Be aware 300% is not actually always 300%
I believe the way the benefit is communicated is potentially misleading. On page 5 of the policy, the Essential Gap Cover benefit is advertised as "Up to 300% (3 times) of the medical aid tariff." Most people would reasonably understand this to mean that the gap cover itself pays up to 300%.
However, it is only on page 29, a full 24 pages later, that the policy explains:
"The amount that We will pay is limited to 2 times the Medical Scheme Tariff if Your Medical Scheme covers You for 100% of the Medical Scheme Tariff..."
The policy further illustrates this with the following example:
Scheme covers We cover Total cover100% 200% (2 x 100%) 300% 200% 100% (1 x 100%) 300%
This means that if a medical aid already pays 100% of tariff, Zestlife will only pay an additional 200%, resulting in a combined total of 300%. That is very different from the impression created by the wording on page 5.
My concern is that this important limitation is not clearly disclosed alongside the advertised benefit. Instead, it only appears 24 pages later in the detailed policy wording, with no prominent reference on page 5 directing readers to it. Had the benefit summary clearly stated that the 300% was a combined limit including the medical aid's contribution, it would have been much easier for consumers to understand the actual level of cover being offered.
As it stands, the benefit summary on page 5 creates the impression that the cover is up to 300%, while the detailed wording on page 29 reveals that the insurer's contribution may in practice be limited to 200%. I believe many customers could reasonably be misled by this difference.
I raised this issue with the Insurance Ombudsman because I felt that the way the benefit was presented was potentially misleading. Unfortunately, my complaint was not upheld, and my request was rejected. While I respect that outcome, I remain concerned that the wording on page 5 creates a very different impression from the limitation only explained on page 29, and I believe many consumers could easily reach the same interpretation that I did.
