Zestlife Gap Cover is for ALL Medical Scheme Members in SA

    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.

    Zestlife Medical Gap CoverThat 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 Medical Match Policy which offers a more limited range of cover.

    Who Qualifies for Universal Gap Cover?

    1. Members of all medical schemes in South Africa qualify for gap cover
    2. Single medical scheme members under the age of 55 qualify for lower monthly premiums
    3. Also, gap cover continues without a maximum expiry age

    In-Hospital Cover

    Up to five times the medical scheme tariff for charges imposed by the medical profession

    Claim limit of R150 000 per person per year for the medical expense shortfall cover section of the policy

    Out-Patient Cover

    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 R150 000 per person per year for the medical expense shortfall cover section of the policy

    Internal Prosthesis and Artificial Limb Cover

    Cover of up to R30 000 annually for internal prostheses such as artificial joints once medical scheme limits have been exhausted

    Co-Payment Cover

    Full cover for medical scheme co-payments.

    Claim limit of R150 000 per person per year for the medical expense shortfall cover section of the policy

    Co-Payments for Non-DSP Hospitals

    Full cover as stipulated by medical schemes for members using non-DSP hospitals or service providers

    Maximum cover of R8 600 per policy annually

    Enhanced Cancer Cover – Lump Sum Pay-Outs

    This benefit pays policyholders R25 000 if diagnosed as a first-time 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

    Also, this amount can be increased to R75 000 or R175 000, subject to an additional premium being levied

    Essential Cover – Zestlife Gap Cover

    Who Qualifies?

    Members of all medical schemes

    Single medical scheme members under the age of 55 qualify for lower monthly premiums

    In-Hospital Cover

    Cover for charges imposed by members of the medical profession up to thrice the amount paid by the medical scheme

    Out-Patient Cover

    Cover for doctor and specialist charges for about 50 listed out-patient treatments, including CT, PET and MRI scans

     

     

    Note – Zestlife Gap Cover

    There are no policy benefits for co-payments or cancer sufferers under Zestlife’s Essential scheme.

     

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