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SA's No 1 Insurance Blog

The thing about insurance is that we seldom ask enough questions. You think we would investigate things thoroughly before committing to an insurance policy purchase with a long term fixed monthly premium, but that’s not necessarily the case. We know we need the cover, we take it out, we know we should give the policy wording a read, we don’t, we claim, we hope, and inevitably we get disappointed when we find out that the claim didn’t pan out the way we hoped. Avoid disappointment; ask the correct questions at point of sale. If you are in the market for medical aid gap cover, here is one question you should definitely be asking. Are excesses payable at claim stage?

The answer is “No”.  Well, that’s if you are with the guys at Zestlife. They don’t have any excesses payable on their Medical Gap Cover policy unless you are over the age of 60. Then, the excess structure is 5% of the benefit payable, subject to a minimum of R250.

Most medical aid gap cover companies exclude older applicants. Zestlife don’t! Actually they don’t even charge older applicants any more than younger applicants. To balance the equation, they do, however, have this one excess structure in place.

But 5% of the benefit payable isn’t much when you’ve got a heavy claim hospital claim.

Let’s assume that you’ve got a hospital bill that isn’t paid in full by your medical aid. Let’s assume again, that the unpaid portion of the bill is R40 000 and it’s within 400% of tariff (Zestlife use the Admed tariff)

5% of R40 000 is R2000. R40 000 less R2000 (the applicable excess) is R38 000 due to you.

Come on now, imagine you had a R40 000 outstanding specialist bill and your gap cover company picked up 95% of the bill. Fair? I think so…

Looking for gap cover?

Kind regards,

The InsuranceFundi Team

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