TABLE OF CONTENTS

• Introduction
  • What is Transfer of cover?
• Supporting Documentation required 
• The information we look at when applying Transfer of Cover Underwriting
• The difference between cover for 12 months or more and cover for less than 12 months
  • Underwriting applicable when transferred from another gap provider and they were on cover for 12 consecutive months or more:
  • Underwriting applicable when transferred from another gap provider and they were on cover for less than 12 consecutive months:
• The effect on Premiums

Introduction

This article explains the Transfer of Cover Underwriting process for new business and additional dependant application forms received.  

What is Transfer of cover?

The Transfer of Cover Underwriting refers to policy holders and dependants who belong to a Gap provider for a certain duration of time and elect to join Sirago. From the point of terminating their cover with the previous gap provider to joining Sirago, there must not be a break in cover (ie. Uninterrupted cover) in order for the transfer of cover concession to be applied.   

Supporting Documentation required 

1. A fully completed Application or Transfer of Cover Form is expected from new members or an Additional Dependant Application form for dependants to be registered to an existing policy. 
2. Relevant supporting previous proof of cover documentation from the previous Gap provider
   1. A recent copy, not older than 30 days of the previous gap provider’s master policy schedule, to prove continuous creditable cover; or
   2. A recent copy, not older than 30 days of the previous gap cancellation certificate to prove continuous creditable cover

NB – For points 1 & 2 above the original inception date and the product option name must be reflected.

The information we look at when applying Transfer of Cover Underwriting

The following information is vital when looking at applying transfer of cover as the Transfer of Cover Underwriting concession is dependent on the submission of proof for continuous creditable cover.

1. Is the client transferring from to Sirago where the policies have been on cover for 12 (twelve) months or longer;
2. Is the client transferring from to Sirago where the policies have been on cover for less than 12 (twelve) months;
3. Who (ie. policy holder & dependants)  is covered on the previous provider;
4. Which Gap provider option are they on; and
5. Which Sirago Gap option have they selected.

The difference between cover for 12 months or more and cover for less than 12 months

1. In the event that the policy holder and dependants have been on cover for 12 months or more, no 3 (three) month general waiting periods or waiting periods on pre-existing conditions will apply however general policy terms, conditions & exclusions will apply.
2. In the event that the policy holder and dependants have been on cover for less than 12 months and these policies are currently serving waiting periods, the balance of the unexpired waiting periods will be applicable, no 3 (three) month general waiting periods however general policy terms, conditions & exclusions will apply.

Underwriting applicable when transferred from another gap provider and they were on cover for 12 consecutive months or more:

• Transferring from another Gap provider to Sirago (Benefit A to A) where the policies have been on cover for 12 (twelve) months or longer:
  • 3-month general waiting periods – WAIVED 
  • Pre-existing condition specific waiting periods – WAIVED 
  • Policy specific waiting period – WAIVED 
  • Policy specific benefit categories waiting periods – WAIVED  
  • General policy terms, conditions & exclusions - APPLICABLE

Example:

Transfer of Cover: Member was previously covered with Gap Provider as from 01 November 2011 until 31 January 2020. No 3 (three) month general waiting periods or waiting periods on pre-existing conditions apply and have been waived. General policy terms, conditions & exclusions will apply

• Transferring from another Gap provider to Sirago (Benefit A to B) where the policies have been on cover for 12 (twelve) months or longer:
  • 3-month general waiting periods – WAIVED 
  • Pre-existing condition specific waiting periods – WAIVED 
  • Policy specific waiting period – WAIVED 
  • Policy specific benefit categories waiting periods – WAIVED  
  • 3-month waiting period on all additional benefits – APPLICABLE
  • General policy terms, conditions & exclusions - APPLICABLE 

Example:

Transfer of Cover: Member was previously covered with Gap Provider as from 01 November 2011 until 31 January 2020. No 3 (three) month general waiting periods or waiting periods on pre-existing conditions apply and have been waived. General policy terms, conditions & exclusions will apply.

A 3 (three) month waiting period on Additional Benefits is imposed as follows:

Step Down, Cancer Benefit - Boost, PMB Cover, Gap Policy Premium Waiver Benefit. Please note the various limits applicable.

Underwriting applicable when transferred from another gap provider and they were on cover for less than 12 consecutive months:

• Transferring from another Gap provider to Sirago (Benefit A to A) where the policies have been on cover for 12 (twelve) months or less:
  • A 3-month general waiting periods – WAIVED 
  • Balance of pre-existing condition specific waiting periods carried over – APPLICABLE
  • Policy specific waiting period – WAIVED 
  • Policy specific benefit categories waiting periods – WAIVED  
  • The balance of unexpired Policy Specific Waiting Periods on certain procedures may be applied
  • General policy terms, conditions & exclusions - APPLICABLE

Example:

Transfer of Cover: Member was previously covered with Gap Provider as from 01 October 2019 until 31 December 2019. No 3 (three) month general waiting periods apply and have been waived. Balance of pre-existing conditions from previous provider apply. General policy terms, conditions & exclusions will apply.

Balance of 9 (Nine) months pre-existing conditions excluded from previous Gap provider are applicable from inception:

Cardiovascular Disorders (Unspecified), Related conditions, surgery, treatment and complications thereof.

• Transferring from another Gap provider to Sirago (Benefit A to B) where the policies have been on cover for 12 (twelve) months or less:
  • A 3-month general waiting periods – WAIVED 
  • Balance of pre-existing condition specific waiting periods carried over – APPLICABLE
  • Policy specific waiting period – WAIVED 
  • Policy specific benefit categories waiting periods – WAIVED  
  • A 3-month waiting period on all additional benefits – APPLICABLE
  • The balance of unexpired Policy Specific Waiting Periods on certain procedures may be applied
  • General policy terms, conditions & exclusions - APPLICABLE

Example:

Transfer of Cover: Member was previously covered with Gap Provider as from 01 October 2019 until 31 December 2019. No 3 (three) month general waiting periods apply and have been waived. Balance of pre-existing conditions from previous provider apply. General policy terms, conditions & exclusions will apply.

Balance of 9 (Nine) months pre-existing conditions excluded from previous Gap provider are applicable from inception:

Cardiovascular Disorders (Unspecified), Related conditions, surgery, treatment and complications thereof.

A 3 (three) month waiting period on Additional Benefits is imposed as follows:

Step Down, Cancer Benefit - Boost, PMB Cover, Gap Policy Premium Waiver Benefit. Please note the various limits applicable.

The effect on Premiums

Premiums payable for benefit cover are determined by age and family size, and is based on the following two age group categories: Prospective policyholders who are 64 (sixty-four) years and younger and 65 (sixty-five) years or older, will be charged different premiums when applying for cover as either individuals or families.

The age of the policyholder is linked directly to the Certificate of Membership (COM) as issued by your registered medical scheme. The benchmark for premium determination is based on the prospective policyholder’s age at the inception of the policy.

Premiums would be determined by the policy holder’s entry age at inception of the previous gap provider. All transferring policyholders with an entry age of under 64 and 65 + years will pay premiums as determined by the relevant age category premium table and duration of uninterrupted cover from the previous Gap provider.

If the principal was under the age of 64 years at inception of their policy (ie. their entry age with the previous provider is under 64 years) they will qualify to pay under 64 rates on their Sirago gap cover policy

The implementation and preservation of the above relies on accurate and full disclosure of each beneficiary’s medical history on the application form as well as the supporting proof of continuous, that is, without a break in cover from the previous provider.

Sirago is on a customer services journey to ensure we add value to your business and is committed to providing our clients, brokers and stakeholders with an unmatched level of service excellence at all times.