Zestlife Gap Cover Information
One of the biggest headaches for health aid members is the shortfall, also known as the gap, which is the difference between what doctors charge and what schemes pay out. Hence, Zestlife shortfall insurance takes steps to cater for the extra costs that arise.
The upper limits set by medical aids are only limited to Medical Scheme Tariffs, but doctors do not follow such rules.
At any rate, members of health schemes pay the difference. In other words, members face extra costs stemming from the gap between MST and bills from doctors.
Zestlife Shortfall Insurance has a Solution to the Problem
It offers clients two policies; the universal premium Gap, and the Essential gap cover.
Who is covered by Medical Shortfall insurance?
- Both gap cover policies are open to all health scheme holders
- The standard plan applies to the main health cover members, listed as family members.
- Individual health policies applies to persons under the age of 55 for both premiums
- There is no maximum entry age when applying for Zestlife Gap Cover..
In-Hospital Cover with Zestlife shortfall cover
The universal plan provides cover up to 500% of the MST for expert charges.
Out-Patient Cover with Zestlife Shortfall Cover
The two plans cover about 50 listed out-patient treatment procedures. But, while the universal package pays up to five times the MST for doctors costs, the Essential gap covers triple to what is paid by your medical scheme.
Further, both policies cover, CT, MRI, and PET scans and are not subject to any yearly limit.
Zestlife Universal Gap Cover Enhanced Benefits for 2019:
- Overall regulatory maximum for medical expense shortfall cover increased from R150 000 to R160 000.
- Cancer lump sum increased from R25 000 to R30 000.
- Casualty benefit increased from R10 000 to R20 000. Casualty visit must be within 48 hours of the accident.
- Medical Aid and Gap Cover Premium Waiver maximum increased from R6 500 toR7 300.
- Medical Aid and Gap Cover Premium Waiver limited to accidental only, but the payment period increased from 3 to 12 months. This change was due to legal requirements.
- Accidental dentistry maximum increased from R15 750 to R19 250 and amount per tooth increased from R2 250 to R2 750.
- Non-Designated Service Provider co-payment increased from R8 600 to R9 300.
- Oncology co-payment maximum increased from 20% to 25%.
- Cover for robotic procedures up to R30 000.
- Cover for procedures in day clinics.
- New Oncology Benefit to cover 20% of treatment cost when oncology limit is exceeded.
- Varicose veins have been added as an out-of-hospital procedure that is covered.
Zestlife Premiums for 2021:
Optional Extra Cover
Indeed, one more great thing about Zestlife shortfall insurance is the option to boost your cover to cater for cancer and dentistry.
Thus, these two crucial areas of health care often find members in danger of sudden gaps between the MST and expert fees.
Simply complete and submit the form and we will send you a FREE Quote!
All info was correct at time of publishing