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Sirago Gap Assist (🇿🇦 2025*)

💙 Overall, Sirago Gap Assist is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Gap Assist Plan starts from R401 ZAR. Admed has a trust score of 4.4.

🔎 Provider	🥇 Sirago Gap Assist
🟥 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	R401
🟥 Oncology Benefit	✅ Yes
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes

Sirago Gap Assist – 7 Key Point Quick Overview

Sirago Gap Assist Overview

💙 The Sirago Gap Assist is one of six plans that starts from R401 per month. Sirago’s Gap Assist has benefits for cancer, accidents, trauma, appliances/prostheses, premium waivers, and more.

👉 Sirago Gap Cover has six plans to choose from:

✅ Sirago Ultimate Gap

✅ Sirago Plus Gap

✅Sirago Gap Core

✅ Sirago Gap Assist

✅ Sirago Exact Cover with Gap and Co-Pay

✅ Sirago Gap Liberal

Sirago Gap Assist Premiums

🅰️ Age Limit	🅱️ Monthly Contribution
🟧 Overall Annual Limit per Beneficiary	R213,000
🟨 Price per Individual who is between 0 – 64 years old	R401
🟩 Price per Family with beneficiaries from 0 – 64 years old	R461
🟦 Price per Individual who is >65 years old	R659
🟪 Price per Family with a beneficiary of >65 years old	R731

Sirago Gap Assist Benefits and Cover Breakdown

🅰️ In-Hospital Benefits	🅱️ Description
🟧 Gap Cover	This covers the difference (the shortfall or the gap) between what the medical scheme pays and the doctors and specialists charge in hospital. They settle claims at up to 500% above scheme rate to a maximum of 600% or at the stated benefit value. For Robotic surgery claims that are reflected on the hospital account, they will cover up to a sub-limit of R12 000 per claim, maximum of 1 claim per policy
🟨 Hospital Account Shortfall	This benefit will cover hospital account charges not covered by the medical plan, such as consumables and take-home medication. Sirago will pay up to R3,000 per policy, R500 per claim, and a maximum of three claims per beneficiary. A sub-limit of R1,000 applies to private room upgrades, and the OAL governs the benefit.
🟩 Day Hospital, Clinic, In-Room	Covers the shortfall on any day hospital/clinic or in-room procedures if you elect to have the treatment normally performed in-hospital as an out-patient. Subject to the OAL.
🟦 Co-Payments	Co-payment cover is for the co-payments (including co-payments expressed as a percentage), excesses, or deductibles as stipulated, or imposed by a medical scheme, for specified procedures, cover for hospital admission fees, or surgical procedures. The co-payment must be part of your medical scheme rules which will be highlighted on the authorisation for your procedure. They pay up to a sub-limit of R13 500 per claim. Subject to the OAL.
🟪 Penalty Fee Co-Payments	Covers penalty fees imposed by a medical scheme for using a non-designated service provider or network hospital. Sub-limit of R8,000 per claim, per policy. Governed by the OAL.
🟩 Prescribed Minimum Benefits	All scheme members are entitled to the PMB, which covers diagnosis and treatment for predetermined conditions. Covers costs incurred from using an unapproved medical professional for scheduled PMB procedures. This applies if you meet the OAL.
🅰️ Out-of-Hospital Benefits	🅱️ Description
🟧 Emergency Room Cover	There is a sub-limit of R8 000 per policy for all Casualty Benefit. This benefit covers the initial emergency event at any registered casualty facility when you require immediate medical treatment due to an accident and trauma, or illness. We will cover a general practitioner (GP)’s consultation rooms if no other emergency facility is available within a 30 km radius. Ambulance costs are not covered by this benefit
🟨 Appliances	Covers up to R4,000 per policy and R1,300 per claim. Covers the difference between the tariff of the medical scheme and the service provider on hearing aids, wheelchairs, humidifiers, etc.
🟩 Accidental and Trauma	Covers all costs associated with accidents or traumatic events.
🟦 Child Emergency Illness	All costs related to the initial emergency illness event will be covered and paid up to R2 000 per claim of the sub-limit, if you are liable to pay the costs out of your own pocket, or if paid from your medical scheme savings. This is applicable to any beneficiary 12 years and younger who needs emergency treatment outside of normal consultation hours or treatment that can only be done in an emergency facility
🅰️ Value-Added Benefits	🅱️ Description
🟧 Sira’GO Baby	A lump sum of R1,500 for a newborn child is paid if the birth certificate is submitted within 90 days of birth.
🟨 Sirago Medcare – Free ADR Service	Offers free alternative dispute resolution (ADR) service for PMB claims over R9,000 not considered valid. Provides discounted rates (60%, 20%, or 15%) for claims under R9,000, including non-scheme disputes.
🟩 Premium Waiver	In the event of accidental death only or total permanent disability of the Sirago policyholder, we will keep the premiums for your policy as a credit for 6 months. This benefit may be claimed by the surviving spouse or adult dependent on the Sirago policy.
🅰️ Cancer Benefits	🅱️ Description
🟧 Cancer Co-Payments	This applies if your medical plan’s cancer benefit has been exhausted and a co-payment is required. Includes co-payments for ongoing cancer treatments and biological medications. Ongoing treatment must comply with your medical plan’s registered treatment plan to be eligible for this benefit of up to R22,000 per claim. The Overall Annual Limit (OAL) governs this benefit.
🟨 Cancer Boost	The Cancer Boost Benefit is applicable to policyholders whose medical scheme option has a defined rand limit for cancer treatment and the rand limit on the medical scheme has been reached. They will cover the costs of ongoing treatment in line with the medical scheme’s registered treatment plan once the rand limit has been reached. Subject to the OAL.

