Plus Gap Cover

Your whole policy has an Overall Annual Limit (OAL) of R150 000 per beneficiary to utilise.

INDIVIDUAL, UNDER 65
R270 / mon
FAMILY, UNDER 65
R308/ mon
FAMILY, 65+
R434/ mon

Benefits

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Gap Cover:

Will settle claims up to 500% of your Medical Scheme rate. Limited to a maximum of 600% or at the stated benefit value.
Co-pay Cover:
Limited to the Overall Annual Limit of this policy. However, your Medical Scheme defines your co-payment as a percentage of the benefit, your co-payment benefit will be limited to a maximum payment of R13 000 per claim.
Admission Fee Cover:
Paid to a maximum of R3 500 per admission. A maximum of 4 claims per policy per annum.
Penalty Fee Cover:
R5 500 per claim, a maximum of 2 claims per policy per annum for the voluntary use of a Non-DSP. Including the use of a partial cover network hospital as determined by your Medical Scheme
Day Hospital / Clinic and/or In Room Surgical Procedures Cover:
Will settle the Gap portion of claims.
Emergency Room Cover:
R6 500 sub-limit. Emergency Room – Accident and Trauma Treatment R4 500. Emergency Room - Illness Treatment R2 000, for the Gap portion only.
PMB Cover:
Subject to OAL for use of Non-DSP facilities for PMB treatments.
Cancer Benefit:
A R300 000 limit per policy applies once your Medical Scheme Oncology benefit limit has been reached and a percentage Co-payment is applied. With a limit of R60 000 per claim for Cancer Co-payments. Cancer Cover incorporates Co-payment cover and Biological drugs. In order to access this benefit you need to be on a registered treatment plan with your Medical Scheme. In the event of the Medical Scheme approving reconstructive surgery on the affected breast, we will cover the Gap portion up to 200% of the claim. In addition to this, Sirago will make available R15 000 (Stated Benefit) for the reconstruction of the non-affected breast, with supporting documentation.
Cancer Boost:
Limited to R50 000 per beneficiary and subject to the OAL of R150 000 per beneficiary per annum. This benefit is restricted to policyholders whose Medical Scheme options has a rand value for Cancer Cover. The Cancer Boost benefit can only be claimed once your rand limit on your Medical Scheme Oncology benefit has been reached and you need further approved treatment. This benefit is furthermore dependent upon the Insured having and participating in an approved Treatment Plan prescribed by their Medical Scheme.
Day To Day Specialist Consultation Fee:
R4 000 sub-limit per policy. Mamimum of R825 per claim. 3 claims per beneficiary per annum for the GAP portion only
Trauma Counselling:
R3 000 sub-limit per policy per annum. Limited to a stated benefit of R600 per claim. You will be covered within the first 6 months after a traumatic event with a registered medical professional. This benefit covers you but not limited to; Dread Disease, Hijacking and or Violent Crimes at the discretion of the Insurer on the provision of supporting documentation
Hospital Account Shortfalls:
R3 000 sub-limit per policy per annum. Maximum of R750 per claim. Maximum 3 claims per beneficiary per annum
Preventative Care Cover:
R3 600 sub-limit per policy. R1 000 per claim. Maximum 3 claims per beneficiary per annum. Defined as: Pap Smear, Cholesterol Test, Blood Glucose Test, Flu Vaccination, Childhood Immunisation, Bone Density Scans, Prostate Specific Antigen Tests, Mammogram, Contraceptive Device Implantation.

The policy wording supercedes any marketing documentation and all benefits will be payable against the policy wording terms and conditions only.

Value Added Benefits

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THESE DO NOT FORM PART OF THE AGGREGATED OAL R150 000 LIMIT

Gap Cover Premium Waiver:
In event of Death and or Total Permanent Disability of the Premium Payer of the Sirago policy. The Premium Waiver is directly linked to your policy premium per month as indicated in your Schedule of Insurance. This benefit is not paid in cash, but held as a credit against the policy for a 12 month period. Should there be any premium adjustments within the 12 month period, the credit balance available for the rest of the waiver period, will be adjusted accordingly.
Medical Scheme Premium Waiver:
Payable in the event of Death and or Total Permanent Disability of the Premium Payer of the Medical Scheme. A stated benefit up to R3 000 per month for a 6 month period will be paid to the beneficiary for the upkeep of their Medical Scheme contributions. In order to receive the benefit the Gap cover policy and Medical Scheme Membership must remain active during this period. A certificate of membership from your Medical Scheme must be presented monthly for authentication of current membership.
Accidental Death:
R6 000 principal, R5 000 adult dependent, R3 000 per child per policy per life.
Cancer Cover (Initial Diagnosis):
R10 000 upon the initial diagnosis of cancer per beneficiary per annum as defined.
Sira-Go’ Baby:
A branded Sirago Welcome Pack will be couriered to your physical address as per your application form upon receipt of the instruction to add the newborn child to the policy within 30 days of the birth. Subject to availability.
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Sirago Underwriting Managers (Pty) Ltd is an Authorised Financial Services Provider (FSP:4710).
Underwriting Agency for GENRIC Insurance Company Limited (FSP:43638).
GENRIC is an Authorised Financial Services Provider and Registered Short-term Insurer.

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Contact

Tel: 010 599 1163

Fax: 086 508 2292

Email: info@sirago.co.za

Address: Midrand Business Park, Building 3, 563 Old Pretoria Main Road, Midrand, 1685

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