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Sirago – Gap-Lite Cover

In-Hospital Benefits

Gap Cover
Will settle claims above Medical Scheme rate or at the stated benefit value.
Additional 200% above Medical Scheme rate
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.
Sub-limit of R25 000 per policy per annum
Limited to R5 500 per claim
Penalty Fee Cover
For the voluntary use of a non-designated service provider / network hospital.
This includes the use of a partial cover network hospital as determined by your medical scheme.
Sub-limit of R3 000 per claim
Maximum 2 claims per policy per annum
Day Hospital/Clinic and/or In Room Surgical Procedures Cover
Will settle the GAP portion of claims
Subject to OAL
PMB Cover Subject to OAL

Out-of-hospital benefits

Emergency Room Cover
This benefit covers an emergency at any registered emergency facility when you require immediate medical treatment due to an accident or illness.
The following benefits collectively accumulate to the sub-limit:
Accident benefit: all costs related to the accidental event will be covered and paid to a maximum value of the sub-limit available, whether you are liable to pay the costs related to the emergency event out of your own pocket or if your medical scheme pays from your savings account.
Illness benefit: when you visit an emergency room in a medical emergency as a result of illness, we will cover the Gap portion only if the medical scheme has paid a portion.
We will cover a GP’s emergency facility where no hospital emergency is available within a 30km radius within the above stated benefit limits.
A sub-limit of R4 000 is applicable

Value Added Benefits

Sira-Go’ Baby
An instruction to add a new-born to the policy must be submitted within 31 days of the birth of the child.
After confirmation of pregnancy, this benefit is for claims for prenatal scans, childhood immunisations or pre-and post-birth tests (to limit) per child.
In the event of twins, the benefit will be doubled, and in the event of triplets, the benefit will be tripled
Sublimit of R2 000