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.

Yes, you are only covered by Liberty Gap Cover while you are a member of a registered South African medical aid.

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.

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.

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.

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.

The product is underwritten by Guardrisk Insurance Company, a licensed non-life insurer and authorised FSP (75).