Sirago Underwriting Managers

Exact with Gap and Co-pay Cover

Cover for specific procedures that your medical scheme excludes, with additional gap and co-payment cover.

What is Exact with Gap and Co-pay cover?

The Exact with Gap and Co-Pay option provides cover for specific procedures that your medical scheme excludes, with additional Gap and Co-payment cover for the events that are covered by the medical scheme. The Exact Cover option 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 limit.

OAL per beneficiary per annum for Gap and Co-pay cover: R201 000

OAL per beneficiary per annum for Exact cover: 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 (R15 000) - R10 000

out-of-hospital gap benefits

Co-payment cover is for the co-payments (including co-payments expressed as a percentage), excesses, or deductibles imposed by a medical scheme for specified procedures, cover for hospital admission fees, scans, or surgical procedures. Sirago will pay up to R12 000 per claim.

Gap Benefits

Will settle claims up to 300% of the Medical Scheme rate.
Limited to a maximum of 400% or at the stated benefit value.

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.

Value Added Benefits

Accidental Death

This benefit will cover the accidental death of the policyholder only at R5 000.

Gap Cover Premium Waiver

In the event of death or total permanent disability of the Sirago policyholder, we will keep the premiums for your policy for a 6-month period as a credit. This benefit may be claimed by the surviving spouse or adult dependent on the Sirago policy.

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

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