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 200% of the medical scheme tariff. It also features cover for co-payments, outpatient surgical procedures and emergency room cover, subject to a sublimit.

Gap Cover Benefits

Co-payment benefit

Benefit covers all procedural co-payments limited to R25,000, subject to OAL. Limited to R5,500 per claim

Admission fee limit of R3,000 pppa, max of x2 claims per policy

Dental benefit

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

Diagnosis benefit

No Benefit

Emergency/casualty benefit

Overall sub-limit of R4,000 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 200% of the medical scheme tariff 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

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

Single 0 - 54yrs

R 203


Single 55 - 64yrs

R 244


Single 65yrs+

R 285


Family 0 - 54yrs

R 218


Family 55 - 64yrs

R 272


Family 65yrs+

R 325

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