Sirago - Gap Assist Cover Gap Cover

Sirago - Gap Assist Cover Gap Cover

Sirago Gap Assist Cover is the ideal, low-cost gap cover. It includes gap cover for in-hospital medical expense shortfalls at up to 500% of the medical scheme tariff.

It also features cover for co-payments, outpatient surgical procedures and emergency room treatment – and a benefit for medical appliances.

Gap Cover Benefits

Co-payment benefit

Benefit covers all procedural co-payments limited to R42,000, subject to OAL. Limited to R11,000 per claim

Dental benefit

In-Hospital Dental; Shortfalls and Copayments, subject to OAL

Diagnosis benefit

No Benefit

Emergency/casualty benefit

Overall sub-limit of R4,500 per policy per year

Full time students over 21

Covered up to the age of 27 as long as they are full-time students (including if they are on their own option) – they do not have to be unmarried

Gap cover limits

An Overall Annual Limit (OAL) of R164,000 per beneficiary, for in- and out-of-Hospital surgical procedures

Gap cover percentage benefit

Cover for up to 500% of the medical scheme tariff. Limited to a max of 600% or at stated benefit value, for hospital admissions; doctors, specialists, basic radiology, pathology, physiotherapy. Procedures performed as an outpatient basis are also covered (see list of procedures in policy document)

Lives Covered

Main medical scheme member; All family members registered as medical scheme dependants OR no more than 2 Adults and 3 Child dependants on different medical schemes

Maximum entry age

There is no maximum entry age applicable

Oncology benefit

A R100,000 per policy applies once your medical scheme oncology benefit limit has been reached and your require further treatment and a percentage co-payment is applied. Limited to R15,000 per claim.

Oncology supplementary benefit

A R100,000 per beneficiary and subj to OAL is applied when medical scheme oncology benefit is reached and you require further and R50,000 (Stated benefit) for defined rand limit for cancer treatment.

PMB cover

Prescribed Minimum Benefits are covered to a limit of R30,000

Voluntary use of non-DSP for PMB treatment is covered.

*No cover for emergency or involuntary PMB treatment

Sub-limit benefit

No Benefit

Trauma counselling

No Benefit

Gap Cover Contributions

Contributions

Single 0 - 54yrs

R 278


Single 55 - 64yrs

R 344


Single 65yrs+

R 409


Family 0 - 54yrs

R 299


Family 55 - 64yrs

R 371


Family 65yrs+

R 443

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