Zestlife Optimal

Overall, Zestlife Optimal Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Zestlife Optimal Gap Cover Plans start from R239 ZAR. Zestlife has a trust score of 4.1.

Zestlife Optimal Gap Cover – 7 Key Point Quick Overview

1. ✅ Zestlife Optimal Overview
2. ✅ Zestlife Optimal Premiums
3. ✅ Zestlife Optimal Benefits and Cover Breakdown
4. ✅ Zestlife Optimal Exclusions and Waiting Periods
5. ✅ Zestlife Optimal vs Other Gap Cover Plans
6. ✅ Our Verdict on Zestlife Optimal
7. ✅ Zestlife Optimal Frequently Asked Questions

Zestlife Optimal Overview

The Zestlife Optimal is one of three plans that starts from R239 per month. The Zestlife Optimal Plan has benefits for general co-payments, casualty and emergency room treatment, robotic medical procedures, accidental death, and more.

Zestlife Gap Cover has three plans to choose from:

• • Zestlife Universal
  • Zestlife Optimal
  • Zestlife Essential

Zestlife Optimal Premiums

Zestlife Optimal Benefits and Cover Breakdown

Zestlife Optimal Gap Cover offers extensive medical expense shortfall cover and financial protection against various health risks.

Zestlife Optimal Section A – Medical Expense Shortfall Cover

• ️ In-hospital covers up to 500% of the medical aid tariff.
• ️ Out-of-Hospital covers up to 500% of the medical aid tariff.
• ️ Covers general co-payments for hospital admission and scans (CT, PET, MRI).
• ️ Covers non-network co-payments for treatment with non-DSP providers, up to R11,600 per policy per year.
• ️ Covers MRI, PET, and CT scans exceeding medical aid sub-limits, up to R3,200 per insured person annually.
• ️ Covers casualty and emergency room treatment up to R22,100 per policy annually.
• ️ Covers internal prostheses and artificial joints, up to R38,500 per policy annually.
• ️ Covers robotic medical procedures, up to R33,000 per policy annually.

Zestlife Optimal Section B – Health Insurance Benefits

• ️ Accidental dentistry covers up to R22,500 for accidental tooth fractures, paid at R3,200 per fractured tooth, regardless of medical aid contribution.
• ️ Accidental Death and Disability cover up to R50,000 for members under 65.
• ️ Trauma Counselling covers up to R800 per session, with an annual limit of R26,500 for treatment started within 6 months of the event, paid up to 6 months of treatment.

Medical Aid Gap Cover Premium Waiver covers 12 times the combined medical aid premiums, up to R110,000, for insured persons under 65.

Zestlife Optimal Exclusions and Waiting Periods

Zestlife Optimal Exclusions

Zestlife Optimal Gap Cover does not cover the following items and services:

• ✅ Cosmetic surgery, unless required due to illness or injury.
• ✅ Penalty co-payments imposed by medical aids for non-compliance with rules.
• ✅ Medication and other materials.
• ✅ External prosthetics.
• ✅ Pre- and post-hospitalization doctor and specialist charges.
• ✅ Treatment for obesity or treatments required because of obesity.
• ✅ Treatment for depression, mental, or stress-related conditions.
• ✅ Claims not covered by medical aid.
• ✅ Split billing charges.
• ✅ Private and home nursing.
• ✅ Hospital charges and day-to-day medical practitioner charges.
• ✅ Breast or dental implants.
• ✅ Emergency medical transportation.
• ✅ Out-of-hospital dental procedures.
• ✅ Diagnosis or treatment for sleeping disorders.

and more.

Benefits are not paid for claims originating from the following:

• ✅ Nuclear weapons or nuclear or ionizing radiation.
• ✅ Suicide, attempted suicide, or intentional self-injury.
• ✅ Illness or injury caused by using alcohol.
• ✅ Illegal behavior or breaking the law of the Republic of South Africa.
• ✅ Aviation accidents, except on a commercial flight as a fare-paying passenger.

and more. A full list of exclusions will be provided.

Zestlife Optimal Waiting Periods

General or condition-specific waiting periods are not typically imposed. However, the following conditions apply:

• ✅ If the policyholder had prior coverage under another Medical Expense Shortfall Policy with similar benefits, the pre-existing condition waiting period would only apply to the remaining portion of the waiting period from the previous policy.
• ✅ For benefits not provided under the previous policy, the full 12-month exclusion will apply.

Medical conditions for which advice, diagnosis, care, or treatment was received or would reasonably have been recommended within 12 months before the policy’s start date will not be eligible for benefits for the first 12 months.

Pregnancy before the policy’s start date is considered a pre-existing condition, and pregnancy and birth-related claims will be excluded for 12 months from the start date.

Zestlife Optimal vs Other Gap Cover Plans

Our Verdict on Zestlife Optimal

Our research shows that Zestlife Optimal offers a comprehensive gap cover plan with several notable features and options.  The plan provides in-hospital benefits, covering medical expenses incurred during hospital stays and out-of-hospital cover for treatments received outside of a hospital setting.

It also includes cover for scopes and scans, emergency room treatments, and trauma counseling sessions and offers a premium waiver for medical aid and gap cover premiums.

Zestlife Optimal Frequently Asked Questions

Is Zestlife Optimal suitable for individuals requiring cover for oncology treatments?

No, Zestlife Optimal does not provide cover for oncology treatments.

What does the in-hospital benefit of Zestlife Optimal cover?

The in-hospital benefit covers medical expenses incurred during hospital stays.

Does Zestlife Optimal offer cover for treatments received outside of a hospital setting?

Yes, Zestlife Optimal includes out-of-hospital cover for medical treatments.

Is maternity benefit included in the Zestlife Optimal plan?

No, Zestlife Optimal does not provide cover for maternity-related expenses.

Does Zestlife Optimal provide cover for trauma counseling?

Yes, Zestlife Optimal includes cover for trauma counseling sessions.