Zestlife Universal

Overall, Zestlife Universal Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Zestlife Universal Gap Cover Plans start from R506 ZAR. Zestlife has a trust score of 4.1.

Zestlife Gap Cover has three plans to choose from:

• • Zestlife Universal
  • Zestlife Optimal
  • Zestlife Essential

Zestlife Universal Gap Cover – 6 Key Point Quick Overview

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

Zestlife Universal Premiums

You might consider advancing your healthcare knowledge about affordable Health Insurance in South Africa

Zestlife Universal Benefits and Cover Breakdown

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

Zestlife Universal 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 imposed by the policyholder’s medical aid for hospital admission, CT, PET, and MRI scans.
• ️ Covers non-network co-payments for treatment with non-DSP providers, up to R11,600 per policy per year.
• ️ Covers MRI, PET, and CT scan over the medical aid sub-limit, up to R3,200 per insured person annually.
• ️ Covers casualty and emergency room treatment, up to R22,100 per policy annually.
• ️ Covers casualty facility emergency treatment for children under 11, up to R2,500 per policy per year.
• ️ Covers internal prostheses and artificial joints with shortfalls or co-payments, up to R38,500 per policy annually.
• ️ Covers stents, up to R3,200 per insured individual per year.
• ️ Covers robotic medical procedures, up to R33,000 per policy annually.
• ️ Covers oncology treatment co-payments, up to 25% of the treatment cost.
• ️ Covers continued treatment for oncology treatments exceeding medical aid limits, up to 20% of the insured person’s treatment costs.

Covers cosmetic breast reduction after a single mastectomy due to breast cancer, up to R24,000 per insured person.

Zestlife Universal Section B – Health Insurance Benefits

• ️ Enhanced cancer covers up to R30,000 for unexpected costs during an initial cancer diagnosis.
• ️ Covers accidental dentistry for accidental tooth fracture, up to R22,500 at a rate of R3,200 per fractured tooth.
• ️ Provides accidental death and disability cover, up to R50,000, for members under 65.
• ️ Covers trauma counseling up to R800 per session, with an annual limit of R26,500 for treatment within 6 months of the event.

Offers medical aid gap cover premium waiver, 12 times the combined medical aid premium, up to R110,000 for insured persons under 65 years old.

Zestlife Universal Exclusions and Waiting Periods

Zestlife Universal Exclusions

Zestlife Universal 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.
• ✅ Cancer treatment or planned procedures received outside the Republic of South Africa.
• ✅ 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.
• ✅ Treatment costs for services rendered by allied health care professionals.

and more.

Zestlife will not cover the following Pre-existing Conditions:

• ✅ 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 Universal Waiting Periods

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

Zestlife Universal vs Other Gap Cover Plans

Our Verdict on Zestlife Universal

According to our research, Zestlife Universal Gap Cover offers comprehensive benefits, particularly in oncology, in-hospital and out-of-hospital cover, and trauma counseling.

However, it lacks coverage for maternity benefits, co-payment coverage, accidental benefits, and travel cover extender. Furthermore, in our experience, the final decision on whether Zestlife Universal Gap Cover is suitable for an individual or family will depend on their specific needs and priorities.

Zestlife Universal Frequently Asked Questions

What is Zestlife Universal Gap Cover?

Zestlife Universal Gap Cover provides extensive cover for medical expense shortfalls and financial protection against various health risks. In addition, it offers individual and family plan options.

What does Zestlife Universal Gap Cover include?

It includes in-hospital and out-of-hospital cover, comprehensive oncology benefits, co-payments and shortfalls, and a premium waiver for medical aid and gap cover.

How does Zestlife Universal Gap Cover help with medical expenses?

It covers the difference between what your medical aid pays and what doctors and specialists charge, protecting you from unexpected medical expense shortfalls.

Can I choose Zestlife Universal Gap Cover for my family?

Yes, Zestlife Universal Gap Cover offers options for individuals and families, providing cover for all lives insured, including those over 65.

Does Zestlife Universal Gap Cover include cover for maternity benefits?

No, maternity benefits are not included in the cover provided by Zestlife Universal Gap Cover.