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, penalty fee cover, cancer cover, out-patient surgical procedures and emergency room treatment – and a benefit for medical appliances.
Gap Cover Benefits
| Co-payment benefit |
R42 000 sub-limit per policy per annum. Limited to R11 000 per claim and subject to R191 000 per insured person per annum. PENALTY FEES will be covered up to R6 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 |
No Benefit |
| Diagnosis benefit |
No Benefit |
| Emergency/casualty benefit |
Overall sub-limit of R6,500 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 R191,000 per beneficiary per annum (from 1 April 2023), 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 |
The oncology co-payment is applicable to the copayment imposed by the medical aid once the oncology limit is reached. There is a limit of R20 000 per incident. Subject to R191 000 per insured person per annum. |
| Oncology supplementary benefit |
Cancer Boost Benefit is limited to R50 000 per insured person per year and subject to R191 000 per insured person per year. This can be claimed once your Rand limit on your Medical Scheme Oncology benefit has been reached and you need further treatment |
| PMB cover |
Prescribed Minimum Benefits are covered subject to OAL 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 |
R342 for individuals (ages 0 - 64) R539 for individuals (ages 65+) R371 for families (ages 0 - 64) R583 for families (ages 65+) |
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