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Sirago Plus Gap (🇿🇦 2025*)

💙 Overall, Sirago Plus Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Plus Gap Cover Plans start from R466 ZAR. Sirago has a trust score of 4.4.

🔎 Provider	🥇 Sirago Plus Gap
🟥 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	R466
🟥 Oncology Benefit	✅ Yes
🟧 In-Hospital Benefit	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes

Sirago Plus Gap Cover – 7 Key Point Quick Overview

Sirago Plus Gap Overview

💙 The Sirago Plus Gap is one of six plans that starts from R466 per month. Sirago’s Plus Gap has benefits for hospital account shortfalls, PMBs, preventative care, illness, specialist consultation, trauma counseling, 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 Plus Gap Premiums

🟥 Age Limit	🟥 Monthly Contribution
🟧 Overall Annual Limit per Beneficiary	🟧 R213,000
🟨 Price per Individual who is between 0 – 64 years old	🟨 R466
🟩 Price per Family with beneficiaries from 0 – 64 years old	🟩 R563
🟦 Price per Individual who is >65 years old	🟦 R752
🟪 Price per Family with a beneficiary of >65 years old	🟪 R880

Sirago Plus Gap Benefits and Cover Breakdown

🟥 In-Hospital Benefits	🟥 Description
🟧 Gap Cover	Gap Cover pays the difference between the medical scheme rate and the rate service providers charge, i.e., doctors and specialists. The cover extends to 500% above the medical scheme rate or the stated benefit value, with a maximum of 600%. Covers up to R17 000 per policy, with a maximum of R6 000 per claim per beneficiary on robotic surgery. Subject to the OAL.
🟨 Hospital Account Shortfall	This benefit will cover hospital account charges not covered by the medical plan, such as consumables and take-home medication. Sirago will pay up to R4,500 per policy, R1000 per claim, and a maximum of three claims per beneficiary. A sub-limit of R1,100 applies to private room upgrades, and the OAL governs the benefit.
🟩 Day Hospital, Clinic, In-Room	Covers the shortfall on any day hospital/clinic or in-room procedures if you elect to have the treatment normally performed in-hospital as an out-patient. Subject to the OAL.
🟦 Co-Payments	The Co-payment Cover feature is intended to cover co-payments, excesses, and deductibles imposed by a medical scheme for specified procedures, hospital admission fees, scans, or surgical procedures.
🟪 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 R13,000 per claim, per policy. Governed by the OAL.
🟥 Sub-Limit Enhancer	This benefit is subject to a sublimit of R36,000 per policy and R12,000 per claim. The sub-limit enhancer benefit is applicable when you have exceeded your medical plan’s benefit limit for MRI and CT scans and internal prostheses. The OAL governs this benefit.
🟧 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 R15,000. They 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.
🟦 Preventative Care	If your medical plan option includes preventative care benefits, an R5,000 sub-limit will apply. Each claim will receive up to R950. Covers pap smears, cholesterol tests, blood glucose testing, flu vaccines, etc. The OAL governs this benefit.
🟪 Appliances	Covers up to R5,500 Covers the difference between the tariff of the medical scheme and the service provider on the following appliances: hearing aids, wheelchairs, continuous positive airway pressure (CPAP) machines, humidifiers, insulin pumps, glucometers, nebulisers, and Mirena devices.
🟥 Accidental and Trauma	Covers all costs associated with accidents or traumatic events.
🟧 Illness	All costs associated with the emergency illness event will be covered and paid up to the sub-limit of R1,000 if you are responsible for paying the costs out of pocket or if paid from your medical scheme savings.
🟨 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.
🟩 Trauma Counselling	This benefit covers trauma counseling with a registered medical professional following a traumatic event, such as dread disease, hijacking, or violent crime. A sublimit of R6,000 per policy . You are covered for the first six months following the incident.
🟦 Day-to-Day Specialist Consultations	This benefit covers the difference between the medical scheme rate and the specialist’s consultation rate only if your medical aid pays a portion of the fee from your savings. Sub-limits of R5000 per policy, R1000 per claim, and three claims per beneficiary apply. The benefit is subject to the OAL.
🟪 Value-Added Benefits	🟪 Description
🟥 Sira’GO Baby	Sirago will pay out a lump sum of R2 000 to you, per newborn baby, when the baby is registered on your gap policy within 90 days of birth. To register your newborn(s), Simply fill out the additional dependant form and submit it to [email protected] together with your baby’s birth certificate.
🟧 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.
🟨 Premium Waiver (Gap Cover)	If the Sirago policyholder dies or becomes totally and permanently disabled, the surviving spouse or adult dependent may file a claim for a Premium Waiver benefit. ·Sirago will hold your policy’s premiums as a credit for six months.
🟩 Premium Waiver (Medical Aid)	Sirago will pay the medical scheme premium, up to R4,000 monthly over six months. In the event of the death or total and permanent disability of the Sirago policyholder and where all beneficiaries are linked to a single medical scheme, this will be paid to the beneficiary for the maintenance of medical scheme contributions.
🟦 Initial Cancer Diagnosis	This benefit will pay a lump sum of R20,000 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: R9,000 for the Sirago policyholder and R3,000 for child dependents.
🟥 Cancer Benefits	🟥 Description
🟧 Cancer Co-Payments	This benefit applies if your medical scheme cancer benefit has been reached and a percentage co-payment is imposed. This benefit incorporates co-payments for ongoing cancer-related treatments and biological drugs. Ongoing treatment must be in line with the registered treatment plan of your medical scheme to access this benefit. Subject to the OAL.

