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Zestlife Universal (🇿🇦 2025*)

💙 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 R537 ZAR. Zestlife has a trust score of 4.1.

👉🏿 Zestlife Gap Cover has three plans to choose from:

✅ Zestlife Universal

✅ Zestlife Optimal

✅ Zestlife Essential

🔎 Provider	🥇 Zestlife Universal
🟥 Years in Operation	3 years
🟧 Market Share in South Africa	>15%
🟨 Gap Cover Waiting Period	3 – 12 months
🟩 Do Exclusions Apply	✅ Yes
🟦 Average Monthly Premium	R537
🟪 Oncology Benefit	✅ Yes
🟥 In-Hospital Benefit	✅ Yes
🟧 Out-of-Hospital Cover	✅ Yes
🟨 Maternity Benefit	None

Zestlife Universal Gap Cover – 6 Key Point Quick Overview

Zestlife Universal Premiums

🟥 Cover for Individuals	🟥 Monthly Contribution
🟨 <55 Years	🟨 R537 per month
🟩 55 – 64 Years	🟩 R700 per month
🟦 >65 Years	🟦 R838 per month
🟪 Cover for Families	🟪 Monthly Contribution
🟥 Where all insured are <65 Years	🟥 R700 per month
🟧 Where one or more insured are >65 Years	🟧 R838 per month

👉🏿 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 R16,000 per policy per year.
✅️ Covers MRI, PET, and CT scan over the medical aid sub-limit, up to R3,700 per insured person annually.
✅️ Covers casualty and emergency room treatment, up to R25,400 per policy annually.
✅️ Covers casualty facility emergency treatment for children under 11, up to R2,800 per policy per year.
✅️ Covers internal prostheses and artificial joints with shortfalls or co-payments, up to R44,000 per policy annually.
✅️ Covers stents, up to R3,700 per insured individual per year.
️✅ Covers robotic medical procedures, up to R37,600 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 R27,500 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 R25,700 at a rate of R3,700 per fractured tooth.
✅️ Provides accidental death and disability cover, up to R50,000, for members under 65.
✅️ Covers trauma counseling up to R900 per session, with an annual limit of R30,300 for treatment within 6 months of the event.

💙 Offers medical aid gap cover premium waiver, 12 times the combined medical aid premium, up to R122,400 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.

💙 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.

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

🔎 Provider	🥇 Zestlife Universal	🥈 Medway GapCore	🥉 Turnberry Optimal
🟥 Years in Operation	3 years	33 years	22 years
🟧 Market Share in South Africa	>15%	<1%	<5%
🟨 Gap Cover Waiting Period	3 – 12 months	3 – 12 months	3 – 12 months
🟩 Do Exclusions Apply	✅ Yes	✅ Yes	✅ Yes
🟦 Average Monthly Premium	R537	R465	R510
🟪 Oncology Benefit	✅ Yes	✅ Yes	✅ Yes
🟥 In-Hospital Benefit	✅ Yes	✅ Yes	✅ Yes
🟧 Out-of-Hospital Cover	✅ Yes	✅ Yes	✅ Yes
🟨 Maternity Benefit	None	None	None
🟩 Scopes and Scans	✅ Yes	None	✅ Yes
🟦 Co-payment Cover	None	None	✅ Yes
🟪 Emergency Room	✅ Yes	None	✅ Yes
🟥 Accidental Cover	None	✅ Yes	✅ Yes
🟧 Trauma Counseling	✅ Yes	None	✅ Yes
🟨 Premium Waiver	✅ Yes	None	✅ Yes
🟩 Non-DSP Co-Payment	✅ Yes	None	✅ Yes
🟦 Prostheses	✅ Yes	None	None
🟪 Travel Cover Extender	None	None	✅ Yes
🟥 Accidental Death/ Permanent Disability	✅ Yes	None	✅ Yes

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.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.