Sirago Underwriting Managers

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Gap Assist Cover

A great start to your gap cover.

Monthly Premiums

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Key Benefits

OAL per beneficiary per annum:
R183 000

in-hospital gap benefits
In-Hospital Benefits

Gap Cover
Co-payments
Day Hospital/Clinic and/or In Room Surgical
PMB Cover
Hospital Account Shortfalls

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cancer benefits
Cancer Benefits

Cancer Co-payment Benefit
Cancer Benefit - Boost

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out-of-hospital gap benefits
Out-of-hospital Benefits

Emergency Room Cover
Appliance Benefit

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value added benefits
Value Added Benefits

Gap Cover Premium Waiver
Sira’Go Baby
Sirago MedCare (Free Medical Scheme Alternative Dispute Resolution Service (ADR))

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In-hospital Benefits

Gap Cover

Will settle claims up to 500% of the medical scheme rate. Limited to a maximum of 600% or at the stated benefit value.

Co-payments

The excesses imposed by your medical scheme payable to a maximum rand limit for specified procedures or tests. Cover for co-payments imposed by medical schemes for hospital admissions, scans and surgical procedures. Co-payment benefits are subject to a sub-limit of R42 000 per policy per annum, limited to R11000 per claim. Co-payments related to cancer are catered for in a separate benefit category.

Day Hospital/Clinic and/or In Room Surgical Procedures Cover

Will settle the GAP portion of claims.

PMB Cover

This benefit will cover the shortfall for the voluntary use of a non-designated service provider for planned procedures, except in the event of an emergency. Limited to R30 000 per claim. Subject to OAL.

Hospital Account Shortfalls

R5 000 sub-limit per policy per annum. Maximum of R500 per claim, maximum 3 claims per beneficiary per policy per annum.

Out-of-hospital Benefits

Emergency Room Cover

A sub-limit of R6 000 is applicable. This benefit covers an emergency at any registered emergency facility when you require immediate medical treatment due to an accident or illness. The following benefits collectively accumulate to the sub-limit. Accident benefit: all costs related to the accidental event will be covered and paid to a maximum value of the sub-limit available, whether you are liable to pay the costs related to the emergency event out of your own pocket or if your medical scheme pays from your savings account. Illness benefit: when you visit an emergency room in a medical emergency as a result of illness, we will cover the Gap portion only. We will cover a GP’s emergency facility where no hospital emergency is available within a 30km radius within the above stated benefit limits.

Appliance Benefit

Subject to a sub-limit of R3 600 per policy per annum with a claim limit of R1 200 for your Gap component as per the defined list: hearing aids, wheelchairs, CPAP machine, humidifiers, insulin
pump, glucometer, nebuliser and the Mirena device.

Cancer Benefits

Cancer Co-payment Benefit

This benefit applies once your medical scheme cancer benefit limit has been reached and a percentage co-payment is applied. Limited to R18 000 per claim for cancer co-payments. Subject to the OAL. Cancer cover incorporates co-payment cover and biological drugs. In order to access this benefit you need to be on a registered treatment plan with your medical scheme.

Cancer Benefit – Boost

The Cancer Boost benefit is limited to R50 000 per beneficiary per annum. This benefit is restricted to policyholders where their medical scheme option has a defined rand limit for cancer treatment. The Cancer Boost benefit can only be claimed once your rand limit on your medical scheme cancer benefit has been
reached and you require ongoing treatment. This benefit is dependent upon the insured having already been registered on the
medical scheme’s cancer programme. The Cancer Boost benefits are limited to those that were determined within the approved medical scheme treatment plan which must be submitted to Sirago upon application for this benefit. This benefit provides a subsidy
towards the cost of ongoing treatments and drugs. This applies when the medical scheme’s cancer benefit limit is reached and provides no further funding.

Value Added Benefits

Gap Cover Premium Waiver

In event of death or total permanent disability of the policyholder of the Sirago policy. The Premium Waiver is directly linked to your policy premium per month as indicated in your schedule of insurance. This benefit is not paid in cash, but held as a credit against the policy for the applicable 6 month period. Should there be any premium adjustments within the 6 month period, the credit balance available for the rest of the waiver period, will be adjusted accordingly. This benefit cannot be transferred, ceded or converted to cash.

Sira’Go Baby

An instruction to add a new-born to the policy must be submitted within 31 days of the birth of the child. After confirmation of pregnancy, this benefit has a R2 000 sub-limit for claims for prenatal scans, childhood immunisations or pre- and post-birth tests (to limit) per child. In the event of twins, the benefit will be doubled, and in the event of triplets, the benefit will be tripled.

Sirago MedCare

If a PMB claim does not qualify as a valid claim, you will have access to MedCare’s free alternative dispute resolution (ADR) service for all claims exceeding R12000.
You can also access the MedCare service for all claims less than R12 000, including all potential medical scheme disputes, at a 50%, 15%, or 10% discounted rate depending on the required service.
Your financial advisor can also access this service on your behalf and will have access to the MedCare website.

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