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. |
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| 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. |
| 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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