Exact with Gap and Co-pay Cover

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

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

in-hospital gap benefits
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

out-of-hospital gap benefits
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 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.
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.

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