Zestlife Shortfall Cover Information

December 15, 2021

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.

Zestlife Medical Shortfall CoverThe 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 amount per policy for shortfalls on the cost of internal prosthesis such as artificial joints. 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 Gap Policy Premium Waiver. In the event of the policyholder’s death or permanent disability, this benefit pays a certain amount a month for 12 consecutive months to cover the payment of both the medical scheme and Gap cover amounts. This cover is only valid up to the age of 65.


Here are 2024 cost comparisons for the two schemes.

Zestlife Gap Cover 2024



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

All info was correct at time of publishing