Sirago Underwriting Managers

Exact Cover

Cover for specific procedures that your medical scheme excludes.

What is Exact Cover

The EXACT COVER benefit covers necessary medical procedures that your medical scheme excludes because it is listed as a medical scheme specific policy exclusions. This benefit covers the hospital and service providers accounts up to the cover limit as specified.

Subject to an Overall Annual limit (OAL) of R110 000.

in-hospital gap benefits
Medical Procedures We Will Cover

Arthroscopic Surgery - R85 000
Back And Neck Surgery - R85 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 - R25 000
Joint Replacement Surgery - R50 000
Oesophageal Reflux And Hiatus Hernia Surgery - R60 000
Varicose Vein Surgery - R22 500
Knee and shoulder surgery - R20 000
MRI and CT scans due to accident - R10 000
Emergency casualty benefit - R6 000

What This Benefit Does Not Cover

Medical procedures listed as specific exclusions by your medical scheme that do not form part of our list of medical procedures covered.

Service providers accounts where your medical scheme paid a portion towards the account, where your medical scheme applied an Overall Annual Limit (OAL) as a cover limit to in-hospital medical procedures.

If your medical scheme sub-limit benefit is exhausted at the time of the event, or your chosen service providers charge a rate that exceeds the cover limit we provide.

NB: Exact cover can be enhanced by purchasing additional benefits, related co-payments and Gap Cover. Not applicable to Exact benefits, only to the medical scheme cover.

Waiting Periods

A 12 month waiting period on pre-existing condition specific disease and or illness applies to this policy. In the event that there is no pre-existing conditions related to the stated conditions within this policy, a 10 month waiting period applies where no claims can be submitted for a procedure or surgery related to the following conditions, unless due to an injury resulting from an accident. Dental procedures for reconstructive plastic surgery, functional nasal surgery, oesophageal reflux and hiatus hernia surgery, back and neck surgery, joint replacement surgery, cochlear implant, auditory brain implant and internal nerve stimulator surgery including the device and processor, bunion surgery, arthroscopic surgery and varicose veins surgery. When a new beneficiary joins the policy, they are subject to normal underwriting terms and conditions and waiting periods as denoted above will apply.

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