THE BIGGEST GAP OF ALL IS IN ZEST LIFE'S MEDICAL EXPENSES GAP COVER

 Dear Sick People

Craig Swain Zestlife's
Contact Centre Manager

When I took a Zestlife Medical Gap Cover insurance policy to cover the shortfall in my medical aid payments I assumed this would cover, at the very least what my Medical Aid did not pay if I was hospitalized. As this is one of the most expensive aspects of any serious illness I automatically assumed this was covered in the 24 page Policy Document because of what was in the letter I received from Noleen Bell congratulating me on becoming a Gap Cover policy holder.

    The first paragraph of her letter told me I was now covered for "The most frequent in-hospital and approximately 50 out-of-hospital medical expenses shortfalls that may not be covered in full by my medical aid.. This is the 'gap' your Gap cover  policy is designed  to cover." 

       In the third paragraph I was lulled into a further sense of security with this: "The policy specifically (note this word) covers medical expenses shortfalls that are not covered in full by your medical aid." I believe that most people would definitely think that this means that the shortfall of any medical aid payment would be covered.

       In the second last paragraph I was told "To ensure we are continuously covering the most frequent and significant medical expenses shortfalls your policy benefits, cover limits terms, conditions and premium will be revised and be effective on 1 January each

year."

        Well if a short payment of the actual hospital bill by your medical aid is not one 

of the "most frequent and significant medical expense shortfalls" then I don't know what is.

        I had had the policy for three years when I was shocked to learn that it did not

cover the shortfall of R7 369 between what my medical aid paid for my stay in the Tokai Melomed Hospital and the actual hospital bill. I got the following from Zestlife

when I tried to claim this amount.

        "Please note that in accordance with the terms and conditions of your policy hospitals and day to day clinic fees, including theater charges and related costs are specifically (there is that word again) excluded from cover."

         It is only on Page 7 of the Policy Document that I was given was the vitally important  information that I would not be paid for "Hospital fees including theater charges, ward charges or any other hospital costs."

         Who in their right mind would take a gap cover policy that doesn't pay the outstanding amount of their hospital bill when their medical aid does not cover it in full? Unfortunately that impressive letter from Noleen Bell gave me a completely false impression of what Zestlife actually covers.

           As it turned out it was like being told when your car is under guarantee and you put in for repairs that the manufacturer will only cover the wheels and you have to foot the bill for everything else.

            I finished my email to Craig Swain with this. So the last thing you need to find out when you are sick is that the shortfall

between what your Medical Aid paid and the Hospital bill is the Biggest Gap in your Gap Cover medical insurance policy.                            Get well soon all you sick people and I                                                   hope none of you have the same                                                          Gap Cover experience as I did.

                                                     Regards, Jon

nn