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Welcome to Sirago Gap Cover.

Sirago QUOTES MADE EASY

Sirago Gap Cover: Sirago Underwriting Managers focus on offering unique Gap Cover products for all South African medical aid members. For more than 20 years, Sirago has been in operation, and is well known for its affordable options tailored to different needs and budgets.

No Obligation Quotes – Free Brokerage Services

By simply filling in the form provided, one of our Gap Cover Experts will contact you via phone or email. Should you take out a Gap Cover policy, you will receive our market leading brokerage services free of charge.

Applicants must be a medical aid scheme member.

Fill in our easy Gap Cover quote form provided.

One of our Sirago experts will contact you right back!

2025 Brochure About Gap Cover Get Medical Aid

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Page Contents

• Sirago Gap Cover

Co-payment Cover
Prescribed Minimum Benefits

• Watch Sirago Video

• 2025 Sirago Updates

• Sirago Products

Gap Lite
Gap Assist
Plus Gap
Ultimate Gap
Exact
Exact + Gap & Co-pay

• Sirago Gov Gap

• Sirago Waiting Periods

Sirago Gap Cover

Get family cover from R291 per month!

Sirago offers Gap Cover for hospitalisation shortfalls including co-payment cover and cover for non-designated service providers for prescribed minimum benefit conditions. Focusing on quality assurance, Sirago offers some of the best customer service on the market. Visit Sirago Website >

Market leading personalised customer service.

Gap Cover for in and out-of-hospital procedures or services.

Day-to-day shortfall cover for GP’s, specialists, dentists, and therapy.

Fast claim settlements, Sirago pays a Stated Benefit directly into your bank account.

Co-payment Cover

Co-payment is the fixed amount excess imposed by your medical aid scheme. This will include specific in or out of hospital procedures, for example CT scans, MRI scans, ultrasound scans and scopes.

Prescribed Minimum Benefits

Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical aid members have access to certain minimum health services. The aim is to provide people with continuous affordable care.

What Our Clients Have To Say

Hi David,

I have received the money for the second claim.

From my side, I just want to say a big thank you for all your help, you have really made my life with these claims so much easier. And given I’m home with a newborn, I am really grateful for the extra mile and excellent service from your side.

Have a good week.

Thanks
Chantelle

2025 Updates

SIRAGO GAP COVER SERIES

Click to View Or Download 2025 Products Brochure.

2025 Brochure

Sirago Guide Brochure

Sirago Gap Cover products are tailored to fit your budget.
Adaptable, modern solution for gap insurance that meets your specific needs.

Sirago Gap Cover
2025 Products

Benefits & Rand figures displayed are prone to change without notice, contact us for latest benefits & pricing.

Core Cover

Core Cover
Premium	Age 0-64: Single: R360 Family: R 415
	Age limit is 64





Overall Annual Limit	R 213 000 per person per annum
Cover	Claims settled up to 350% above the
	scheme rate and to a max of 400%.





Co-Payment Cover	Co-payment must be part of your medical scheme
	rules.
	Penalty fee of R11 500 per claim.
	Cancer co-payment benefit


Sub-limit benefit	R26000 per policy and R950 per claim.



Oncology & biologicals	No Benefit
	Co-payment if not PMB



Additional Benefits	Exact Cover Benefits
Cover for Day hospital/ clinic or in-room procedure	Covers the shortfall
Primary Care	No Benefit
Specialist consultant fee	No Benefit



Emergency Room Cover - Accident and Emergency	R2000 casualty benefit
Preventative Care	No Benefit
Appliance benefit	No Benefit
Trauma Counselling	No Benefit
Accidental Death	No Benefit
Child related illness	No Benefit
	Sirago Baby R1500
Gap Premium Waiver	No Benefit
Medical Aid Premium Waiver	No Benefit
Initial Cancer Diagnosis	No Benefit
Hospital account shortfalls	R4500 per policy,and R950 per claim.

