GOV GAP COVER
A tailor-made solution for
government employees.
Monthly Premiums
Why Choose Gov Gap?
This product is a tailor made solution for Government employees who need to optimise their healthcare cover portfolio and premiums covered by Persal.
Membership Eligibility: Principal policyholders must be in the full-time employment of the State and be in possession of a valid and current Persal number in order for a Gov-Gap policy document to be issued. Gov-Gap has a policy cease age of 65. The policy will cease at the end of the benefit year when the policyholder turns 65.
Key Benefits
OAL per beneficiary per annum: R223 000 (from 1 April 2026)
In-hospital Benefits
Gap Cover
Gap Cover will settle claims up to 500% above your medical scheme plan/option rate, to a maximum of 600% or at the scheme stated benefit value as determined within your scheme policy.
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 R40 000 per policy per annum, limited to R6 000 per claim.
Refer to the Cancer Co-payment benefit for claims related to cancer.
Day Hospital/Clinic and/or In Room Surgical Procedures Cover
Will settle the GAP portion of claims.
Prescribed Minimum Benefit (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.
Hospital Account Shortfall
This benefit will cover any charges, like consumables or take-home medication, on the hospital account that the medical scheme has not paid. We also cover take-home medication that the medical scheme has not paid from risk and the cost of upgrading to a private ward up to the benefit amount.
We pay up to R7 000 per policy, and R1 500 per claim,
3 claims per dependant. Subject to the OAL.
Sub-limit Enhancer
This benefit has a sub-limit of R25 000 per policy, per annum at R10 000 per claim. This benefit caters for all sub-limits. We will provide cover when there is a benefit on your medical scheme option for devices like MRI & CT scans, cochlear implants, intraocular lenses, internal prostheses only, and Transcatheter Aortic Valve Implantation (TAVI) procedure valves. When you exceed your medical scheme benefit limit during the time of the event, resulting in a shortfall or “gap”, we will pay the shortfall depending on the Gap option you are on. If you claim and your medical scheme limit has been reached at the time of the event, meaning it was used up before the claim event, and your medical scheme does not contribute anything towards this benefit, we will also not pay Subject to the OAL.
Out-of-hospital Benefits
Specialist Consultation Fee
This benefit covers the shortfall on the consultation at a specialist outside of hospital (excluding Psychiatrist and Psychologist) up to R5 500 per policy, and R1 100 per claim. This benefit is only applicable to consultation codes 0190, 0191, and 0192. The medical scheme needs to make at least partial payment towards the consultation code mentioned above. Subject to the OAL.
Casualty Benefit
There is a sub-limit of R8 000 for all Emergency Room Cover. This benefit covers an emergency at any registered emergency room, hospital, or casualty facility when you require immediate medical treatment due to an accident and trauma, or illness. We will cover a general practitioner (GP)’s consultation rooms if no other emergency facility is available within a 30 km radius. Ambulance costs are not covered by this benefit.
ACCIDENT & TRAUMA BENEFIT
All costs related to the accident/trauma event will be covered, whether you are liable to pay the costs out of your own pocket or if your medical scheme pays from your savings.
ILLNESS BENEFIT
All costs related to the emergency illness event will be covered and paid up to R1 500 of the sub-limit, if you are liable to pay the costs out of your own pocket, or if paid from your medical scheme savings. This is applicable to any beneficiary 13 years and older who needs emergency treatment outside of normal consultation hours or treatment that can only be done in an emergency facility.
Out of normal consultation hours means 18h00 to 07h00 on Monday to Friday, and all of Saturday, Sunday, and South African public holidays. Subject to the OAL.
Cancer Benefits
Cancer Co-payment Benefit
This benefit applies if your Medical scheme cancer benefit has been reached and a percentage co-payment is imposed. This benefit incorporates co-payments for ongoing cancer-related and biological drugs. Ongoing treatment must be in line with the registered treatment plan of your Medical scheme to access this benefit. Subject to the OAL
Cancer Boost Benefit
The Cancer Boost Benefit is applicable to policyholders whose medical scheme option has a defined rand limit for cancer treatment and the rand limit on the medical scheme has been reached.
We will cover the costs of ongoing treatment in line with the medical scheme’s registered treatment plan once the rand limit has been reached. Subject to the OAL.
Value-added Benefits
Gap Cover Premium Waiver
Medical Scheme Premium Waiver
Sirago will pay the rand amount of the medical scheme premium, not higher than R4 000 per month for a
6-month period. This will be paid to the beneficiary for the upkeep of the medical scheme contributions in event of an accidental death or total permanent disability of the Sirago policyholder and where all beneficiaries are linked to a single medical scheme. This benefit is only payable for the medical scheme that the policyholder was on if there is dual medical scheme membership.
Accidental Death
This benefit will pay out for accidental death: at R6 000 for the Sirago policyholder, R5 000 for the adult dependant, and R3 000 for child dependants.
Cancer Cover (Initial Diagnosis)
This benefit will pay out a lump sum of R12 000 per dependant per lifetime in the event where you are diagnosed with malignant cancer from stage 2 onwards the first time ever. Any cancer prior to inception of the policy or pre-existing cancer is excluded. Skin cancer is specifically excluded from cover on this policy, except malignant melanomas.
Sira'Go Baby
Sirago will pay out a lump sum of R2 000 to you, per newborn baby, when the baby is registered on your gap policy within 90 days of birth.
To register your newborn(s), simply fill out the additional dependant form and submit it to changes@sirago.co.za together with your baby’s birth certificate.
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: siragomedcare.co.za.
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