Sirago Underwriters offers gap and co-payment cover to existing members of registered medical aid schemes in South Africa. It has been operating in the short-term insurance market since 1993, and is an Authorised Financial Services Provider (FSP No: 4710), underwritten by Genric Insurance Company Limited, an authorised Financial Services Provider (FSP No: 436358)
By law, Sirago gap cover products are marketed and distributed through a network of accredited financial brokers. The specialist underwriter management agency (UMA) is contracted to risk partners, Genric Insurance, and acts as a de facto agent of the short term insurer.
In addition to more than 20 years in the health insurance industry, Sirago boasts an experienced executive management team seasoned in identifying and managing financial and clinical risk.
Key benefits, available across the Sirago Underwriters product portfolio, cover the financial shortfall relating to:
- unlimited gap cover
- accident and trauma-related incidents in the ER
- prescribed minimum benefits (PMBs)
- procedures conducted in the doctors’ or specialists’ rooms.
Opt for the premium gap cover products – Plus and Ultimate Gap Cover - and you and your family will enjoy a number of extra benefits, with insurance for:
- admission and penalty fees imposed by medical aid schemes
- specialist out-patient consultations
- reconstructive surgery.
The portion of your hospital bill not covered by your medical aid scheme is paid, and there’s a lump sum oncology payout covering co-payments and in-formulary biological drugs.
In addition, there are attractive value added benefits that ensure you are never financially compromised when seeking quality healthcare.
Sirago gap cover products
Sirago has tailored its gap cover and co-payment products for a cross-section of medical aid beneficiaries in South Africa. Rates are competitive, and the level of cover is commensurate with your monthly contribution.
The Gap Cover option accepts consumers up to the age of 65 and offers a slightly higher level of cover, as follows:
- the healthcare provider shortfall in-hospital is covered up to 500 percent of the scheme rate
- ER cover is subject to an overall annual limit of R3000 per policy per year
- benefits for PMBs, up to a limit of R25 000 per claim, and out-patient procedures.
General exclusions are as follows:
- no benefits available for the first six months
- benefits payable at 50 percent of the rate for the initial seven to 10 months
- a 10-month wait for pre-existing conditions.
Plus Gap Cover
With Plus Gap Cover, there's no restriction on members' age, and gap cover benefits in-hospital are settled up to 500 percent of the scheme rate. There are unlimited out-patient and PMB benefits, and ER cover has an overall annual limit of R6000 per policy per year.
Additionally, there is cover for:
- co-payments, and admission and penalty fees
- the gap component of specialist out-patient consultations
- the hospital account shortfall
- the first-time diagnosis of defined cancers, paid out in a lump sum of up to R200 000
- the first-time lump sum payment on diagnoses of defined cancers, plus additional cover when oncology limit reached and percentage imposed by scheme up to R200 000; previously diagnosed cancers must be in remission for 5 years
- prostheses, with no sub-limit cover for shortfalls on prosthesis, and corrective surgery.
Value added benefits are a health premium waiver of R2000 per month for six months, and accidental death cover of R5000 for the principal insured and adult dependent, and R3000 for a child.
Ultimate Gap Cover
Ultimate Gap Cover offers the same gap cover benefits as the Plus Gap Cover product, but with cancer benefits capped at a higher value of R400 000.
In addition, this top-tier gap cover product includes:
- a health premium waiver of R3500 per month for six months
- R10 000 and R5000 accidental death cover for adult and child beneficiaries, respectively
- a sub limit enhancer of R100 000 per year, or R20 000 per incident
- an appliance benefit of R5000 per incident.
Why choose Sirago as your gap cover provider?
Advantages of Sirago gap cover:
- all options cover the gap for optometry and dentistry in-hospital
- gap cover benefits for most registered medical professionals
- individual and family rates
- the only provider to assist with the gap portion for specialist out-patient consultations
- lump sum benefits are paid into your bank account
- Sirago gap products are compatible with all registered medical aid schemes in South Africa.
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