Zestlife - Essential Gap Cover

Zestlife - Essential Gap Cover

Zestlife's Essential Gap Cover is ideal if you're looking for affordable gap cover.

It provides in-hospital medical expense shortfall cover; copayment cover; gap cover for specific out-of-hospital procedures; emergency room/casualty ward cover; and a range of health insurance benefits.

Gap Cover Benefits

Co-payment benefit

All co-payments subject to R165 000 per insured person per annum.

Dental benefit

R19 250 Accidental tooth fracture cover is provided per person per year. Limited to R2 750 per tooth, irrespective of cover provided by your medical scheme.

Diagnosis benefit

No Benefit

Emergency/casualty benefit

Limited to R20 000 per policy per year and subject to R165 000 per insured person per annum. The visit must have taken place within 48 hours of incident.

Full time students over 21

Covered, as long as they are dependants on your medical scheme.

Gap cover limits

R165 000 overall limit per insured person per year.

Gap cover percentage benefit

Shortfall calculated as amount charged by provider (limited to 300% of med aid tariff) less the higher of the medical aid tariff or the amount paid/payable by the medical aid. This includes cover for doctor's, specialists as well as PMB conditions. Cover of up to R30 000 per policy per calendar year for medical expense shortfalls that arise directly from the use of robotic machinery in the course of in-hospital operative treatment.

Lives Covered

Main member & Spouse, even if they are not on the same medical scheme; All dependants registered on Main member's or Spouse's medical scheme; Individuals of all ages.

Maximum entry age

There is no maximum entry age applicable.

Oncology benefit

No Benefit

Oncology supplementary benefit

No Benefit

PMB cover

Prescribed Minimum Benefits are covered.

Sub-limit benefit

No Benefit

Trauma counselling

Covers consultation fees up to R25 000 per policy per year with a sub-limit of R750 per counselling session and subject to R165 000 per insured person per annum.

Gap Cover Contributions

Contributions

R296 for individuals (55<)


R372 for individuals (55 - 64)


R424 for individuals (65+)


 R372 for families (65<)


 R424 for families (65+)

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