Exact with Gap & Co-pay Cover

EXACT WITH GAP & CO-PAY COVER

Cover for specific procedures that your medical scheme excludes, with additional gap and co-payment cover.

Monthly premiums

Why choose Exact with Gap and CoPay?

The Exact with Gap and Co-Pay option provides cover for specific procedures that your medical scheme excludes, with additional Gap and Co-payment cover for the events that are covered by the medical scheme. The Exact Cover option provides access to a defined list of stated procedures when your Medical scheme option excludes those specific procedures over and above their standard exclusions. Sirago will negotiate with all service providers on your behalf and pay the claim directly, up to the stated amounts as listed below. The cost of the hospital and all service providers are included in the cover limit.” TO: “Sirago will negotiate with all service providers on your behalf and pay the claim directly, up to the stated amounts as listed under the Exact benefit cover. The cost of the hospital and all service providers are included in the cover limit.

Key benefits

OAL per beneficiary per annum: R213 000

In-hospital Benefits

Gap Cover

Gap Cover will settle the claims up to 300% of the medical scheme rate. Limited to a maximum of 400%, or at the stated benefit value.

Co-payments

The excesses imposed by your medical scheme payable to a maximum rand limit for specified procedures or tests. Cover for co-payments imposed by medical schemes for hospital admissions, scans and surgical procedures. Co-payment benefits are subject to OAL per policy per annum, limited to R12 000 per claim, including co-payments charged as a percentage.

Casualty Benefit

Sub-limit of R6 500 Accident & Trauma. Child Casualty Illness – costs related to the illness for children 12 and younger – stated benefit, R2 000 per claim

Value-added Benefits

Gap Cover Premium Waiver

In the event of accidental death or total permanent disability of the Sirago policyholder, we will keep the premiums for your policy for a 6-month period as a credit. This benefit may be claimed by the surviving spouse or adult dependent on the Sirago policy.

Accidental Death

This benefit will cover the accidental death of the policyholder only at R5 000.

Gap Cover

Gap Cover will settle the claims up to 300% of the medical scheme rate. Limited to a maximum of 400%, or at the stated benefit value.

Co-payments

Casualty Benefit

Sub-limit of R6 500 Accident & Trauma. Child Casualty Illness – costs related to the illness for children 12 and younger – stated benefit, R2 000 per claim

Gap Cover will settle the claims up to 300% of the medical scheme rate. Limited to a maximum of 400%, or at the stated benefit value.

Sub-limit of R6 500 Accident & Trauma. Child Casualty Illness – costs related to the illness for children 12 and younger – stated benefit, R2 000 per claim

Gap Cover Premium Waiver

Accidental Death

This benefit will cover the accidental death of the policyholder only at R5 000.

Procedures we cover


Arthroscopic Surgery	R90 000
Back and neck surgery and treatment	R90 000
Bunion surgery	R20 000
Cochlear implant, auditory brain implant and internal nerve stimulator surgery including the device and processor	R85 000
Dental procedures for reconstructive plastic surgery due to an accident	R80 000
Dental procedures for impacted wisdom teeth for children under 18 year old	R15 000
Functional nasal surgery	R30 000
Joint replacement surgery	R55 000
Oesophageal reflux and hiatus hernia surgery	R60 000
Varicose vein surgery	R22 500
Knee and shoulder surgery	R30 000
MRI and CT scan due to an accident	R10 000
Skin disorders including benign growth and lymphomas	R20 000
Endoscopic procedures	R8 000
Tonsillectomy, grommets, and adenoidectomy	R10 000 pp, R15 000 combined procedure

GET A GAP COVER SOLUTION

that is tailored for your unique requirements

Get a quote

Explore our gap products