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 R192 000 per insured person per annum. |
|---|---|
| Dental benefit |
No Benefit |
| Diagnosis benefit |
No Benefit |
| Emergency/casualty benefit |
Injury treatment due to an accident limited to R22 100 per policy per year and subject to R192 000 per insured person per annum. Emergency treatment of up to R2 500 per policy per year for children younger than 11. Please refer to product brochure / policy schedule for terms & conditions. |
| Full time students over 21 |
Covered, as long as they are dependants on your medical scheme. |
| Gap cover limits |
R192 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 R33 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 R26 500 per policy per year with a sub-limit of R800 per counselling session and subject to R192 000 per insured person per annum. |
Gap Cover Contributions
| Contributions |
R351 for individuals (35<) R351 for individuals (55<) R439 for individuals (55 - 64) R520 for individuals (65+) R439 for families (65+) |
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