Sirago Plus Gap Exclusions and Waiting Periods

Plus 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.
✅ Suicide or attempted suicide.
✅ Cosmetic surgery unless defined as a covered benefit under this policy.
✅ Optional procedures.
✅ Diagnostic procedures, therapy, and surgery regarding eating disorders, obesity, etc.
✅ 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.

Plus 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.

👉🏿 Read more about the 5 Top Medical Aids for Childbearing Women

Sirago Plus Gap vs Other Gap Cover Plans

🔎 Provider	🥇 Sirago Plus Gap	🥈 Netcare GapCare500+	🥉 Stratum Benefits Elite Gap Cover
🟥 Years in Operation	31 years	28 years	25 years
🟧 Underwriters	GENRIC Insurance Company Limited (FSP: 43638)	The Hollard Insurance Company Limited	Guardrisk Insurance Company Limited (FSP 75)
🟨 Market Share in South Africa	>10%	<5%	>5%
🟩 Gap Cover Waiting Period	From 3 months (up to 12)	3 – 12 months	3 Months
🟦 Do Exclusions Apply	✅ Yes	✅ Yes	✅ Yes
🟪 Average Monthly Premium	R466	R315	R481
🟥 Oncology Benefit	✅ Yes	✅ Yes	✅ Yes
🟧 In-Hospital Benefit	✅ Yes	✅ Yes	✅ Yes
🟨 Out-of-Hospital Cover	✅ Yes	✅ Yes	✅ Yes
🟩 Maternity Benefit	✅ Yes	✅ Yes	✅ Yes
🟦 Scopes and Scans	✅ Yes	✅ Yes	✅ Yes
🟪 Co-payment Cover	✅ Yes	✅ Yes	✅ Yes
🟥 Emergency Room	✅ Yes	✅ Yes	✅ Yes
🟧 Accidental Cover	✅ Yes	✅ Yes	✅ Yes
🟨 Trauma Counseling	✅ Yes	✅ Yes	✅ Yes
🟩 Premium Waiver	✅ Yes	✅ Yes	✅ Yes
🟦 Non-DSP Co-Payment	✅ Yes	✅ Yes	✅ Yes
🟪 Prostheses	✅ Yes	✅ Yes	✅ Yes
🟥 Travel Cover Extender	None	None	✅ Yes
🟧 Accidental Death/ Permanent Disability	✅ Yes	✅ Yes	✅ Yes

Our Verdict on Sirago Plus Gap

💙 According to our research, the Sirago Plus Gap plan offers a comprehensive suite of benefits that cater to a wide range of healthcare needs. The plan’s in-hospital benefits, co-payment cover, and cancer benefits are particularly noteworthy, providing substantial financial protection against the high costs of medical treatments and procedures.

💙 Including unique benefits such as the Sira’GO Baby benefit, Sirago Medcare – Free ADR Service, and the Premium Waiver adds value to the plan and demonstrates Sirago’s commitment to providing comprehensive and customer-focused solutions.

💙 However, it is important to note that the plan does have some limitations.

Sirago Plus Gap Frequently Asked Questions

What is the Overall Annual Limit per Beneficiary for Sirago Plus Gap?

The Overall Annual Limit per Beneficiary for Sirago Plus Gap is R213,000.

What are the premiums for Sirago Plus Gap?

The premiums for Sirago Plus Gap vary based on age and family size, ranging from R466 for an individual aged 0-64 to R880 for a family with a beneficiary over 65.

What are the in-hospital benefits of Sirago Plus Gap?

Sirago Plus Gap covers up to 500% above the medical scheme rate or the stated benefit value, to a maximum of 600% for in-hospital benefits.

Does Sirago Plus Gap provide co-payment cover?

Yes, Sirago Plus Gap covers co-payments, excesses, or deductibles imposed by a medical scheme for specific procedures.

What is the Premium Waiver benefit in Sirago Plus Gap?

If the Sirago policyholder dies or becomes totally and permanently disabled, the surviving spouse or adult dependent may file a claim for a Premium Waiver benefit.

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.