Medical aid gap cover is pretty important insurance. Actually in my mind, it’s probably one of the most important insurance policies you can own nowadays. A medical aid gap cover policy makes sure everyone on your medical aid plan is covered against the possibility of landing up in hospital and not having the bill covered in full by your medical scheme.  But here is a question I know you are dying to ask. “What are maximum amounts of cover that my family and I will qualify for under a policy like this?”

Our preferred medical aid gap cover provider is Zestlife. They’ve got an awesome medical aid gap cover product which covers everyone on your existing medical aid plan, has no age restrictions and allows you to get on cover with your pre-existing conditions. All for R140 per month.

But what are the maximum amounts of cover that my family and I will qualify for under the policy? Good question, let’s have a look at that.

The maximum benefit payable per individual is R200 000 per annum and the maximum benefit per family is R2 000 000 per annum.

So, if you, your wife and 2 kids belonged to a medical aid scheme and decided to top-up your cover with a Zestlife medical gap cover product, your cover as a family would be restricted to R800 000 for that year (R200 000 per individual x 4 individuals covered under the policy).

Ok, that’s easy enough, so the next question is this.

“As an individual, can I have multiply claims in a year?”

The answer to that question is Yes. Let’s assume you claim against the policy (3) times in a year for a sum total of R80 000. That falls within the R200 000 pa  individual limit so you are within the parameters.

Are the benefit amounts reviewed annually? I mean it doesn’t help having a policy like this and the benefits are being eroded by inflation. R200 000 next year isn’t going to have the same value as R200 000 did this year.

Yip, every February the guys at Zestlife reviewed and increased the policy benefits (and naturally you will be advised)

Last question Brendan.”How do I submit a claim?”

Easy Peasy! Within 6 months of a hospital admission giving rise to a claim you need to simply submit a claim. This can be done by contacting the ZestLife who will advise you of the documents that will need to be completed in submitting a claim.

Kind regards,

The InsuranceFundi Team

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