Sirago Gap Core Cover ( 🇿🇦2025*)

💙 Overall, Sirago Gap Core is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Gap Core Plan starts from R360 ZAR. Sirago has a trust score of 4.4.

🔎 Provider	🥇 Sirago Gap Core
🟥 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	R360
🟥 Oncology Benefit	None
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes

👉 Download Sirago Core Gap cover 2025

Sirago Gap Core – 7 Key Point Quick Overview

Sirago Gap Core Overview

💙 The Sirago Gap Core is one of six plans that starts from R360 per month. Sirago’s GapCore has benefits for in and out-of-hospital events, Sira’GO Baby, PMBs, accidental trauma and child emergencies, 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 Core Premiums

🅰️ Age Limit	🅱️ Monthly Contribution
🟧 Overall Annual Limit per Beneficiary	R213,000
🟨 Price per Individual who is between 0 – 64 years old	R360
🟩 Price per Family with beneficiaries from 0 – 64 years old	R415

Sirago Gap Core 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 350% above scheme rate to a maximum of 450% or at the stated benefit value. Subject to OAL
🟨 Day Hospital, Clinic, In-Room	Pays the difference between what the hospital would have charged and what you paid for an outpatient procedure. Governed by 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. 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 R11,500 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.
🟥 Hospital account shortfalls	This benefit will cover any charges, like consumables on the hospital account that the medical scheme has not paid. They also cover take-home medication that the medical scheme has not paid from risk. They pay up to R4 500 per policy, and R950 per claim, A sub-limit of R1 000 is available for private room upgrades. Subject to the OAL.
🟧 Sub-limit Enhancer	This benefit has a sub-limit of R26 000 per policy, up to R13 000 per claim. Medical scheme benefits available on the medical scheme option for MRI & CT scans, internal prostheses, and Transcatheter Aortic Valve Implantation (TAVI) procedure valves only. When you exceed your medical scheme benefit limit during the time of the event, resulting in a shortfall or “gap”, they will pay the shortfall depending on the Gap option you are on. If you claim and your medical scheme limit has been reached at the time of the event, meaning it was used up before the claim event, and your medical scheme does not contribute anything towards this benefit, we will also not pay
🅰️ Out-of-Hospital Benefits	🅱️ Description
🟧 Emergency Room Cover	This benefit will cover the shortfall for any day hospital, clinic, or in-room procedures including acute hospitals if a policyholder elects to have the treatment that would normally be performed in hospital, done in a day hospital, clinic, or in a doctor’s room by a registered medical professional. Subject to the OAL.
🟨 Accidental and Trauma	All costs related to the initial accident/trauma event will be covered, whether you are liable to pay the costs out of your own pocket or if your medical scheme pays from your savings – stated benefit.
🟩 Casualty benefits	There is a sub-limit of R2 000 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. 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.
🅰️ 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	This benefit gives you access to MedCare’s free ADR service for all disputed PMB claims exceeding R9 000. You can also access the MedCare service for all claims less than R9 000, including all potential medical scheme disputes, at a 60%, 20%, and/or 15% discounted rate depending on the required service.

Sirago Gap Core Exclusions and Waiting Periods

Gap Core 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.
✅ Cosmetic surgery unless defined as a covered benefit under this policy.
✅ Optional procedures.
✅ 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.

Gap Core 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.

Sirago Gap Core vs Other Gap Cover Plans

🔎 Provider	🥇 Sirago Gap Lite	🥈 Liberty Essential Gap Cover	🥉 Ambledown Gap Cover 200
🟥 Years in Operation	30 years	66 years	19 years
🟧 Underwriters	GENRIC Insurance Company Limited (FSP: 43638)	Guardrisk Life Limited (FSP 76)	Guardrisk Insurance Company Limited
🟨 Market Share in South Africa	>10%	>25%	20%
🟩 Gap Cover Waiting Period	From 3 months (up to 12)	12 months	3 – 12 months
🟦 Do Exclusions Apply	✅ Yes	✅ Yes	✅ Yes
🟪 Average Monthly Premium	R360	R397	R318
🟥 Oncology Benefit	None	None	✅ Yes
🟧 In-Hospital Benefit	✅ Yes	✅ Yes	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes	None	✅ Yes
🟩 Maternity Benefit	✅ Yes	None	None
🟦 Scopes and Scans	None	✅ Yes	None
🟪 Co-payment Cover	✅ Yes	None	None
🟥 Emergency Room	✅ Yes	✅ Yes	✅ Yes
🟧 Accidental Cover	✅ Yes	✅ Yes	✅ Yes
🟨 Trauma Counseling	None	✅ Yes	None
🟩 Premium Waiver	None	✅ Yes	None
🟦 Non-DSP Co-Payment	✅ Yes	None	None
🟪 Prostheses	None	None	None
🟥 Travel Cover Extender	None	None	None
🟧 Accidental Death/ Permanent Disability	None	✅ Yes	None

Our Verdict on Sirago Gap Core

💙 In our experience, the Sirago Gap Core plan offers comprehensive coverage for individuals seeking additional financial protection beyond their medical scheme.

💙 With its cover for in-hospital benefits, day hospital procedures, co-payments, penalty fees, and Prescribed Minimum Benefits (PMB), the plan provides valuable support in covering medical expenses.

💙 However, it is important to note that Sirago Gap Core does have certain limitations. For example, we found that it does not provide cover for oncology benefits, scopes and scans, prostheses, trauma counseling, and some non-DSP co-payments.

Sirago Gap Core Frequently Asked Questions

What are the main benefits of Sirago Gap Core?

Sirago Gap Core offers in-hospital benefits, cover for day hospital procedures, co-payments, penalty fees, and cover for Prescribed Minimum Benefits (PMB).

Does Sirago Gap Core cover out-of-hospital expenses?

Yes, Sirago Gap Core provides some out-of-hospital benefits, including cover for emergency room costs and expenses related to accidental and trauma events.

Are there any limitations to Sirago Gap Core’s cover?

Yes, Sirago Gap Core has limitations, such as excluding oncology benefits, scopes and scans, prostheses, trauma counseling, and some non-DSP co-payments. Maternity benefits are also not covered.

What is Sira’GO Baby?

Sira’GO Baby is a value-added benefit of Sirago Gap Core that provides a lump sum payment of R1,500 for a newborn child if the birth certificate is submitted within 90 days of birth.

How can I determine if Sirago Gap Core is suitable for my needs?

We recommend reviewing the cover, limitations, and pricing of Sirago Gap Lite, considering your specific needs and requirements. Comparing it with other gap cover plans can also help make an informed decision.

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.