Sirago Underwriting Managers

Gap-Lite Cover

For the younger generation.

Key Benefits

OAL per beneficiary per annum:
R183 000

in-hospital gap benefits
In-Hospital Benefits

Gap Cover
Co-payments
Penalty Fee Cover
Day Hospital/Clinic and/or In Room Surgical Procedures Cover
PMB Cover

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value added benefits
Value Added Benefits

Sira-Go’ Baby
Sirago MedCare (Free Medical Scheme Alternative Dispute Resolution Service (ADR))

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

Emergency Room Cover
Preventative Care Cover

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In-hospital Benefits

Gap Cover

Will settle claims at an additional 250% above medical scheme rate or at the stated benefit value, to a maximum of 350%. 

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 R25 000 per policy per annum, limited to R7 500 per claim.

Penalty Fee Cover

Subject to a sub-limit of R5 000 per claim, a maximum of 1 claim per policy per annum for the voluntary use of a non-designated service provider or network hospital. This includes the use of a partial cover network hospital as determined by your medical scheme.

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

Will settle the Gap portion of claims. Subject to OAL.

PMB Cover

This is for shortfalls resulting from the use of a non-designated service provider for a planned PMB procedure. This is not applicable in the event of an emergency. Subject to a sub-limit of R50 000 per policy and up to R20 000 per claim.

Out-of-hospital Benefits

Emergency Room Cover

A sub-limit of R4 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 if the medical scheme has paid a portion. We will cover a GP’s emergency facility where no hospital emergency is available within a 30km radius within the above stated benefit limits.

Preventative Care Cover

A sub-limit of R1 800 applies. Claims will be paid up to R600 per claim, limited to 2 claims per beneficiary. The following tests or treatments are covered: Pap smear, cholesterol test, blood glucose test, flu vaccination,
childhood immunisation (Department of Health formulary) – up to the age of 12 years, bone-density scans, prostate-specific antigen tests, mammogram, and contraceptive implantation only.

Value Added Benefits

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 R12 000.
You can also access the MedCare service for all claims less than R12000, 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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