Sirago Exact Cover
Overall, Sirago Exact Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Exact Cover Plan starts from R195 ZAR. Sirago has a trust score of 4.4.
| 🔎 Provider | 🥇 Sirago Exact Cover |
| 🟥 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 | R195 |
| 🟥 Oncology Benefit | None |
| 🟧 In-Hospital Benefit | ✅ Yes |
| 🟨 Out-of-Hospital Cover | None |
Sirago Exact Cover – 7 Key Point Quick Overview
- ✅ Sirago Exact Cover Overview
- ✅ Sirago Exact Cover Premiums
- ✅ Sirago Exact Cover Benefits and Cover Breakdown
- ✅ Sirago Exact Cover Exclusions and Waiting Periods
- ✅ Sirago Exact Cover vs Other Gap Cover Plans
- ✅ Our Verdict on Sirago’s Exact Cover
- ✅ Sirago Exact Cover Frequently Asked Questions
Sirago Exact Cover Overview
The Sirago Exact Cover is one of eight plans that starts from R195 per month. Sirago’s Exact Cover has benefits for procedures and surgeries excluded from medical aid cover. Furthermore, Sirago negotiates with service providers and pays claims directly according to a predefined rate.
Sirago Gap Cover has eight plans to choose from:
Sirago Exact Cover Premiums
| 🟥 Age Limit | 🟥 Monthly Contribution |
| 🟧 Overall Annual Limit per Beneficiary | 🟧 R140,000 |
| 🟨 Price per Individual who is between 0 – 64 years old | 🟨 R195 |
| 🟩 Price per Family with beneficiaries from 0 – 64 years old | 🟩 R225 |
| 🟦 Price per Individual who is >65 years old | 🟦 R412 |
| 🟪 Price per Family with a beneficiary of >65 years old | 🟪 R508 |
Sirago Exact Cover Benefits and Cover Breakdown
If your selected health insurance policy explicitly omits a particular service, Sirago Exact Cover will continue to provide cover if the service is part of a pre-established list of covered services. Sirago will handle all discussions with service providers and settle your claim up to the outlined amounts below. Moreover, the expenses covered encompass the cost charged by the hospital and all other service providers.
Members are advised to be aware that the following restrictions 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 |
Sirago Exact Cover Exclusions and Waiting Periods
Exact Cover Exclusions
The following are excluded from the cover by Sirago on the Exact Cover:
- ✅ Sirago does not enumerate any medical procedures your health insurance plan specifically excludes.
Deficits that remain after Sirago has fulfilled the cover limit for the approved procedure, for procedures on Sirago’s list, provided that your health insurance plan has contributed a portion towards the account.
Exact Cover Waiting Periods
Sirago Gap Cover applies the following waiting periods on Exact Cover:
- ✅ 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 vs Other Gap Cover Plans
| 🔎 Provider | 🥇 Sirago Exact Cover | 🥈 Cura Administrators Gap Standard | 🥉 Kaelo Gap Core |
| 🟥 Years in Operation | 30 years | 26 years | 19 years |
| 🟧 Underwriters | GENRIC Insurance Company Limited (FSP: 43638) | GENRIC Insurance Company Limited | Centriq Insurance Company Limited |
| 🟨 Market Share in South Africa | >10% | <5% | <1% |
| 🟩 Gap Cover Waiting Period | From 3 months (up to 12) | 3 – 12 months | 12 months |
| 🟦 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Average Monthly Premium | R195 | R281 | R255 |
| 🟥 Oncology Benefit | None | None | None |
| 🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟨 Out-of-Hospital Cover | None | None | None |
| 🟩 Maternity Benefit | None | None | None |
| 🟦 Scopes and Scans | ✅ Yes | ✅ Yes | None |
| 🟪 Co-payment Cover | None | ✅ Yes | None |
| 🟥 Emergency Room | ✅ Yes | ✅ Yes | None |
| 🟧 Accidental Cover | ✅ Yes | None | ✅ Yes |
| 🟨 Trauma Counseling | None | None | None |
| 🟩 Premium Waiver | None | None | ✅ Yes |
| 🟦 Non-DSP Co-Payment | None | None | None |
| 🟪 Prostheses | ✅ Yes | None | None |
| 🟥 Travel Cover Extender | None | None | None |
| 🟧 Accidental Death/ Permanent Disability | None | None | ✅ Yes |
Discover more about the Best Medical Aids in South Africa Covering Braces
Our Verdict on Sirago’s Exact Cover
The Sirago Exact Cover is a comprehensive plan that fills the gaps left by your medical scheme, especially for specific procedures that are typically excluded. In addition, it offers a substantial overall annual limit per beneficiary, and the direct payment of claims simplifies the process for the policyholder.
However, it has some limitations including waiting periods for certain procedures and conditions.
Sirago Exact Cover Frequently Asked Questions
What is Sirago’s Exact Cover?
Sirago Exact Cover is a specialized insurance product that covers certain medical procedures specifically excluded from your chosen medical insurance plan. It covers the total cost incurred by the hospital and all other service providers for these procedures.
How do Sirago Exact Cover handle payments and negotiations with service providers?
Sirago manages all negotiations with service providers under the Exact Cover plan. They also make direct payments on your claim up to the specified amounts.
Are there any limitations to the cover provided by Sirago Exact Cover?
Yes, there are certain limitations to the cover provided by Sirago Exact Cover. For instance, it does not cover out-of-hospital or day-to-day treatments or procedures, maternity, or cancer-related treatments.
Are there any waiting periods associated with Sirago Exact Cover?
Yes, there is a 10-month waiting period during which no claims for the specified procedures or surgeries can be submitted. Additionally, pre-existing conditions, certain diseases, and illnesses related to the services must wait 12 months before receiving treatment.
What happens if the cost of a procedure exceeds the cover limit under Sirago Exact Cover?
If the cost of a procedure exceeds the cover limit under Sirago Exact Cover, any shortfalls after Sirago has paid the cover limit for the authorized procedure will be the member’s responsibility.
