Gap Core Cover
About this plan
Family-focused gap cover providing up to 350% medical scheme tariff cover for specialist shortfalls, approved co-payments, and a range of hospital and cancer benefits
Monthly premium
From
R395
per month
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Gap Core Cover
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 2025Sirago Gap Core - 7 Key Point Quick Overview
- ✅ Sirago Gap Core Overview
- ✅ Sirago Gap Core Premiums
- ✅ Sirago Gap Core Benefits and Cover Breakdown
- ✅ Sirago Gap Core Exclusions and Waiting Periods
- ✅ Sirago Gap Core vs Other Gap Cover Plans
- ✅ Our Verdict on Sirago Gap Core
- ✅ Sirago Gap Core Frequently Asked Questions
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 LiberalSirago 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.
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.
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 |
