Sirago Underwriting Managers

Exact Cover

Cover for specific procedures that your medical scheme excludes.

What is Exact Cover

The Exact Cover product provides access to a defined list of stated procedures when your Medical scheme option excludes those specific procedures over and above their standard exclusions. Sirago will negotiate with all service providers on your behalf and pay the claim directly, up to the stated amounts as listed below. The cost of the hospital and all service providers are included in the cover limits.

Subject to an Overall Annual limit (OAL) of R201 000.

in-hospital gap benefits
Medical Procedures We Will Cover

Arthroscopic Surgery - R80 000
Back And Neck Surgery - R80 000
Bunion Surgery - R20 000
Cochlear Implant, Auditory Brain Implant and Internal Nerve Stimulator Surgery, Including the Device and Processor - R85 000
Dental Procedures for Reconstructive Plastic Surgery due to an Accident - R80 000
Dental procedures for impacted wisdom teeth for children under 18 years old - R15 000
Functional Nasal Surgery - R30 000
Joint Replacement Surgery - R55 000
Oesophageal Reflux And Hiatus Hernia Surgery - R60 000
Varicose Vein Surgery - R22 500
Knee and shoulder surgery - R22 500
MRI and CT scans due to accident - R10 000
Emergency casualty benefit: Accident & Trauma, Children under 8 years old (max R4000) - R6 000
Skin disorders including benign growths and lymphoma - R20 000
Non-cancerous breast conditions - R20 000
Endoscopic procedures - R8 000
Tonsillectomy, Grommets, and Adenoidectomy (Single procedure) Combined procedure (15 000) - R10 000

What This Benefit Does Not Cover

Medical procedures listed as specific exclusions by your medical scheme that are not on our list of medical procedures. .

Sirago’s listed procedures if your medical scheme paid a portion towards the account.

Any shortfalls after Sirago has paid the cover limit for the authorised procedure.

Waiting Periods

A 10-month waiting period applies where no claims can be submitted for a procedure or surgery related to our list of procedures.

A 12-month waiting period on pre-existing conditions, specific diseases and/or illnesses related to our list of procedures.

Get a Gap Cover solution that's tailored for your unique requirements

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