DV
Dinese V
1 reviews | Active since Jun 2017
14 Nov 2022, 22:08
Pathetic service short pay of claims
I'm absolutely frustrated with the service received by zestlife. I'm on the essential plan which means 300% cover. They only covered the shortfall of 2 time medical aid rate. When it supposed to be 3 times medical aid rate. Pathetic service How can yourl short pay a claim. I'm with you guys for more than 2 years. Be loyal to your clients. Pathetic
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Zestlife's replyOfficial
15 Nov 2022, 09:24Dear Dinese,
I do apologise that you feel the product does not meet your expectation.
Your benefit has been paid correctly in terms of the policy terms and conditions which states that the benefit is calculated as the medical provider invoiced amount (limited to 3 times the medical aid tariff) less the highest of the amount paid by the medical aid or the medical aid tariff. This equates to a maximum Gap shortfall benefit of 2 times your medical aid tariff and then with your medical aid covering 1 times you have cover in total up to 3 times.
We at all times ensure that we do pay benefits correctly in terms of the policy terms and conditions and that we treat our customers fairly.
Kind regards
I do apologise that you feel the product does not meet your expectation.
Your benefit has been paid correctly in terms of the policy terms and conditions which states that the benefit is calculated as the medical provider invoiced amount (limited to 3 times the medical aid tariff) less the highest of the amount paid by the medical aid or the medical aid tariff. This equates to a maximum Gap shortfall benefit of 2 times your medical aid tariff and then with your medical aid covering 1 times you have cover in total up to 3 times.
We at all times ensure that we do pay benefits correctly in terms of the policy terms and conditions and that we treat our customers fairly.
Kind regards
Zestlife's reply15 Nov 2022, 09:24
Official
Dear Dinese,
I do apologise that you feel the product does not meet your expectation.
Your benefit has been paid correctly in terms of the policy terms and conditions which states that the benefit is calculated as the medical provider invoiced amount (limited to 3 times the medical aid tariff) less the highest of the amount paid by the medical aid or the medical aid tariff. This equates to a maximum Gap shortfall benefit of 2 times your medical aid tariff and then with your medical aid covering 1 times you have cover in total up to 3 times.
We at all times ensure that we do pay benefits correctly in terms of the policy terms and conditions and that we treat our customers fairly.
Kind regards
I do apologise that you feel the product does not meet your expectation.
Your benefit has been paid correctly in terms of the policy terms and conditions which states that the benefit is calculated as the medical provider invoiced amount (limited to 3 times the medical aid tariff) less the highest of the amount paid by the medical aid or the medical aid tariff. This equates to a maximum Gap shortfall benefit of 2 times your medical aid tariff and then with your medical aid covering 1 times you have cover in total up to 3 times.
We at all times ensure that we do pay benefits correctly in terms of the policy terms and conditions and that we treat our customers fairly.
Kind regards