Zestlife gap cover

Covers up to 400% of the medical scheme rate. The policy is written as a 400% total ceiling, inclusive of what your scheme pays.

Overall limit R219 800 a year.

What it covers

• Shortfall on the specialist bill in hospital
  In-hospital gap — Up to 400% (4 times) of the medical scheme tariff.
• Shortfall on the specialist bill in hospital
  Out-of-hospital — Up to 400% (4 times) of the medical scheme tariff.
• Co-payments and deductibles the scheme imposes
• Above the scheme’s MRI/CT sub-limit (per policy)
• Casualty unit after an accident (per policy)
• Internal prosthesis — above the scheme sub-limit (per policy)
• Co-payment on robotic surgery (per policy)
• Extras the provider adds at no charge
• Dental work after an accident
• Cash lump sum on accidental death or permanent disability
  Accidental Death and PTD Cover — R55,000.
• Cash lump sum on accidental death or permanent disability
  Violent Crimes Assist Benefit — once-off R55,000 for death/PTD from violent crime (additi…
• Trauma counselling
• Your scheme contributions paid if you die or are disabled
• Your gap premium paid if you die or are disabled

What it does not cover

• Specialist consultations out of hospital
• Physiotherapists, dietitians and other allied professionals
• Casualty unit for sudden illness
• Shortfall on cancer treatment
• Cancer treatment above the scheme’s oncology limit
• Cash lump sum on a first cancer diagnosis
• Breast reconstruction after a mastectomy
• Above a scheme sub-limit generally
• Co-payment on an MRI or CT scan
• Co-payment on a scope
• Screening scopes
• Procedures done out of hospital
• Prescribed Minimum Benefit shortfalls
• Physical rehabilitation
• Preventative screening
• External appliances
• Recovery after trauma
• Preventative mastectomy
• Co-payment on the scheme’s defined procedure list
• Dental work in hospital
• Dental implants
• Basic dentistry for children
• Shortfall on the hospital account itself
• A private ward
• MedBoost
• A daily cash amount while in hospital

Using a hospital off your network

Covered up to R16 800 per policy, 2 claim per calendar_year.

“Non-network Co-payments — up to R16,800, two claims per policy per calendar year.”

What it costs

Covers up to 300% of the medical scheme rate. The policy is written as a 300% total ceiling, inclusive of what your scheme pays.

Overall limit R219 800 a year.

What it covers

• Shortfall on the specialist bill in hospital
  In-hospital gap — Up to 300% (3 times) of the medical scheme tariff.
• Shortfall on the specialist bill in hospital
  Out-of-hospital — Up to 300% (3 times) of the medical scheme tariff.
• Co-payments and deductibles the scheme imposes
• Casualty unit after an accident (per policy)
• Casualty unit for sudden illness (per policy)
• Co-payment on robotic surgery (per policy)
• Extras the provider adds at no charge
• Cash lump sum on a first cancer diagnosis
• Dental work after an accident
• Cash lump sum on accidental death or permanent disability
  Accidental Death and PTD Cover — R55,000.
• Cash lump sum on accidental death or permanent disability
  Violent Crimes Assist Benefit — once-off R55,000 for death/PTD from violent crime (additi…
• Breast reconstruction after a mastectomy
• Trauma counselling
• Your scheme contributions paid if you die or are disabled
• Your gap premium paid if you die or are disabled

What it does not cover

• The penalty for using a hospital off your network
• Specialist consultations out of hospital
• Physiotherapists, dietitians and other allied professionals
• Above the scheme’s MRI/CT sub-limit
• Internal prosthesis — above the scheme sub-limit
• Shortfall on cancer treatment
• Cancer treatment above the scheme’s oncology limit
• Above a scheme sub-limit generally
• Co-payment on an MRI or CT scan
• Co-payment on a scope
• Screening scopes
• Procedures done out of hospital
• Prescribed Minimum Benefit shortfalls
• Physical rehabilitation
• Preventative screening
• External appliances
• Recovery after trauma
• Preventative mastectomy
• Co-payment on the scheme’s defined procedure list
• Dental work in hospital
• Dental implants
• Basic dentistry for children
• Shortfall on the hospital account itself
• A private ward
• MedBoost
• A daily cash amount while in hospital

What it costs

Covers up to 500% of the medical scheme rate. The policy is written as a 500% total ceiling, inclusive of what your scheme pays.

Overall limit R219 800 a year.

What it covers

• Shortfall on the specialist bill in hospital
  In-hospital gap — Up to 500% (5 times) of the medical scheme tariff.
• Specialist consultations out of hospital
• Shortfall on the specialist bill in hospital
  Out-of-hospital — Up to 500% (5 times) of the medical scheme tariff, for over 60 out-pati…
• Physiotherapists, dietitians and other allied professionals (per policy)
• Co-payments and deductibles the scheme imposes
• Above the scheme’s MRI/CT sub-limit (per policy)
• Casualty unit after an accident (per policy)
• Casualty unit for sudden illness (per policy)
• Internal prosthesis — above the scheme sub-limit (per policy)
  Sub-limit: stents R5 000, pacemakers R8 000, intraocular lenses per lens R6 500
• Co-payment on robotic surgery (per policy)
• Shortfall on cancer treatment
• Cancer treatment above the scheme’s oncology limit
• Extras the provider adds at no charge
• Cash lump sum on a first cancer diagnosis
• Dental work after an accident
• Cash lump sum on accidental death or permanent disability
  Accidental Death and Permanent and Total Disability Cover — R55,000.
• Cash lump sum on accidental death or permanent disability
  Violent Crimes Assist Benefit — a once-off R55,000 for death or PTD from violent crime, I…
• Breast reconstruction after a mastectomy
• Trauma counselling
• Your scheme contributions paid if you die or are disabled
• Your gap premium paid if you die or are disabled

What it does not cover

• Network penalty buyback note penalty rule breach
• Above a scheme sub-limit generally
• Co-payment on an MRI or CT scan
• Co-payment on a scope
• Screening scopes
• Procedures done out of hospital
• Prescribed Minimum Benefit shortfalls
• Physical rehabilitation
• Preventative screening
• External appliances
• Recovery after trauma
• Preventative mastectomy
• Newer cancer drugs the scheme does not fund
• Co-payment on the scheme’s defined procedure list
• Dental work in hospital
• Dental implants
• Basic dentistry for children
• Shortfall on the hospital account itself
• A private ward
• MedBoost
• A daily cash amount while in hospital

Using a hospital off your network

Covered up to R16 800 per policy, 2 claim per calendar_year.

“Non-network Co-payments — up to R16,800, subject to two claims per policy per calendar year.”

What it costs