Sirago - Gap Lite Cover Gap Cover

Sirago - Gap Lite Cover Gap Cover

Sirago Gap-Lite Cover is entry-level, affordable gap cover.

Ideal for the younger generation, it includes in-hospital gap cover at up to 250% of the medical scheme tariff. It also features cover for co-payments, penalty fee cover, out-patient surgical procedures and emergency room treatment, subject to available limits.

Gap Cover Benefits

Co-payment benefit

R25 000 sub-limit per policy per annum. Limited to R7 500 per claim and subject to R191 000 per insured person per annum. PENALTY FEES will be covered up to R5 000 per incident with a maximum of 1 (one) claim per annum for the voluntary use of a Hospital or Day Clinic outside your medical scheme's Designated Network.

Dental benefit

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

Diagnosis benefit

No Benefit

Emergency/casualty benefit

Provides cover when you visit the emergency room for trauma and accident. There is a sub-limit of R4 500 for Emegency Room cover. This benefit covers an emergency at any registered emergency, 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 emergency facility if no emergency hospital is available within a 30 km radius.

Ambulance costs are not covered by this benefit

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

R191 000 Overall Annual Limit (OAL) per insured person per annum

Gap cover percentage benefit

We cover up to 250% above your medical scheme rates or at the stated benefit value, to a maximum of 350%. Subject to the OAL.

Lives Covered

All dependants are covered under the principal member's medical aid. If membership split on more than two Medical Aids / options cover will be limited to family size i.e. 2 adults and unlimited children up to 21 and to age 27 if full time students.

Maximum entry age

There is no maximum entry age applicable

Oncology benefit

No Benefit

Oncology supplementary benefit

No Benefit

PMB cover

Prescribed Minimum Benefits are covered to a limit of R50,000, paid to a max of R20,000 per claim

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

R249 for individuals (0 - 64)


R269 for families (0 - 64)


R369 for individuals (65+)


R419 for families (65+)

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