gap policy will not cover any medical expense that your medical aid refuses to pay.
And remember when completing your Zestlife claim form that shortfall cover is only there to fill in the gaps. That is the gaps between what your medical scheme agrees to pay and what the actual hospital or specialist bill then is.
For example, if you have an op that costs R25 000 but your medical aid (such as Bonitas, Sizwe, Discovery, Momentum, Genesis, Selfmed, etc.) agrees to pay only R10 000 of that, then Zestlife will pay the balance (in this case R15 000).
Read the Small Print
Importantly, when you first take out gap cover, first read the small print in the policy. Because when filling in the Zestlife claim form it is too late to discover exclusions.
For instance, you will find in a typical gap cover policy the following wording:
“An Insured Person suffering an Insured Incident (as defined) which necessitates the Insured Person being confined to Hospital and then undergoing Medical or Surgical Procedures (as defined) or Treatment (as defined) whilst in Hospital.
An Insured Incident (as defined) which necessitates the Insured Person undergoing Treatment (as defined) in respect of surgical or medical procedures performed on an outpatient basis, but they are limited to the following surgical or medical procedures:
• Surgical Biopsy of Breast Lump
• Hernia Repairs, but limited to:
– Inguinal Hernia
– Femoral Hernia
– Umbilical Hernia
– Epigastric Hernia
– Spigelian Hernia
• Ischio-rectal abscess drainage
• Closure of Colostomy
• Surgical Haemorrhoidectomy (excluding sclerotherapy or band ligation)
• Lymph node biopsy
• Prostate biopsy
• Cataract removal
• Pterygium removal
• Also, tonsillectomy
• Sinus surgery, but limited to:
– Frontal sinus
– Functional endoscopic sinus surgery
– Bilateral function endoscopic sinus surgery
• Carpal Tunnel Release
• Ganglion surgery
• Needle biopsy of the liver
• Coronary angioplasty
• Coronary angiogram
• Tubal ligation
• Childbirth in a non-hospital setting
• Incision and drainage of Bartholin’s cyst
• Marsupilisation of Bartholin’s cyst
• Cervical laser ablation
• Dilatation and curettage
• MRI – Magnetic Resonance Imaging
• PET – Position Emission Tomograph
• Also, CT Scan Computer Axial Tomography
Significantly, this includes the necessity for chemotherapy or radiotherapy for the treatment of cancer on an out-patient basis. Or the need for kidney dialysis on an out-patient basis.
Importantly, any other medical treatment on an out-patient basis as may be agreed to by the Company.
And it will also tell you if you have a cancer provision or one for additional dental work. So it is up to you to check.
That Zestlife Claim Form Again
And here’s the Zestlife claim form link again. Click here.