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Sirago Exact Cover with Gap and Co-Pay

Overall, Sirago Exact Cover with Gap and Co-Pay is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Exact Cover with Gap and Co-Pay Plan starts from R349 ZAR. Sirago has a trust score of 4.4.

🔎 Provider	🥇 Sirago Exact Cover with Gap and Co-Pay
🟥 Years in Operation	30 years
🟧 Underwriters	GENRIC Insurance Company Limited (FSP: 43638)
🟨 Market Share in South Africa	>10%
🟩 Gap Cover Waiting Period	From 3 months (up to 12)
🟦 Do Exclusions Apply	✅ Yes
🟪 Average Monthly Premium	R349
🟥 Oncology Benefit	None
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	None

Sirago Exact Cover with Gap and Co-Pay – 7 Key Point Quick Overview

Sirago Exact Cover with Gap and Co-Pay Overview

The Sirago Exact Cover with Gap and Co-Pay is one of eight plans that starts from R349 per month. Sirago’s Exact Cover with Gap and Co-Pay has benefits for various surgeries, procedures, and treatments in the hospital.

Sirago Gap Cover has eight plans to choose from:

Sirago Exact Cover with Gap and Co-Pay Premiums

🟥 Age Limit	🟥 Monthly Contribution
🟧 Overall Annual Limit per Beneficiary	🟧 R140,000 – R191,000
🟨 Price per Individual who is between 0 – 64 years old	🟨 R349
🟩 Price per Family with beneficiaries from 0 – 64 years old	🟩 R395
🟦 Price per Individual who is >65 years old	🟦 R737
🟪 Price per Family with a beneficiary of >65 years old	🟪 R887

Sirago Exact Cover with Gap and Co-Pay Benefits and Cover Breakdown

The Exact with Gap and Co-Pay option provides supplementary cover for services not included in your medical scheme, including those procedures that your Medical Scheme option specifically excludes in addition to its standard exclusions. This option avails a specific list of procedures. Sirago takes responsibility for negotiating with service providers and directly paying for your claim up to the amounts specified below.

The cover includes the total cost incurred at the hospital and by any other service providers. However, members should note that the following limits apply to Exact Cover:

🟥 Procedure	🟧 Cover Limit	🟨 Procedure	🟩 Cover Limit
🟧 Arthroscopic Surgery	R75,000	Joint Replacement Surgery	R50,000
🟨 Back and Neck Surgery	R75,000	Oesophageal reflux and hiatus hernia surgery	R60,000
🟩 Bunion Surgery	R20,000	Varicose vein surgery	R22,500
🟦 A cochlear implant, auditory brain implant, and internal nerve Stimulator surgery, including the device and processor	R85,000	Knee and shoulder surgery	R20,000
🟪 Dental procedures for reconstructive plastic surgery due to an accident	R80,000	MRI and CT scans due to an accident	R10,000
🟥 Dental procedures for impacted wisdom teeth for children under 18 years old	R15,000	Emergency casualty benefit: Accident & Trauma, Children under 8 years old (max R4 000)	R6,000
🟧 Functional Nasal Surgery	R25,000	Skin disorders, including benign growths and lymphoma	R20,000
🟨 Non-cancerous breast conditions	R20,000	Endoscopic Procedures	R5,000

Exact Cover with Gap and Co-Pay | Gap Cover

✅ This cover bridges the gap between the rate charged by service providers, such as doctors and specialists, and the rate your medical scheme pays.
✅ Sirago will provide cover up to 300% above your medical scheme rates or at the stated benefit value, up to a maximum of 400%.
✅ This is subject to the Overall Annual Limit (OAL).

Exact Cover with Gap and Co-Pay | Co-Payments

✅ This cover is designed for co-payments (including those expressed as a percentage), excesses, or deductibles imposed by a medical scheme for specific procedures, hospital admission fees, scans, or surgical procedures.
✅ Sirago covers up to R21,000 per policy and R7,000 per claim, subject to the OAL.

Exact Cover with Gap and Co-Pay | Gap Cover Premium Waiver

✅ In the event of the death or total permanent disability of the Sirago policyholder, the surviving spouse or adult dependent on the Sirago policy can claim a Premium Waiver benefit.
✅ Sirago will hold the premiums for your policy as a credit for 6 months.

Exact Cover with Gap and Co-Pay | Accidental Death Benefit

This benefit provides cover of R5,000 in the event of the policyholder’s accidental death.

