Get Gap Cover from as little as R239pm
Protects you and your family against unexpected medical expense shortfalls when doctors and specialists charge more than your medical aid pays.
Liberty Gap Cover benefits
Liberty Gap Cover benefits
- No general waiting period applies.
- Cover is available for all ages and does not expire at a certain age.
- Family cover includes all your medical aid dependents, including adult dependents.
- Extensive shortfall cover for in-hospital, and approximately 50 out-of-hospital procedures.
- Cover for co-payments charged by the medical aid for hospital admissions and scans.
- Minimal exclusions.
- Swift claim resolution.
Overview of Cover and Benefits
The table below provides an overview of the medical expense shortfall cover and health insurance benefits available on each of the policy options.
MEDICAL EXPENSE SHORTFALL COVER
MEDICAL EXPENSE SHORTFALLS COVERED Max cover limit of R212 500 per individual insured for 2024 |
Universal | Essential | Optimal |
In-hospital Cover Out-of-hospital Cover (+50 procedures) |
Up to 500% (5 times) of the medical aid tariff. | Up to 300% (3 times) of the medical aid tariff. | Up to 400% (4 times) of the medical aid tariff. |
Pre- and Post-surgery Consultations | |||
General Co-payments | |||
Non-network Co-payments | |||
MRI, PET, and CT Scans in Excess of Medical Aid Sub-limit | |||
Casualty Facility Treatment for Injury in an Accident | |||
Casualty Facility Emergency Treatment | |||
Internal Prosthesis and Artificial Joints | |||
Robotic Medical Procedures | |||
Oncology Treatment Programme Co-payments | |||
Oncology Treatment in Excess of Medical Aid Cancer Limit | |||
Cosmetic Breast Reconstruction |
HEALTH INSURANCE COVER
HEALTH INSURANCE BENEFIT | Universal | Essential | Optimal |
Enhanced Cancer Cover | |||
Accidental Dentistry Cover | |||
Accidental Death and Permanent Disability Cover | |||
Trauma Counselling Cover | |||
Medical Aid and Gap Cover - Premium Waiver Cover |
View our brochure
To assist you in choosing the Gap Cover option that best suits your needs and for a full explanation of all the policy benefits and the policy terms and conditions.
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Apply online for Gap Cover
Ready to secure financial protection against medical expenses not covered by your medical aid? Apply online now for our Gap Cover and insure yourself against medical expense shortfalls with the option that best suits your needs.
Apply OnlineContact details
Zestlife (the Liberty Gap Cover policy administrator) can be contacted for more information and support.
Frequently asked questions
What is Liberty Gap Cover?
Liberty Gap Cover is a health insurance policy that covers medical expense shortfalls that arise when your medical aid only pays for part of your medical treatment costs. Without gap cover you would be responsible for these payment shortfalls. Liberty Gap Cover is not a medical aid, and the cover is not the same as a medical aid. It is not a substitute for medical aid membership.
Why do I need Liberty Gap Cover?
Surgeons, anaesthetists, and other specialists frequently charge more than the amount covered by the medical aid. When this occurs, you (the medical aid member) become liable to pay for the medical expense shortfall (self-payment gap). Liberty Gap Cover helps solve this problem.
Do I need to have medical aid to get gap cover?
Yes, you are only covered by Liberty Gap Cover while you are a member of a registered South African medical aid.
What are medical aid shortfalls?
Medical aids have a predetermined amount that they pay toward surgeons, anaesthetists, and other specialists charges. These professionals often charge more than the amount covered by the medical aid. When this occurs, there is a self-payment gap that you, as the medical aid member, are liable for.
How do I claim from Liberty Gap Cover?
Policyholders can contact the policy administrator, Zestlife, by email on [email protected] or by phone on 021 180 4220 or 0860 009 378 to submit a claim. Zestlife will supply you with the necessary claim form and guide you through the claim’s process. Please remember that Zestlife must be notified of claims within 6 months of the medical treatment being received, and the completed claim form and the required support documents must be submitted to Zestlife within 12 months of the medical treatment being received.
Are there any waiting periods for Liberty Gap Cover?
There are no general waiting periods or condition specific waiting periods that withhold cover after the start date of the policy. However, no benefits are payable for a period of 12 months from the start date of cover in respect of medical conditions, for which in the 12 months before the start date of the cover, medical advice, diagnosis, care, or treatment was received or would reasonably have been recommended. Pregnancy before the start date of cover will be regarded as a pre-existing condition and any pregnancy and birth related claims will be excluded for 12 months from the start date of the cover.
Who is covered under the Liberty Gap Cover policy?
Universal and Essential Gap Cover are available to individuals and families on all South African medical aids. Individual Cover is for those who don't have any medical aid dependents. Family Cover is for the main medical aid member, spouse and family dependents including adult dependents, on the same medical aid. Family Cover also extends to a policyholder's spouse and mutual children that are registered as dependents on the spouse's medical aid. Optimal Gap Cover is only available to single individuals younger than 34 who don't have any medical aid dependents.
Who is the Insurer of Gap Cover?
The product is underwritten by Guardrisk Insurance Company, a licensed non-life insurer and authorised FSP (75).
Latest News and Knowledge Articles
Some articles of interest relating to Gap Cover are available below, click on the relevant images and the full article will be displayed.