One of the most critical factors about medical aid insurance is the list of exclusions. Here we will have a look at Zestlife medical gap insurance.
That is why it is so important to read the fine print of medical aid contracts.
Exclusions are pretty standard to most medical aid schemes and this is also true of Zestlife Gap Cover.
What are Zestlife’s Exclusions?
- Cosmetic surgery unless required due to illness or injury.
- Penalty co-payments imposed by medical aids for not following the rules of the medical aid. Examples of these penalties are amounts due as a result of not obtaining a pre-authorisation from the medical aid for a procedure or consulting a specialist without first obtaining a referral from a general practitioner.
- Pre- and post-hospitalisation doctors and specialists charges.
- Treatment for obesity or treatment that is required as a result of obesity.
- Elective or routine procedures and physical examinations including tests, annual check-ups, ECGs, vasectomies and contraception-related treatments.
- Treatment for depression, mental or stress-related conditions.
- Claims not covered by the medical aid.
- Private and home nursing.
- Hospital charges.
- Medication and other materials.
- External prosthesis.
- Cancer treatment outside of the borders of South Africa.
- Day-to-day medical practitioner charges.
- Dental implants.
- Emergency medical transportation.
- Out-of-hospital dental procedures
- Exploratory procedures or procedures that are paid for by your medical aid on exception or ex-gratia basis.
- Diagnosis and/or treatment for sleeping disorders
- Treatment costs for services rendered by allied health care professionals such as dieticians, podiatrists, audiologists, chiropractors, acupuncturists, speech therapists, biokineticists, occupational therapists, scientists and technologists.
Zestlife will, however, cover the gap between the amount a medical aid will pay and the additional costs imposed by the medical profession provided that the claimant receives authorization from his/her m
edical aid prior to the medical procedure.
What Does Gap Insurance Cover?
- Gap insurance covers the difference between the recommended tariff stipulated by the medical scheme and the charges imposed by the medical profession.
- Specialists, anaesthetists and private hospitals do not have to adhere to the tariffs and can charge the patient up to five times more than what the medical aid scheme is prepared to pay.
- Gap cover insurance costs South African medical scheme members as little as R274 a month for everyone on the plan.
What are the costs of Zestlife Gap Insurance?
Who Qualifies? – Zestlife Gap Insurance
Applicants must be a member of a medical aid scheme like GEMS or Momentum to qualify for Zestlife Gap Cover.
Zestlife Gap Cover Leads the Field
So Zestlife prides itself as a leader in the gap cover industry, assisting wherever possible to bridge the financial difference between medical aid tariffs and final bills imposed by members of the medical profession.
To get a FREE gap cover quote, complete the form on this page and click on the “Get a Quote” button.