Sirago Gap Only
Overall, Sirago Gap Only is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Gap Only Plan starts from R131 ZAR. Sirago has a trust score of 4.4.
| 🔎 Provider | 🥇 Sirago Gap Only |
| 🟥 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 | R131 |
| 🟥 Oncology Benefit | None |
| 🟧 In-Hospital Benefit | ✅ Yes |
| 🟨 Out-of-Hospital Cover | None |
Sirago Gap Only – 7 Key Point Quick Overview
- ✅ Sirago Gap Only Overview
- ✅ Sirago Gap Only Premiums
- ✅ Sirago Gap Only Benefits and Cover Breakdown
- ✅ Sirago Gap Only Exclusions and Waiting Periods
- ✅ Sirago Gap Only vs Other Gap Cover Plans
- ✅ Our Verdict on Sirago Gap Only
- ✅ Sirago Gap Only Frequently Asked Questions
Sirago Gap Only Overview
The Sirago Gap Only is one of eight plans that starts from R131 per month. Sirago’s Gap Only has benefits for shortfalls for in-hospital treatment, outpatient treatments, PMBs, and more.
Sirago Gap Cover has eight plans to choose from:
Sirago Gap Only Premiums
| 🟥 Age Limit | 🟥 Monthly Contribution |
| 🟧 Overall Annual Limit per Beneficiary | 🟧 R191,000 |
| 🟨 Price per Individual | 🟨 R131 |
| 🟩 Price per Family | 🟩 R172 |
Sirago Gap Only 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 200% above your medical plan’s rates or the stated benefit value, with a maximum of 300% 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. |
| 🟩 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. |
| 🟦 Value-Added Benefits | 🟦 Description |
| 🟪 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 Only Exclusions and Waiting Periods
Sirago Gap Only 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.
- ✅ 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.
Sirago Gap Only 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 Only vs Other Gap Cover Plans
| 🔎 Provider | 🥇 Sirago Gap Only | 🥈 Cura Administrators Gap Basic | 🥉 Bonitas MedGap Student Plan |
| 🟥 Years in Operation | 30 years | 26 years | 41 years |
| 🟧 Underwriters | GENRIC Insurance Company Limited (FSP: 43638) | GENRIC Insurance Company Limited | Centriq Insurance Company Limited |
| 🟨 Market Share in South Africa | >10% | <5% | 5%> |
| 🟩 Gap Cover Waiting Period | From 3 months (up to 12) | 3 – 12 months | 3 – 12 months |
| 🟦 Do Exclusions Apply | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Average Monthly Premium | R131 | R182 | R125 |
| 🟥 Oncology Benefit | None | None | None |
| 🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | None |
| 🟨 Out-of-Hospital Cover | None | ✅ Yes | None |
| 🟩 Maternity Benefit | None | None | None |
| 🟦 Scopes and Scans | None | ✅ Yes | None |
| 🟪 Co-payment Cover | None | None | ✅ Yes |
| 🟥 Emergency Room | None | ✅ Yes | ✅ Yes |
| 🟧 Accidental Cover | None | ✅ Yes | None |
| 🟨 Trauma Counseling | None | None | None |
| 🟩 Premium Waiver | None | None | None |
| 🟦 Non-DSP Co-Payment | None | None | None |
| 🟪 Prostheses | None | None | None |
| 🟥 Travel Cover Extender | None | None | None |
| 🟧 Accidental Death/ Permanent Disability | None | None | None |
Our Verdict on Sirago Gap Only
According to our research, Sirago Gap Only offers in-hospital benefits, covering the difference between medical scheme rates and charges from doctors and specialists. With premiums averaging R131 per month, it provides cover up to 200% above medical plan rates or the stated benefit value, governed by the Overall Annual Limit (OAL).
We also found that Sirago Gap Only covers costs related to unapproved medical professionals for Prescribed Minimum Benefit (PMB) procedures.
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Sirago Gap Only Frequently Asked Questions
What are the in-hospital benefits provided by Sirago Gap Only?
Sirago Gap Only covers the difference between the medical scheme rate and the charges of doctors and specialists, offering up to 200% above your medical plan’s rates or the stated benefit value, with a maximum of 300% cover.
Does Sirago Gap Only cover Prescribed Minimum Benefits (PMB)?
Yes, Sirago Gap Only covers PMB, including diagnosing and treating predetermined conditions. It also covers costs incurred from using an unapproved medical professional for scheduled PMB procedures.
Does Sirago Gap Only offer out-of-hospital coverage?
No, Sirago Gap Only does not provide cover for out-of-hospital expenses.
Are there any exclusions or limitations with Sirago Gap Only?
Yes, Sirago Gap Only has certain exclusions, such as oncology benefits, maternity benefits, scopes and scans, co-payment cover, and accidental death/permanent disability cover.
How long has Sirago Gap Only been in operation?
Sirago has operated for 30 years, establishing itself as a trusted gap cover provider in the industry.