Step down or physical rehab	No Benefit

Download Brochure

Gap Assist

Gap Assist
Premium	Age 0-64: Single: R 401 Family: R 461
	Age 65 and over: Single: R 659 Family: R 731





Overall Annual Limit	R 213 000 per person per annum
Cover	Up to 500%, max 600%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	up to 500%


Co-Payment Cover	Co-payments and co-payments charged as a
	percentage R13 500 per claim
	Penalty fee co-payment R8000 per claim - 1 claim



Sub-limit benefit	No Benefit



Oncology & biologicals	R 22 000 per claim for co-payments.
	Cancer boost benefit subject to OAL
	Breast reconstruction: No benefit


Additional Benefits
Cover for Day hospital/ clinic or in-room procedure	Covers the shortfall
Primary Care	No Benefit
Specialist consultant fee	No Benefit



Emergency Room Cover - Accident and Emergency	Limit of R8000
Preventative Care	No Benefit
Appliance benefit	R4000 per policy, R1300 per claim
Trauma Counselling	R4000 per policy
Accidental Death	No Benefit
Child related illness	Sirago Baby R2000 per child

Gap Premium Waiver	6-month period
Medical Aid Premium Waiver	No Benefit
Initial Cancer Diagnosis	No Benefit
Hospital account shortfalls	R3000 per policy, up to R500 per claim

Step down or physical rehab	No Benefit

Download Brochure

Plus Gap

Plus Gap
Premium	Age 0-64: Single: R 466 Family: R 563
	Age 65 and over: Single: R 752 Family: R 880





Overall Annual Limit	R213 000 per person per annum
Cover	Up to 500%, max 600%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	up to 500%


Co-Payment Cover	Subject to Overall Annual Limit
	Penalty fee co-payment R13 000 pc - 1 claim




Sub-limit benefit	R36 000 per annum per policy


	R12 000 per claim
Oncology & biologicals	Co-payments subject to OAL
	Cancer boost benefit subject to OAL
	Breast reconstruction: Up to 500% on the affected breast
	R25 000 for the unaffected breast for reconstruction
	Sublimit of R17 000 for robotic surgery
Additional Benefits
Cover for Day hospital/ clinic or in-room procedure	Covers the shortfall
Primary Care	No Benefit
Specialist consultant fee	R5000 per policy, R1000 per claim



Emergency Room Cover - Accident and Emergency	Limit of R15 000
Preventative Care	R5000 per policy, to to R950 per claim
Appliance benefit	R5500 sublimit per policy
Trauma Counselling	R6000 per policy
Accidental Death	Policy holder R9000, Child R3000
Child related illness	Sirago Baby R2000 per child

Gap Premium Waiver	6-month period
Medical Aid Premium Waiver	R4000 for 6 months
Initial Cancer Diagnosis	Lump sum of R20 000 per beneficiary
Hospital account shortfalls	R4500 per policy, to to R1000 per claim
	R1100 sublimit for private room upgrades
Step down or physical rehab	No Benefit

Download Brochure

Gap Liberal

Gap Liberal
Premium	Rates per individual
	0-29 R172
	30-39 R202
	40-49 R229
	50-59 R320
	60+ R365
	Age adjusted at renewal
Overall Annual Limit	R 213 000 per person per annum
Cover	Up to 400%, max 500%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	Up to 400%, max 500%
	PMB cover only for use of a non-designated
	provider for a planned PMB procedure
Co-Payment Cover	Co-payment must be a part of the
	medical scheme rules highlighted
	on the authorisation of a procedure



Sub-limit benefit	R30 000 per policy per annum.



Oncology & biologicals	No Benefit

	Sublimit of R15 000 for robotic surgery


Additional Benefits
Cover for Day hospital/ clinic or in-room procedure	Covers the shortfall
Primary Care	No Benefit
Specialist consultant fee	Out of hospital, excludes psychiatrist,
	psychologist. R4500 per policy and R1200 pc
	Only applicable to codes 0190, 0191 & 0192
	The medical aid needs to have made a partial payment
Emergency Room Cover - Accident and Emergency	Limit of R10000
Preventative Care	No Benefit
Appliance benefit	No Benefit
Trauma Counselling	R8000 per policy per annum
Accidental Death	No Benefit
Child related illness	Initial emergency event up to R2000 per claim
	Sirago Baby R2000 per child
Gap Premium Waiver	Yes - accidental death only or permanent disability
Medical Aid Premium Waiver	Yes - accidental death only or permanent disability
Initial Cancer Diagnosis	R10 000 per beneficiary per lifetime-malignancy stage 2
Hospital account shortfalls	R4500 per policy, R950 per claim.
	R1000 sublimit for private room upgrades
Step down or physical rehab	No Benefit

Brochure Coming

Ultimate Gap

Ultimate Gap
Premium	Age 0-64: Single: R 583 Family: R 704
	Age 65 and over: Single: R 873 Family: R 1032