Sirago Exact Cover with Gap and Co-Pay Exclusions and Waiting Periods

Exact Cover with Gap and Co-Pay Exclusions

✅ Medical procedures that are specifically excluded by your medical scheme and are not included in the list of covered procedures.
✅ Procedures on Sirago’s list provided your medical scheme has contributed a portion towards the account.

Any remaining costs after Sirago has paid up to the cover limit for the approved procedure.

Exact Cover with Gap and Co-Pay Waiting Periods

Sirago Gap Cover applies the following waiting periods on Exact Cover with Gap and Co-Pay:

✅ In addition, a 10-month duration exists when claims for the specified procedures or surgeries cannot be lodged.

Pre-existing conditions, specific diseases, and illnesses associated with the services must undergo a 12-month waiting period before receiving treatment.

Sirago Exact Cover with Gap and Co-Pay vs Other Gap Cover Plans

🔎 Provider	🥇 Sirago Exact Cover with Gap and Co-Pay	🥈 iWYZE Gap Cover	🥉 Liberty Optimal Gap Cover
🟥 Years in Operation	30 years	13 years	66 years
🟧 Underwriters	GENRIC Insurance Company Limited (FSP: 43638)	Old Mutual Insure Limited	Guardrisk Life Limited (FSP 76)
🟨 Market Share in South Africa	>10%	15%>	>25%
🟩 Gap Cover Waiting Period	From 3 months (up to 12)	3 – 12 months	12 months
🟦 Do Exclusions Apply	✅ Yes	✅ Yes	✅ Yes
🟪 Average Monthly Premium	R349	Variable	R225
🟥 Oncology Benefit	None	✅ Yes	None
🟧 In-Hospital Benefit	✅ Yes	✅ Yes	✅ Yes
🟨 Out-of-Hospital Cover	None	✅ Yes	✅ Yes
🟩 Maternity Benefit	None	✅ Yes	None
🟦 Scopes and Scans	✅ Yes	✅ Yes	✅ Yes
🟪 Co-payment Cover	✅ Yes	✅ Yes	✅ Yes
🟥 Emergency Room	✅ Yes	✅ Yes	None
🟧 Accidental Cover	✅ Yes	✅ Yes	✅ Yes
🟨 Trauma Counseling	None	None	✅ Yes
🟩 Premium Waiver	✅ Yes	✅ Yes	✅ Yes
🟦 Non-DSP Co-Payment	None	✅ Yes	✅ Yes
🟪 Prostheses	✅ Yes	✅ Yes	✅ Yes
🟥 Travel Cover Extender	None	None	None
🟧 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	✅ Yes

Our Verdict on Sirago’s Exact Cover with Gap and Co-Pay

According to our research, the Sirago Exact Cover with Gap and Co-Pay offers a comprehensive in-hospital cover plan that can supplement your medical scheme, especially for typically excluded procedures.

However, it does have its limitations, particularly when it comes to out-of-hospital treatments, maternity, and cancer coverage. As with any insurance product, it is important to carefully consider your personal health needs and circumstances before choosing a plan.

Sirago Exact Cover with Gap and Co-Pay Frequently Asked Questions

What is the cost of the Sirago Exact Cover with Gap and Co-Pay?

The cost of the Sirago Exact Cover with Gap and Co-Pay starts from R498 per month.

What is the Sirago Exact Cover with Gap and Co-Pay?

The Sirago Exact Cover with Gap and Co-Pay is a comprehensive insurance plan that covers services not included in your medical scheme. It provides cover for a defined list of procedures, manages negotiations with service providers, and makes direct payments for your claim.

What is the Accidental Death benefit in the Sirago Exact Cover with Gap and Co-Pay?

The Accidental Death benefit covers the accidental death of the policyholder at R5,000.

What are the exclusions in the Sirago Exact Cover with Gap and Co-Pay?

The plan does not cover medical procedures listed as specific exclusions by your medical scheme that are not on Sirago’s list of medical procedures. It also does not cover any shortfalls after Sirago has paid the cover limit for the authorized procedure.

What are the waiting periods in the Sirago Exact Cover with Gap and Co-Pay?

There is a 10-month waiting period before claims can be submitted for a procedure or surgery on Sirago’s list of covered procedures. There is also a 12-month waiting period for pre-existing conditions, specific diseases, or illnesses related to the procedures on Sirago’s list.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.