| ZESTLIFE OPTIMAL GAP COVER | |
|---|---|
| COVER FOR INDIVIDUALS | |
| Younger than 35 years old | R253 pm |
| ZESTLIFE ESSENTIAL GAP COVER | |
|---|---|
| COVER FOR INDIVIDUALS | |
| Younger than 55 years old | R397 pm |
| 55-64 Years old | R499 pm |
| 65 Years and older | R592 pm |
| COVER FOR FAMILIES | |
| Where all lives insured are younger than 65 | R499 pm |
| Where one or more lives insured are older than 65 | R592 pm |
| ZESTLIFE UNIVERSAL GAP COVER | |
|---|---|
| COVER FOR INDIVIDUALS | |
| Younger than 55 years old | R537 pm |
| 55-64 Years old | R700 pm |
| 65 Years and older | R838 pm |
| COVER FOR FAMILIES | |
| Where all lives insured are younger than 65 | R700 pm |
| Where one or more lives insured are older than 65 | R838 pm |
* Premiums for 2025. Premiums will be revised annually and be effective from 1 January each year.
What is Zestlife Gap Cover?
Gap Cover pays the medical expense shortfalls that arise when medical aids don’t cover what doctors and specialists charge for in-hospital, and certain out-of-hospital treatments. The difference between what your medical aid cover and what private practitioners charge frequently amounts to shortfalls of tens of thousands of Rands, for which you become liable.
Zestlife offers you 3 options
Choose the gap insurance option that best suits your needs and budget. Our Universal option offers the most comprehensive cover while the Essential option will protect you from the most frequent shortfalls. Both these options can be selected as individual or family cover. Our Optimal option is tailor-made for single individuals under 35.
Available to all members of South African registered medical aids. There is no maximum entry age and cover continues without a maximum expiry age.
Please note: Gap Cover is not a medical aid or a substitute for medical aid membership and the cover is not the same as a medical aid.
Advantages of Zestlife Gap Cover
- No maximum entry or expiry age.
- Automatic adult dependent cover.
- No general waiting period at the start date of cover.
- High levels of cover for in-hospital and over 50 out-of-hospital procedures.
- Co-payment cover for hospital admissions and scans.
- High levels of oncology cover.
- Cover for pre- and post-surgery specialist consultations.
- Cover while travelling outside of South Africa.
- Low exclusions.
- Fast and efficient claim settlement.
Documents You Might Need
2025 Policy Benefits
The table below provides an overview of the medical expense shortfall cover and health insurance benefits available on each of the policy options. View the brochure to assist you in choosing the option that best suits your needs and for a full explanation of all the policy benefits and the policy terms and conditions.
| MEDICAL EXPENSE SHORTFALL COVER | |||
| MEDICAL EXPENSE SHORTFALLS COVERED Max cover limit of R212 500 per individual insured for 2024. |
Universal | Essential | Optimal |
| In-hospital Cover Out-of-hospital Cover (+50 procedures) |
Up to 500% (5 times) of the medical aid tariff. | Up to 300% (3 times) of the medical aid tariff. | Up to 400% (4 times) of the medical aid tariff. |
| Pre- and Post-surgery Specialist Consultations | |||
| General Co-payments | |||
| Non-network Co-payments | |||
| MRI, PET and CT Scans in Excess of Medical Aid Sub-limit | |||
| Casualty Facility Treatment for Injury in an Accident | |||
| Casualty Facility Emergency Treatment | |||
| Internal Prosthesis and Artificial Joints | |||
| Robotic Medical Procedures | |||
| Oncology Treatment Programme Co-payments | |||
| Oncology Treatment in Excess of Medical Aid Cancer Limit | |||
| Cosmetic Breast Reconstruction | |||
| HEALTH INSURANCE COVER | |||
| HEALTH INSURANCE BENEFIT | Universal | Essential | Optimal |
| Enhanced Cancer Cover | |||
| Accidental Dentistry Cover | |||
| Accidental Death and Permanent Disability Cover | |||
| Trauma Counselling Cover | |||
| Medical Aid and Gap Cover - Premium Waiver Cover | |||
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 R120 000 or R240 000 to cover the unexpected costs which may arise as a result of the diagnosis.
Please refer to our brochure for full details.
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