Overall Annual Limit	R213 000 per person per annum
Cover	Additional 500%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	up to 500%


Co-Payment Cover	Subject to Overall Annual Limit
	Penalty fee co-payment R16 000 per claim - max 2 claims




Sub-limit benefit	Subject to Overall Annual Limit


	R40 000 per claim - see scheme rules
Oncology & biologicals	Co-payments subject to OAL
	Cancer boost benefit subject to OAL
	Breast reconstruction: Up to 500% on the affected breast
	R40 000 for the unaffected breast for reconstruction
	Robotic surgery: R37500 sub-limit
Additional Benefits
Cover for Day hospital/ clinic or in-room procedure
Primary Care	R5500 per policy, R850 per claim
Specialist consultant fee	R7000 per policy, R1500 per claim



Emergency Room Cover - Accident and Emergency	Limit of R20 000 see scheme rules
Preventative Care	R8500 per policy, R1350 per claim
Appliance benefit	R8250 sublimit per policy
Trauma Counselling	R10 000 per policy
Accidental Death	Policy holder R15000 and adult dep, R6000 per child
Child related illness	Sirago Baby R2500 per child

Gap Premium Waiver	6-month period
Medical Aid Premium Waiver	R5500 for 6 months
Initial Cancer Diagnosis	Lump sum of R30 000 per beneficiary
Hospital account shortfalls	R7800 per policy, up to R1 500 per claim

Step down or physical rehab	R15 000 per beneficiary post accident, stroke or cancer

Download Brochure

Exact With Gap & Co-Pay

Exact With Gap & Co-Pay
Premium	Age 0-64: Single: R 413 Family: R 491
	Age 65 and over: Single: R 896 Family: R 1110

	To access benefits clients must pre-authorise the event
	with Sirago, or the claim will be repudiated.
	Provides cover for specific procedures the
	medical aid excludes
Overall Annual Limit	R 213 000 per person per annum
Cover	300.00%
	Shortfall between the Medical Scheme Rate
	and the private rates (in-hospital) charged
	by the Medical Practioner or Specialist
	up to 400%
	Waiting periods: 12 month pre-existing and
	10-months condiiton specific.
Co-Payment Cover	Limited to R2000 per claim





Sub-limit benefit	No Benefit



Oncology & biologicals	No Benefit




Additional Benefits	Exact Cover Benefits
Cover for Day hospital/ clinic or in-room procedure	Covers medical procedures that your medical
Primary Care	scheme excludes as a specific exclusion.
Specialist consultant fee	The procedures are:
	Arthrospic surgery: R90 000
	Back and neck surgery: R90 000
	Bunions: R20 000
Emergency Room Cover - Accident and Emergency	Chochlear implants: R85 000
Preventative Care	Certain dental procedures: R80 000
Appliance benefit	Impacted teeth children under 18: R15 000
Trauma Counselling	Functional nasal surgery: R30 000
Accidental Death	Joint replacement: R55 000
Child related illness	Reflux and hernia surgery: R60 000
	Varicose vein surgery: R22 500
Gap Premium Waiver	Knee and shoulder surgery: R30 000
Medical Aid Premium Waiver	MRI and CT scans due to accident: R10 000
Initial Cancer Diagnosis	Skin disorders: R20 000
Hospital account shortfalls	Non-cancerous breast conditions: R20 000
	Endoscopic conditions: R8 000
Step down or physical rehab	Tonsils, grommets, and adenoids: R10 000 per procedure
Additional Casualty Benefits	Emergency casualty benefit up to R6500 for adults
	Child casualty illness: R2000 per claim

Download Brochure

Sirago Gap Cover Waiting Periods

3 Month General Waiting Period

There is a general waiting period of 3 months which is applied to all new policies, this includes additional dependents added to a current policy, except in the event of an accident.

6 Month Waiting Period

The following conditions are excluded with the first 6 months (click to open):

Myringotomy and grommets,
Adenoidectomy,
Hysterectomy (unless malignancy can be proven),
Spinal, back, neck and joint related procedures (accidents covered),
MRI scans, CT scans and scopes (accidents covered).

10 Month Waiting Period

All pre-existing conditions, diseases, or illness that was diagnosed prior to the policy inception,
Pregnancy and confinement relating to pregnancy.

12-Month Waiting Period

All pre-existing cancer related treatments,

Welcome to Sirago Gap Cover.