Employee Benefit Cosultants > Listings > Sirago > Sirago – Exact with Gap and Co-pay Cover

Sirago – Exact with Gap and Co-pay Cover

For the Main Member in 2021

Key Benefits

OAL per beneficiary per annum for Gap and Co-pay cover	R174 000
OAL per beneficiary per annum for Exact cover	R100 000

Medical Procedures We Will Cover

Arthroscopic Surgery	R85 000
Back And Neck Surgery	R85 000
Bunion Surgery	R17 500
Cochlear Implant, Auditory Brain Implant and Internal Nerve Stimulator Surgery including the Device and Processor	R80 000
Dental Procedures for Reconstructive Plastic Surgery due to an Accident	R80 000
Functional Nasal Surgery	R25 000
Joint Replacement Surgery	R50 000
Oesophageal Reflux And Hiatus Hernia Surgery	R60 000
Varicose Vein Surgery	R22 500

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.	subject to a sub-limit of R21 000 per policy per annum, Limited to R7 000 per claim

Gap Benefits

Will settle claims up to 300% of the Medical Scheme rate.	Limited to a maximum of 400% or at the stated benefit value.

Waiting Periods

Waiting Periods for Exact Cover

A 12 month waiting period on pre-existing condition-specific disease and/or illness applies to this policy. _{In the event that there are no pre-existing conditions related to the stated conditions within this policy.}
A 10 month waiting period applies where no claims can be submitted for a procedure or surgery related to the stated procedures covered by this policy _{Unless due to an injury resulting from an accident.}
When a new beneficiary joins the policy, _{They are subject to normal underwriting terms and conditions, and waiting perdiods as denoted above will apply.}

Policy Specific Waiting Periods Gap and Co-pay Cover

A 3 month general waiting period is applicable on any new incepted policies and/or additional dependents to the current policy, except in the event of an accident. _{In the event that the policyholder has held a Sirago policy for 12 months or more and wants to upgrade to a higher option, all additional benefits will be subject to a maximum of an additional 3 months waiting period. If the policyholder has held a Sirago policy for less than 12 months and intends to upgrade to a higher option, the waiting periods in the higher option per benefit category is applicable.}
A 10 month waiting period on pre-existing condition specific disease/illness

A 3 month general waiting period is applicable on any new incepted policies and/or additional dependents to the current policy, except in the event of an accident.
_{In the event that the policyholder has held a Sirago policy for 12 months or more and wants to upgrade to a higher option, all additional benefits will be subject to a maximum of an additional 3 months waiting period.

If the policyholder has held a Sirago policy for less than 12 months and intends to upgrade to a higher option, the waiting periods in the higher option per benefit category is applicable.}

A 10 month waiting period on pre-existing condition specific disease/illness

Specific Waiting Periods

A 10 month waiting period for pregnancy and confinement.
A 12 month waiting period on cancer related pre-existing conditions is applicable.