GAP COVER

Medical Expense Shortfall Cover

Protect yourself and your family against unexpected medical expense shortfalls when doctors and specialists charge more than what your medical aid pays.

Call Me Back
Apply Now
Added Cancer Cover
ZESTLIFE UNIVERSAL GAP COVER
COVER FOR INDIVIDUALS
Younger than 55 years old R447 pm
55-64 Years old R566 pm
65 Years and older R650 pm
COVER FOR FAMILIES
Where all lives insured are younger than 65 R566 pm
Where one or more lives insured are older than 65 R650 pm
ZESTLIFE ESSENTIAL GAP COVER
COVER FOR INDIVIDUALS
Younger than 55 years old R333 pm
55-64 Years old R418 pm
65 Years and older R477 pm
COVER FOR FAMILIES
Where all lives insured are younger than 65 R418 pm
Where one or more lives insured are older than 65 R477 pm

* Prices valid for 2022. Premiums to increase 1 Jan 2023.

What is Gap Cover?

All medical aid members face the problem that surgeons, anaesthetists and other specialists frequently charge more than the amount covered by their medical aid. When this occurs, you as the medical aid member becomes liable to pay for the shortfall.

The solution is for medical aid members to insure themselves against medical expense shortfalls through either of Zestlife’s top-of-the-range Gap Cover options.

Zestlife Universal Gap Cover offers the most comprehensive medical expense shortfall cover along with extensive financial protection against a wide range of health risks.

Zestlife Essential Gap Cover offers affordable cover for the most frequent medical expense shortfalls, along with additional financial protection for selected health risks.

Both of these options are available to main members and dependants of all South African registered medical aids. There is no maximum entry age and cover continues without a maximum expiry age.

Please note that Gap Cover is not a medical aid or a substitute for medical aid cover. Gap Cover is top-up health insurance that provides cover for medical expense shortfalls that arise when medical aids only cover treatment and/or procedure costs in part.

Zestlife Gap Cover Benefits

With Zestlife Gap Cover, you and your family have peace of mind knowing that medical expense shortfalls are covered.

The table below provides an overview of the medical expense shortfall cover and health insurance benefits available on both options.

MEDICAL EXPENSE SHORTFALL COVER

Zestlife Gap Cover options include:

  • In-hospital cover for doctor and specialist charges up to 3 times (Essential Gap Cover) or 5 times (Universal Gap Cover) the amount paid by the medical aid.
  • Out-of-hospital cover for doctor and specialist charges up to 3 times (Essential Gap Cover) or 5 times (Universal Gap Cover) the medical aid tariff (for approximately 50 out-of-hospital treatments).
  • Medical aid co-payment cover for hospital admissions, scans and certain surgical procedures.
  • Emergency Room Cover for accidental injury.
  • Robotic Medical Procedure Cover.
  • In addition, Universal Gap Cover also includes Non-network Co-payment Cover, Additional Cancer Cover, Internal Prosthesis and Artificial Joint Cover as well as In-hospital Dentistry Cover.
  • South African Health Insurance Regulations limit the total Medical Expense Shortfall benefit to R182 700 per person in a calendar year.

HEALTH INSURANCE BENEFITS

Zestlife Gap Cover offers::

  • Accidental Death and Permanent Disability Cover.
  • Trauma Counselling Cover
  • Accidental Dentistry Cover
  • Enhanced Cancer Cover (Universal Gap Cover only)
  • Medical Aid and Gap Policy Premium Waiver Cover

To assist you in choosing the Gap Cover option that best suits your needs please study the Zestlife Gap Cover Brochure for a full explanation of all the policy benefits and the policy terms and conditions.

Advantages of Zestlife Gap Cover

  • No blanket waiting period at the commencement of cover.
  • High levels of cover for in-hospital and over 50 out-of-hospital procedures.
  • Co-payment cover for co-payments charged by medical aids for hospital submissions and scans.
  • Cover while traveling outside of South Africa.
  • Automatic adult dependent cover.
  • High levels of emergency room cover for accidental injury.
  • Low exclusions.
  • Fast and efficient claim settlement.

Documents You Might Need

Get Gap Cover Now

OPTIONAL EXTRA COVER

You can enhance your Zestlife Gap Cover policy by adding our Extended Cancer Cover. If you or any of your dependents insured under the policy are diagnosed with cancer for the first time, we will pay you the Extended Cancer Cover benefit of R100 000 or R200 000 to cover the unexpected costs which may arise as a result of the diagnosis.

Please refer to our brochure for full details.

YOU MAY ALSO BE INTERESTED IN:

Medical Premium Waiver – Ensuring you and your family uninterrupted and ongoing medical scheme cover in the event of death or disability.