Sirago Underwriting Managers

Gap Only Cover

Our no frills, gap cover only solution. Smart, simple, value for money.

Key Benefits

OAL per beneficiary per annum:
R201 000

in-hospital gap benefits
In-Hospital Benefits

Gap Cover
Day Hospital/Clinic and/or In Room Surgical
Prescribed Minimum Benefit (PMB) Cover

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value added benefits
Value Added Benefits

Sirago MedCare - Free Medical Scheme Alternative Dispute Resolution Service (ADR)

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In-hospital Benefits

Gap Cover

This covers the difference (the shortfall or the gap) between what the medical scheme pays and the doctors and specialists charge in hospital. We settle claims at up to 200% above scheme rate to a maximum of 300% or at the stated benefit value. Subject to the OAL

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

This benefit will cover the shortfall for any day hospital, clinic, or in-room procedures including acute hospitals if a policyholder elects to have the treatment that would normally be performed in hospital, done in a day hospital, clinic, or in a doctor’s room by a registered medical professional. Subject to the OAL.

Prescribed Minimum Benefits (PMB) Cover

Prescribed Minimum Benefits (PMB) give all scheme members access to certain minimum health benefits, regardless of your medical scheme option. Medical schemes are required to pay the full cost of diagnosis and treatment of a defined list of PMB medical conditions.

PMB Cover on this policy is only for the 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. In the event of an emergency, PMB protocols should be adhered to. Subject to the OAL.

Value-Added Benefits

Sirago Medcare – Free Medical Scheme Alternative Dispute Resolution Service (ADR) 

This benefit gives you access to MedCare’s free ADR service for all disputed PMB claims exceeding R9 000. You can also access the MedCare service for all claims less than R9 000, including all potential medical scheme disputes, at a 60%, 20%, and/or 15% discounted rate depending on the required service.

Your broker can also access this service on your behalf and will subsequently have access to the MedCare website:

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