Sirago Underwriting Managers

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Gov-Gap

A tailor-made solution for government employees.

Monthly Premiums

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What is Gov-Gap Cover

This policy has an Overall Annual Limit (OAL) of R183 000 per beneficiary.

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.

in-hospital gap benefits
In-Hospital Benefits

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

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cancer benefits
Cancer Benefits

Cancer Boost Benefit

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

Emergency Room Cover
Day-to-day Specialist Consultation Fee

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value added benefits
Value Added Benefits

Gap Cover Premium Waiver
Medical Scheme Premium Waiver
Accidental Death
Cancer Cover (Initial Diagnosis)
Sira-Go’ Baby

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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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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.

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

Will settle the GAP portion of claims.

PMB Cover

This benefit will cover your Gap portion 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 500 sub-limit per policy per annum. R1 500 per claim, 2 claims per beneficiary per annum.

Sub-limit Enhancer

Subject to a sub-limit of R45 000 per policy per annum. Subject to R16 000 per claim. Maximum of 2 claims per beneficiary and limited to 3 claims per policy per annum. The sub-limit enhancer benefits are limited to internal prosthesis, intraocular lenses, MRI scans and CT scans only.

Out-of-hospital Benefits

Emergency Room Cover

A sub-limit of R8 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.

Day-to-day Specialist Consultation Fee

R4 000 sub-limit per policy. Maximum of R800 per claim. 3 claims per beneficiary per annum for the Gap portion only.

Cancer Benefits

Cancer Benefit – Boost

This benefit applies if your medical scheme option for cancer has a defined Rand limit. We will cover the costs for 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

Value Added Benefits (These do not form part of the aggregated OAL of R183 000)

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.

Medical Scheme Premium Waiver

Payable in event of death or total permanent disability of the principal policyholder of the Sirago Gap Cover. In the event of dual medical scheme membership, this benefit is only payable in event of death or total permanent disability of the principal policyholder. Sirago will pay the medical scheme premium to the actual amount of the contribution, but not higher than the sub-limit of R3 000 per month for a 4-month period which will be paid to the beneficiary for the upkeep of their medical scheme contributions. In order to receive the benefit, the Gap Cover policy and medical scheme membership must remain active during this period. A certificate of membership from your medical scheme must be presented monthly for authentication of current membership.

Accidental Death

This benefit will pay out at R6 000 for the policyholder, R5 000 for the adult dependant and R3 000 per child dependant. 

Cancer Cover (Initial Diagnosis)

This benefit will pay you a lump sum of R7 500 upon the initial diagnosis of malignant cancer per beneficiary, per annum as defined. This excludes any incidence of cancer/pre-cancer prior to inception of the policy.

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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