Zestlife Essential Gap Cover

December 1, 2024

What is Zestlife Essential Gap Cover?

• This is Zestlife’s affordable gap cover product.
• It covers you for up to 300% of the medical scheme tariff amount.
• Medical aids predetermine what they will pay per procedure.
• These predetermined rates are not often in line with what medical professionals charge.
• Zestlife’s Essential Gap Cover covers you for in-patient procedures.

Medical aids have changed a lot in the last few years. At one stage, if you went into the hospital, you’d be okay because the medical aid would pay everything. Rising medical costs, etc. have changed all of that. The medical aids need to have an idea of what the costs per annum might end up being.

As a result, they work out a set of predetermined rates that they will pay out. Unfortunately, these seldom match what doctors and other medical specialists end up charging. You could end up having to fork out a lot of money yourself because of this mismatch.

What Can You Do?

So, the idea of going to hospital can end up making you feel nervous. What happens if your doctors charge 200% or 300% of what your medical aid will pay out? You could end up having to pay at least the same as, or in other cases, much more, than your medical aid does.

Gap cover is the answer. The Essential Gap Cover policy from Zestlife will allow you to have peace of mind when it comes to in-hospital medical expenses.

How Does It Work?

The gap cover will provide cover for up to three times the standard medical aid rate. So, when you get your bill, the gap cover will pay out the difference between what your medical aid paid, and what appears on the actual bill. (Up to a maximum of 300% of the standard medical aid rates.)

Who Can Apply?

• If you are a member of a registered South African medical aid, you can apply.
• There is no age limit for those applying.
• The cover will include the main member of the medical aid and also anyone listed as a dependent on that member’s medical aid.
• If you are under the age of 55 and are single, you will pay a reduced monthly premium.
• Should you, or any of the dependents covered by the policy, be older than 65, you may be subject to an extra monthly premium.

 

Who Should Apply?

If you are looking for a basic top-up plan to cover commonly required medical treatments and you want an affordable premium, this is the right option.

What are the Benefits of Zestlife Essential Gap Cover?

You have cover for an amount of up to three times the standard medical tariff. The cover is primarily for in-hospital expenses but it covers some out-patient procedures too. Scans such MRI, PET and CT scans are covered as well.

Zestlife Essential gap cover will also pay the co-payments required by your medical aid as long as the following condition is met:

These co-payments have not been levied as a penalty or as a result of using a non-network service provider unless you are part of the Universal cover plan offered by Zestlife.

What are the 2025 premiums for Essential Gap Cover from Zestlife compared to the Universal plan?

 

 

Next step: complete and submit the form on this page to start the process of signing up with Zestlife!

All info was correct at time of publishing