Zestlife Gap Cover is for ALL Medical Scheme Members in SA
December 4, 2018
Members of medical aids must not be fooled into believing that their schemes will pay the full cost of hospitalisation. Sadly this is seldom true. So medical schemes only pay stipulated Medical Scheme Tariffs (MST). Read on further for more on Zestlife gap cover.
So these limits seldom adhere by the medical profession.
They are not obliged to only charge MST and often impose fees of up to five times more than what medical aids will pay.
This also leaves medical aid members with huge financial shortfalls.
That is where Zestlife can give its policyholders peace of mind.
Zestlife’s Gap Cover will ensure policyholders against shortfalls – so the gap created by the MST and final charges imposed by the medical profession.
Also, as explained, fees payable to surgeons, anaesthetists and other medical practitioners can be substantial.
So Gap Cover avoids that financial nightmare.
Also, Zestlife’s solution is its top of the range Universal Policy.
Universal Gap Cover – Zestlife Gap Cover
Zestlife also meets the needs of clients with tighter budgets with its Essential Gap Cover Policy which offers a more limited range of cover.
Who Qualifies for Universal Gap Cover?
- Members of all medical schemes in South Africa qualify for gap cover
- Single medical scheme members under the age of 55 qualify for lower monthly premiums
- Also, gap cover continues without a maximum expiry age
Up to five times the medical scheme tariff for charges imposed by the medical profession
Claim limit per person per year apply for the medical expense shortfall cover section of the policy
Up to five times the medical scheme tariff for charges imposed by the medical profession for about 50 listed out-patient treatments, including CT, PET and MRI scans
Claim limit of R160 000 per person per year for the medical expense shortfall cover section of the policy
Internal Prosthesis and Artificial Limb Cover
Annual cover for internal prostheses such as artificial joints once medical scheme limits have been exhausted
Full cover for medical scheme co-payments.
Claim limit per person per year for the medical expense shortfall cover section of the policy
Co-Payments for Non-DSP Hospitals
Limited cover as stipulated by medical schemes for members using non-DSP hospitals or service providers to a maximum limit
Maximum cover per policy annually applies.
Enhanced Cancer Cover – Lump Sum Pay-Outs
This benefit pays policyholders if diagnosed as a first-time stage 2 cancer sufferer
It excludes skin cancer
So the benefit applies the cancer diagnosis after the 12 month waiting period from the date on which the policy commences
Essential Cover – Zestlife Gap Cover
Members of all medical schemes
Single medical scheme members under the age of 55 qualify for lower monthly premiums
Cover for charges imposed by members of the medical profession up to thrice the amount paid by the medical scheme
Cover for doctor and specialist charges for about 50 listed out-patient treatments, including CT, PET and MRI scans
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All info was correct at time of publishing