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Sirago Gov Gap Cover (🇿🇦 2025*)

💙 Overall, Sirago Gov Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Gov Gap Gap Cover Plan starts from R404 ZAR. Sirago has a trust score of 4.4.

🔎 Provider	🥇 Sirago Gov Gap Cover
🟥 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	R404
🟥 Oncology Benefit	✅ Yes
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes

Sirago Gov Gap Cover – 7 Key Point Quick Overview

Sirago Gov Gap Cover Overview

💙 The Sirago Gov Gap Cover is one of eight plans that starts from R404 per month. Sirago’s Gov Gap Cover has benefits for co-payments, day hospitals, PMBs, illness, day-to-day medical consults, cancer, and more.

👉 Sirago Gap Cover has eight plans to choose from:

✅ Sirago Ultimate Gap

✅ Sirago Gov Gap

✅ Sirago Exact Cover with Gap and Co-Pay

✅ Sirago Exact Cover

Sirago Gov Gap Cover Premiums

🟥 Age Limit	🟩 Monthly Contribution
🟧 Price per Individual who is between 0 – 64 years old	🟦 R404
🟨 Price per Family with beneficiaries from 0 – 64 years old	🟪 R485

Sirago Gov Gap Cover Benefits and Cover Breakdown

💙 The intended recipients of this policy are exclusively employees working for the State. Moreover, individuals who meet the criteria must possess a valid and up-to-date number. The cover provided by this policy will cease automatically when the policyholder reaches the age of 65, marking the end of the year.

🟥 In-Hospital Benefits	🟥 Description
🟧 Gap Cover	The policy covers up to 500% of the medical scheme rates or the stated benefit value, with a maximum cover of 600%.
🟨 Day Hospital, Clinic, In-Room	Will settle the GAP portion of claims.
🟩 Sub-Limit Enhancer	When you exceed your medical scheme benefit limit during the time of the event, resulting in a shortfall or “gap”, we 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. Subject to the OAL.
🟦 Prescribed Minimum Benefits	This benefit has a sub-limit of R45 000 per policy, up to R17 500 per claim. This benefit applies when the medical scheme’s benefit limit has been exceeded for MRI and CT scans, intraocular lenses, and internal prostheses.
🟪 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 R8,000.
🟧 Accidental and Trauma	Covers all costs associated with accidents or traumatic events.
🟨 Illness	All costs related to the emergency illness event will be covered and paid up to R1 500 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 9 years and older who needs emergency treatment outside of normal consultation hours or treatment that can only be done in an emergency facility.
🟩Child Emergency Illness	This benefit is applicable to children 8 years and younger who require emergency treatment for illness out of normal consultation hours or treatment that can only be done in an emergency room. All costs related to the event will be covered, whether you are liable to pay the costs from your own pocket or your medical scheme pays it from your savings account.
🟦 Day-to-Day Specialist Consultations	This benefit covers the shortfall on the consultation at a specialist outside of hospital (excluding Psychiatrist and Psychologist) up to R5 000 per policy, and R1 000 per claim. Subject to the OAL
🟪 Value-Added Benefits	🟪 Description
🟥 Sira’GO Baby	This benefit has a sub-limit of R2 000 for each newborn baby and covers midwife consultations, pathology, ultrasounds, audiology for the newborn, and more.
🟧 Premium Waiver (Gap Cover)	In the event of death or total permanent disability of the Sirago policyholder, they 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.
🟨 Premium Waiver (Medical Aid)	Sirago will pay the rand amount of the medical scheme premium, not higher than R3 550 per month for a 4-month period. This benefit is only payable for the medical scheme that the policyholder was on if there is dual medical scheme membership.
🟩 Initial Cancer Diagnosis	This benefit will pay a lump sum of R9,500 upon the initial diagnosis of stage 1 cancer. Before the policy is started, any cancer or pre-cancer is excluded, including skin cancer.
🟦 Accidental Death	This benefit will be paid out in the event of accidental death at the following rates: R6,000 for the Sirago policyholder, R5,000 for adult dependents, and R3,000 for child dependents.
🟪 Cancer Benefits	🟪 Description
🟥 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. We 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 Gov Gap Cover Exclusions and Waiting Periods

Gov Gap 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.

Gov Gap 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.

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Sirago Gov Gap Cover vs Other Gap Cover Plans

🔎 Provider	🥇 Sirago Gov Gap Cover	🥈 Kaelo Gap Core	🥉 Elixi Executive Single Plus
🟥 Years in Operation	31 years	20 years	7 years
🟧 Underwriters	GENRIC Insurance Company Limited (FSP: 43638)	Centriq Insurance Company Limited	Unity Health
🟨 Market Share in South Africa	>10%	<1%	<5%
🟩 Gap Cover Waiting Period	From 3 months (up to 12)	12 months	3 – 12 months
🟦 Do Exclusions Apply	✅ Yes	✅ Yes	✅ Yes
🟪 Average Monthly Premium	R404	Flexible premiums on quotation.	R486
🟥 Oncology Benefit	✅ Yes	None	✅ Yes
🟧 In-Hospital Benefit	✅ Yes	✅ Yes	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes	None	None
🟩 Maternity Benefit	✅ Yes	None	None
🟦 Scopes and Scans	✅ Yes	None	✅ Yes
🟪 Co-payment Cover	✅ Yes	None	✅ Yes
🟥 Emergency Room	✅ Yes	None	✅ Yes
🟧 Accidental Cover	✅ Yes	✅ Yes	None
🟨 Trauma Counseling	None	None	None
🟩 Premium Waiver	✅ Yes	✅ Yes	✅ Yes
🟦 Non-DSP Co-Payment	None	None	None
🟪 Prostheses	✅ Yes	None	✅ Yes
🟥 Travel Cover Extender	None	None	None
🟧 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	✅ Yes

Our Verdict on Sirago Gov Gap Cover

💙 According to our research, Sirago Gov Gap Cover appears to be a robust and comprehensive policy, especially suited to employees working for the state. In addition, it provides a wide range of benefits at a competitive monthly premium.

💙 However, like all insurance products, we urge potential policyholders to read and understand the terms and conditions, including exclusions and waiting periods, to ensure it meets their specific needs.

Sirago Gov Gap Cover Frequently Asked Questions

Who is eligible for the Sirago Gov Gap Cover?

The Sirago Gov Gap Cover is primarily designed for state employees. Individuals who meet the criteria must possess a valid and up-to-date Persal number.

What are the premium rates for the Sirago Gov Gap Cover?

The monthly premium for an individual between 0 and 64 years old is R404. For a family with beneficiaries from 0 to 64 years old, the premium is R485 per month.

What happens to the Sirago Gov Gap Cover when the policyholder reaches the age of 65?

The cover provided by the Sirago Gov Gap Cover will automatically cease when the policyholder reaches the age of 65.

What are the waiting periods for Sirago Gov Gap Cover?

The waiting period for Sirago Gov Gap ranges from 3 to 12 months.

Are there any exclusions in the Sirago Gov Gap Cover?

Yes, the policy does not cover pre-existing diseases for six months, pre-existing cancer conditions for one year, routine or recurring diagnostic medical treatment, diseases or injuries caused by alcohol or drug abuse, psychological or psychiatric disorders, suicide or attempted suicide, etc.

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.