Sirago Gap Assist Exclusions and Waiting Periods

Gap Assist Exclusions

👉 The following are excluded from the cover by Sirago Gap Cover:

✅ Any pre-existing disease, disorder, or condition for six months.
✅ Any pre-existing cancer condition, disease, disorder, or illness for one year.
✅ Claims for routine or recurring diagnostic medical treatment.
✅ Diseases or injuries caused by alcohol or drug abuse.
✅ Any psychological or psychiatric disorder.
✅ Suicide or attempted suicide.
✅ Used medication, drugs, prescriptions, consumables, and equipment unless covered under this policy’s benefit provisions.
✅ Cosmetic surgery unless defined as a covered benefit under this policy.
✅ Optional procedures.
✅ Diagnostic procedures, therapy, and surgery regarding eating disorders, obesity, and weight management.
✅ Investigations, treatment, medication, or surgery related to any condition for which the policyholder seeks advice, diagnosis, or treatment outside South African borders.
✅ Body Mass Index (BMI), unless defined as a benefit under this policy.
✅ Diagnostic procedures, treatments, or surgical procedures on assisted reproduction.

💙 Participation in any race or speed test involving Mechanically propelled vehicles or crafts, as a professional athlete, or in any hobby is defined as dangerous in the Policy Terms and Conditions will be excluded.

👉 Women might consider making use of our free Ovulation Calculator

Gap Assist Waiting Periods

👉 Sirago Gap Cover applies the following waiting periods:

✅ General Waiting Period of 3 months for new policies and 10 months for pre-existing conditions.
✅ Policy-Specific Waiting Periods apply within the first 6 months of a new policy. After this, 50% of benefits are paid from months 7 – 10, with all benefits accessible after month 11.
✅ Waiting Periods for Specific Benefits include a 10-month pregnancy and delivery waiting period, a 3-month waiting period for death and disability (on plans that include this benefit) and new cancer diagnosis, and 12 months for pre-existing cancer conditions.

💙 Cover Upgrades of 3 months apply when existing policyholders with a previous 12-month consecutive cover upgrade to a higher plan. Those with <12 months of existing cover will wait for the difference between the remaining period and a 3-month waiting period.

👉 Discover the Best Gap Cover with No Waiting Period

Sirago Gap Assist vs Other Gap Cover Plans

🔎 Provider	🥇 Sirago Gap Assist	🥈 Cura Administrators Gap Advanced Plus	🥉 Auto & General Comprehensive Gap Cover
🟥 Years in Operation	30 years	26 years	38 years
🟧 Underwriters	GENRIC Insurance Company Limited (FSP: 43638)	GENRIC Insurance Company Limited	1Life Insurance Limited
🟨 Market Share in South Africa	>10%	<5%	<5%
🟩 Gap Cover Waiting Period	From 3 months (up to 12)	3 – 12 months	10 months
🟦 Do Exclusions Apply	✅ Yes	✅ Yes	✅ Yes
🟪 Average Monthly Premium	R401	R525	R295
🟥 Oncology Benefit	✅ Yes	✅ Yes	✅ Yes
🟧 In-Hospital Benefit	✅ Yes	✅ Yes	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes	✅ Yes	✅ Yes
🟩 Maternity Benefit	✅ Yes	✅ Yes	None
🟦 Scopes and Scans	None	✅ Yes	✅ Yes
🟪 Co-payment Cover	✅ Yes	✅ Yes	✅ Yes
🟥 Emergency Room	✅ Yes	✅ Yes	✅ Yes
🟧 Accidental Cover	✅ Yes	✅ Yes	✅ Yes
🟨 Trauma Counseling	None	✅ Yes	None
🟩 Premium Waiver	✅ Yes	✅ Yes	✅ Yes
🟦 Non-DSP Co-Payment	✅ Yes	✅ Yes	✅ Yes
🟪 Prostheses	✅ Yes	✅ Yes	✅ Yes
🟥 Travel Cover Extender	None	✅ Yes	None
🟧 Accidental Death/ Permanent Disability	None	✅ Yes	None

Our Verdict on Sirago Gap Assist

💙 In our experience, Sirago Gap Assist offers a comprehensive range of benefits, including in-hospital cover, co-payment cover, and cancer benefits. In addition, the tiered premium structure provides flexibility for different budgets and needs.

💙 Unique benefits like the Sira’GO Baby and Sirago Medicare-Free ADR Service add value. However, the lack of cover for scopes and scans, trauma counseling, travel cover extender, and accidental death/permanent disability cover may be drawbacks for some.

💙 The plan’s exclusions and waiting periods are standard but should be considered. Overall, Sirago Gap Assist provides robust cover and valuable financial protection against high healthcare costs, but individual healthcare needs and circumstances should be considered before choosing a plan.

Sirago Gap Assist Frequently Asked Questions

What is the Overall Annual Limit per Beneficiary for Sirago Gap Assist?

The Overall Annual Limit per Beneficiary for Sirago Gap Assist is R213,000.

What are the premiums for Sirago Gap Assist?

The premiums for Sirago Gap Assist vary based on age and family size, ranging from R401 for an individual aged 0-64 to R659 for a family with a beneficiary over 65.

What are the in-hospital benefits of Sirago Gap Assist?

Sirago Gap Assist covers up to 500% above medical scheme rates or at the stated benefit value, to a maximum of 600% for in-hospital benefits.

Does Sirago Gap Assist provide co-payment cover?

Yes, Sirago Gap Assist covers co-payments, excesses, or deductibles imposed by a medical scheme for specific procedures.

What is the Premium Waiver benefit in Sirago Gap Assist?

In the event of the death or total permanent disability of the Sirago policyholder, the surviving spouse or adult dependent on the policy can claim a Premium Waiver benefit.

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.