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Sirago Gap Lite

Overall, Sirago Gap Lite is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Gap Lite Plan starts from R289 ZAR. Sirago has a trust score of 4.4.

🔎 Provider	🥇 Sirago Gap Lite
🟥 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	R289
🟥 Oncology Benefit	None
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes

Sirago Gap Lite – 7 Key Point Quick Overview

Sirago Gap Lite Overview

The Sirago Gap Lite is one of eight plans that starts from R289 per month. Sirago’s Gap Lite has benefits for in and out-of-hospital events, Sira’GO Baby, PMBs, accidental trauma and child emergencies, and more.

Sirago Gap Cover has eight plans to choose from:

Sirago Gap Lite Premiums

🅰️ Age Limit	🅱️ Monthly Contribution
🟧 Overall Annual Limit per Beneficiary	R191,000
🟨 Price per Individual who is between 0 – 64 years old	R289
🟩 Price per Family with beneficiaries from 0 – 64 years old	R315
🟦 Price per Individual who is >65 years old	R369
🟪 Price per Family with a beneficiary of >65 years old	R419

Sirago Gap Lite Benefits and Cover Breakdown

🅰️ In-Hospital Benefits	🅱️ Description
🟧 Gap Cover	Pays the difference between the medical scheme rate and the rate charged by doctors and specialists. Covers up to 250% above your medical plan’s rates or the stated benefit value, with a maximum of 350% cover. Governed by the 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	Provides cover for co-payments, excesses, or deductibles imposed by a medical scheme for specific procedures. Sub-limit of R25,000 per policy and R7,500 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 R5,000 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	Covers emergency costs at registered emergency facilities, hospitals, or casualty centers. There is a sub-limit of R4,500.
🟨 Accidental and Trauma	Covers all costs associated with accidents or traumatic events.
🟩 Child Emergency Illness	Covers emergency treatment for children 8 and younger outside normal consultation hours. Covers all costs related to the event. Subject to the OAL.
🅰️ 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.

Sirago Gap Lite Exclusions and Waiting Periods

Gap Lite 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 Lite 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 Lite 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	R289	R372	R288
🟥 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 Lite

In our experience, the Sirago Gap Lite 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 Lite 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 Lite Frequently Asked Questions

What are the main benefits of Sirago Gap Lite?

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

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

Yes, Sirago Gap Lite 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 Lite’s cover?

Yes, Sirago Gap Lite 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 Lite 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 Lite 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.