Ultimate Gap Cover

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

INDIVIDUAL, UNDER 65
R344 / mon
FAMILY, UNDER 65
R389/ mon
FAMILY, 65+
R516/ mon

Benefits

Image



Gap Cover:
We will settle claims at an additional 500% above Medical Scheme Rate or at the stated benefit value.

Co-Pay Cover:  Limited to the OAL of this policy. If 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 R16 000 per claim.
Admission Fee Cover: The benefit is limited to R5 500 per admission.
Penalty Fee Cover: R9 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 Procedure Cover: We will settle the Gap portion of claims.
Primary Care Consultation Benefits:
R3 500 sub-limit per policy per annum. GP claims x 3 with a R325 limit per consultation. Dental claims x 3 with a R350 limit per consultation. Alternative Therapy x 3 with a limit per consultation of R450 per claim. Applicable to the Gap portion only. (This applies to Biokineticist, Physiotherapist, Chiropractors and Occupational Therapists )
Emergency Room Cover:
R11 000 sub-limit. Emergency Room – Accident and Trauma Treatment R8 500. Emergency Room - Illness Treatment R2 500, for the Gap portion only.

PMB Cover: Subject to OAL for the use of Non-DSP facilities for PMB treatments.
Cancer Benefit: A R450 000 limit per policy applies once your Medical Scheme Oncology benefit limit has been reached and a percentage Co-payment is applied. 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 300% of the claim. In addition to this, Sirago will make available R25 000 (Stated Benefit) for the reconstruction of the non-affected breast, with supporting documentation.
Cancer Boost: Limited to R100 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:
R6 500 sub-limit per policy. R1 350 per claim. 3 Claims per beneficiary per annum for the GAP portion only.

Hospital Account Shortfalls: R5 000 sub-limit per policy. Maximum of R1 250 per claim. Maximum 3 claims per beneficiary per annum.
Preventative Care Cover: R8 000 sub-limit per policy. R1 200 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.
Sub-Limit Enhancer: Sub-limit of R100 000 per policy per annum subject to R25 000 per claim. Maximum of 2 claims per beneficiary limited to 4 claims per policy per annum. The Sub-limit Enhancer benefits are limited to MRI Scans, CT Scans and Internal Prosthesis only.
Appliance Benefit: Maximum claim amount R6 000 per policy per annum for the Gap component as per the defined list: Hearing Aids; Wheelchairs; C-PAP Machine; Humidifiers; Insulin Pump; Glucometer; Nebulisers and Intraocular Lenses.
Frail Care Benefit: R6 500 sub-limit per policy. Maximum of R800 per claim. 5 Claims per beneficiary per annum. This includes the use of step down facilities as prescribed by your Medical Scheme as being an acceptable alternative facility.
Trauma Counselling: R5 000 sub-limit per policy per annum. Limited to a stated benefit of R750 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.

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

Value Added Benefits

Image

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. This benefit cannot be transferred, ceded or converted to cash.
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 of R4 000 per month for a 6 month period will be paid towards your 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:
R12 000 principal, R8 000 adult dependent, R5 000 per child policy per life.
Cancer Cover (Initial Diagnosis):
R20 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.

asset-2.png

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.

asset-4.png

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

Follow Us

Copyright © 2019 Sirago Underwriters.

Search

+880 322448500 Beverly Boulevard Los Angeles