Zestlife Shortfall Cover Information
The biggest financial headache for members of Medical Aid Schemes is the shortfall – known as the gap – between limitations on their cover and costs that doctors charge. So Zestlife Shortfall Cover will help you out with that.
Financial ceilings of medical schemes are limited to Medical Scheme Tariffs (MST), but doctors do not have to abide by those restrictions.
The member of the plan has to pay for the medical shortfall. So often the unsuspecting member will face costly additional expenses as the gap between MST and the final bills from doctors can be substantial.
Zestlife has a solution.
It offers two industry-setting policies – the premium Universal Gap Policy or, for the most modest budget and the Essential Cover Policy. Its range of cover is more limited.
Who is covered with Zestlife shortfall cover
- Both the Universal Gap and the Essential policies are available to members of all medical aid schemes.
- Standard cover applies to the primary medical plan member and all listed family members.
- Single medical plan members under the age of 55 qualify for lower monthly premiums
In-Hospital Cover with Zestlife shortfall cover
The Universal policy offers cover of up to five times the Medical Scheme Tariff (MST) for charges imposed by doctors and specialists. Essential gap covers triple the physician and specialist costs.
Out-Patient Cover with Zestlife medical shortfall cover
Both plans cover approximately 50 listed out-patient procedures, but whereas Universal will pay up to five times the MST for doctor and specialist charges, Essential gap covers three times the amount equal to that paid by the medical scheme.
Both policies include CT, PET and MRI scans and are not subject to total annual claim limits.
Internal Prosthesis and Artificial Joint Cover
Universal offers an annual cover of up to R30 000 per policy for shortfalls on the cost of internal prosthesis such as artificial limbs. The policies do not cover intraocular lenses.
Universal has a range of further benefits, not offered by Essential gap. These include a cover on:
- Non-DSP hospital co-payments
- Enhanced cancer cover including lump sum payout, co-payments and cosmetic breast reconstruction.
- Accidental dentistry
- Medical Scheme and Medical Gap Policy. In the event of the policy holder’s death or permanent disability, this benefit pays a maximum of R6 500 a month for three consecutive months to cover the payment of both the medical scheme and Gap cover amounts. So this cover is only valid up to the age of 65.
Here are cost comparisons for the two schemes.
Universal versus Essential
- Monthly cover for the primary medical plan member and all listed family dependents if all lives are under 65 years old: R409 vs. R307
- Single/Individual insurance holder, 55 years and younger: R324 vs. R245
- Single/Individual insurance holder, between 55 years and 64 years: R409 vs. R307
- Single/Individual insurance holder, 65 years and older: R466 vs. R351
OPTIONAL EXTRA COVER
Another significant innovation is Zestlife’s option to boost funding for cancer and dentistry cover.
So these two critical areas of medical care often find members of medical schemes at risk to meet unexpected shortfalls between MST and amounts charged by practitioners.
To get a FREE gap cover quote, fill in the form on this page with your details