26 January 2023

Following on from our previous article “Best Medical Aids & Gap Cover For Young Working Professionals and Students in 2023” we provide more detail on what happens when your medical aid does not cover specialist treatment costs in full and whether you really need gap cover.

Medical aid radiology x-rayHaving medical aid ensures that you are covered for any accidental injuries such as a car crash or serious illnesses which require hospitalisation. However, all medical aids have a set amount, also called a tariff, which they will pay for specific medical procedures. When a medical aid states that it pays 100% or 200% this indicates that they pay that percentage of their pre-set tariff. Unfortunately specialists may charge more than this tariff which results in out-of-pocket expenses to be paid by the patient.

This is where gap cover steps up and protects you against these unexpected expenses. Gap cover will cover the shortfalls that arise when your medical aid doesn’t cover what doctors and specialists charge for in-hospital and certain out-of-hospital treatments.

Some might ask if gap cover is necessary if 1) I am young, 2) I am healthy and 3) I already have medical aid?

The answer is yes.

In truth, accidents and illnesses can happen at any time. Even though young individuals may be less at risk of falling ill there is still risk present. The medical bills in South African private institutions can quickly rack up if you do fall ill or are involved in some kind of accident. In our opinion: You can’t afford not to have gap cover.

Optimal Gap Cover is designed especially for individuals under 35 to offer high levels of cover at an affordable premium.

Optimal Gap covers up to 400% of the medical aid tariff for in-hospital procedures, co-payments, +-50 out-of-hospital procedures and Prescribed Minimum Benefit (PMB) shortfalls.

This product is priced at R225 per month making it one of the most competitive products with excellent benefits.

See below examples of medical shortfalls paid by Zestlife in 2022 for singles under the age of 35:

Procedure Shortfall Paid
Tumor removal surgery R56 071
Bacterial disease treatment R56 023
Bone cancer treatment R49 726
Spinal cord surgery R49 404
Fracture surgery R43 812
Sinusitis surgery R39 846
Bladder surgery R36 101
Fallopian tube surgery R31 367

Don’t Delay, Click Here and Get Optimal Gap Today!

The information contained in this communication, including attachments, is not to be construed as advice in terms of the Financial Advisory and Intermediary Services Act of 2002 (“FAIS”) as the writer is neither an appointed representative of Zestlife, nor a licensed financial services provider as contemplated in FAIS. Please consult your Financial Adviser or Zestlife should you require advice of a financial nature and/or intermediary services.