Please note: That these Benefits and contributions introduced in these Brochures are as per information provided to Profcon, an accredited intermediary. Certain benefits may be subject to approval by the Council for Medical Schemes. The registered rules of the scheme supersede this
guide at all times.
Contact our offices if you are in need of advice or assistance.
WHO IS COVERED BY THIS POLICY?
The policy wording supersedes any marketing documentation and all benefits will be payable against the policy
wording terms and conditions only. This policy will cover the policyholder and dependants who are listed on the
schedule of Insurance.
Family Cover is limited to 2 Adults and 3 Child dependants. This will apply if there are multiple medical schemes or options within the same family.Individual cover is limited to no more than 1 individual.
Please Note: Cover is limited to all dependents under the main member or spouses medical aid. If on more than 2 medical aids / options, family cover will be limited to 2 adults and 3 children up to 21, and age 27 if full time students.
Child dependant is up to the age of 21, however cover can be extended to the age of 27 for full-time students (documented proof of a full-time student is required to evidence dependents over the age of 21.
Sirago has two different age based premium tables. The benchmark for premium determination is 65 years old.
– Any current policy holder who is 65 years old or older, as at the 1st January 2018 will be charged the 65+ premium.
– Any prospective policy holder who incepts a policy as from the 1st January 2018 and any other period during 2018 who is already 65 years old or older will be charged the 65+ premium
– Any current or prospective policy holder who is 64 years or younger will be charged the 64 and under premiums.
– Premiums are applicable for the duration of the relevant period or until the principal policy holder turns 65 years old and will be defaulted to the new premium table with effect from the 1st day of the following month of their birthday.
Benefits do not change during this period and nor does any underwriting criteria.
– Personalised Customer Service.
– Loyal Partnership with Sirago.
– GAP Cover Solutions.
– Cover for in and out of Hospital.
– Cover for Specialist Disciplines.
– Standard and Flexible Waiting Periods.
– Emergency Room Cover.
– No Maximum Entry Age.
– We provide cover for you and your family either on a Single Medical Scheme or on Multiple Schemes.
– We pride ourselves on effective Turn-Around Times so as not to Compromise Policyholders.
– A Stated Benefit is paid straight into your bank account or arrangements can be made to settle directly with
the providers.
– We have Weekly Claim Runs.
Sirago Gap Cover brochure 2018
UNIQUE SELLING POINTS
DID YOU KNOW?
YOU ARE UNDER NO OBLIGATION TO
DIVULGE ANY INFORMATION ABOUT YOUR
PERSONAL INSURANCE PORTFOLIO TO ANY
PROVIDER OR OUTSIDE PARTY, EVEN IF THE
HOSPITAL OR SPECIALIST REQUESTS IT.
HOW TO CLAIM?
Step 1: Report Your Claim
You need to report your claim to us as soon as possible but not later than 30 days after any health event.
This includes events for which you do not want to claim but which may result in a claim in the future. Should you
be incapacitated and not be able to make contact, you may get someone to contact us on your behalf.
Step 2: Submit Your Documents
All required relevant documents must be submitted to us within 90 days after your medical scheme paid their
portion of the claim.
Step 3: Supporting Documents
• Fully completed and signed claim form for each event;
• All hospital and related accounts substantiating your claim;
• Your medical scheme statement showing all the payments made by you or your medical scheme for the health
event.
• Completed medical reports substantiating the clinical information or any other documentation as requested
by the underwriter.
• Pre-authorisation letter from your medical scheme for co-payment claims.
• In the event of a value added benefit claim all supporting documentation and certification are required by the
insurer, which would include a death certificate and /or a permanent disablement certificate from a registered
medical practitioner.
“HEALTH IS NOT VALUED
TILL SICKNESS COMES”
– THOMAS FULLER
FOR GAP COVER, PLUS GAP COVER AND ULTIMATE GAP COVER
These apply before you are able to claim from specific policy benefits
General Waiting Periods:
• A 3 month waiting period is applicable on any new incepted policies and / or additional dependants to the
current policy, except in the event of an accident.
• A 10 month waiting period on pre-existing condition specific disease or illness.
Policy Specific Waiting Periods:
• A 12 month waiting period on Cancer related pre-existing conditions is applicable.
The following policy specific exclusions apply:
– First 6 months of the policy no benefit available.
– 7 – 10 months after inception benefit payable rate of 50%.
– 11 months onwards full benefits are available.
Specific Waiting Periods:
• A 10 month waiting period applies for pregnancy and confinement.
• Accidental Death and premium waiver are always subject to a 6 month waiting period.
Your whole policy has an Overall Annual Limit (OAL) of R150 000 per beneficiary to utilise. The policy wording supercedes any marketing documentation and all benefits will be payable against the policy wording terms and conditions only.
Cancer Cover (Initial Diagnosis):
Gap Cover Premium Waiver:
Medical Scheme Premium Waiver:
Accidental Death:
Sira-Go’ Baby:
VALUE ADDED BENEFITS
THESE DO NOT FORM PART OF THE AGGREGATED OAL LIMIT
KEY: PPPA – Per Policy Per Annum; OAL – Overall Annual Limit; PP – Per Policy
Enjoy An Exclusive Sira-Go’ Baby Welcome Pack
SIRAGO GOV-GAP
WHAT IS GOV-GAP COVER?
This product is a tailor made solution for government employees who need to optimise their health care cover portfolio and premiums covered by persal. Subject to your Overall Annual limit (OAL) of R150 000. The policy wording supercedes any marketing documentation and all benefits will be payable against the policy wording terms and conditions only.