Ultimate Gap
About this plan
Premium gap cover providing up to 500% medical scheme tariff cover with extensive protection for specialist shortfalls, approved co-payments, oncology treatment, casualty care, and a broad range of hospital and value-added benefits.
Monthly premium
From
R645
per month
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Ultimate Gap
Sirago Ultimate Gap (🇿🇦 2025*)
💙 Overall, Sirago Ultimate Gap Cover is a trustworthy short-term insurance product designed to provide extra protection for those who already have medical aid. The Sirago Ultimate Gap Cover Plan starts from R583 ZAR. Sirago has a trust score of 4.1.
| 🔎 Provider | 🥇 Sirago Ultimate Gap |
| 🟥 Years in Operation | 31 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 | R583 |
| 🟥 Oncology Benefit | ✅ Yes |
| 🟧 In-Hospital Benefit | ✅ Yes |
| 🟨 Out-of-Hospital Cover | ✅ Yes |
Sirago Ultimate Gap Cover - 7 Key Point Quick Overview
- ✅ Sirago Ultimate Gap Overview
- ✅ Sirago Ultimate Gap Premiums
- ✅ Sirago Ultimate Gap Benefits and Cover Breakdown
- ✅ Sirago Ultimate Gap Exclusions and Waiting Periods
- ✅ Sirago Ultimate Gap vs Other Gap Cover Plans
- ✅ Our Verdict on Sirago Ultimate Gap
- ✅ Sirago Ultimate Gap Frequently Asked Questions
Sirago Ultimate Gap Overview
💙 The Sirago Ultimate Gap is one of six plans that starts from R583 per month. Sirago’s Ultimate Gap has benefits for in and out-of-hospital treatment and procedures, penalty fees, step-down facilities, illness, primary care, and more. 👉🏿 Sirago Gap Cover has eight 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 Ultimate Gap Premiums
| 🟥 Age Limit | 🟥 Monthly Contribution |
| 🟧 Overall Annual Limit per Beneficiary | 🟧 R213,000 |
| 🟨 Price per Individual who is between 0 – 64 years old | 🟨 R583 |
| 🟩 Price per Family with beneficiaries from 0 – 64 years old | 🟩 R704 |
| 🟦 Price per Individual who is >65 years old | 🟦 R873 |
| 🟪 Price per Family with a beneficiary of >65 years old | 🟪 R1032 |
Sirago Ultimate 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%. With a maximum of R37,500 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 R7,800 per policy, R1,500 per claim, and a maximum of three claims per beneficiary. A sub-limit of R2,000 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 R16,000 per claim, per policy. It is limited to 2 claims per policy, regardless of whether the medical scheme charges a rand amount or a percentage penalty fee. Governed by the OAL. |
| 🟥 Sub-Limit Enhancer | This benefit is subject to a sublimit of R40,000 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. |
| 🟨 Step-Down Facilities | If your medical scheme provides benefits for rehabilitation as an in-patient in a step-down or sub-acute facility. There is a sub-limit of R15,000 per policy. |
| 🟩 Out-of-Hospital Benefits | 🟩 Description |
| 🟦Casualty Benefit | There is a sub-limit of R20 000 per policy 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, or illness. 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 R8,500 sub-limit will apply. Each claim will receive up to 1,35000. Up to R500 will be paid towards the following tests and treatments, 2 claims per policy: Pap smear. Child Immunisations (Department of Health Formulary) – up to the age of 12 years. Mammogram. Bone density scans The OAL governs this benefit. |
| 🟥 Appliances | Covers up to R8,250 per policy. Covers the difference between the tariff of the medical scheme and the service provider on hearing aids, wheelchairs, humidifiers, etc. |
| 🟧 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 R2,500 if you are responsible for paying the costs out of pocket or if paid from your medical scheme savings. |
| 🟩 Child Emergency Illness | All costs related to the initial emergency illness event will be covered and paid up to R4 000 per claim 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 12 years and younger who needs emergency treatment outside of normal consultation hours or treatment that can only be done in an emergency facility. 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 R10,000 per policy will apply. 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 R7,000 per policy, R1,500 per claim, and three claims per beneficiary apply. The benefit is subject to the OAL. |
| 🟥 Primary Care Benefit | The Primary Care gap cover pays the difference between the medical scheme rate and the provider rate for the consultation fee and any additional services charged and included in the consultation fee. Each claim is subject to an R850 per claim and an R5,500 maximum. Professionals offering primary care services include GPs, dentists, and alternative therapists. |
| 🟧 Value-Added Benefits | 🟧 Description |
| 🟨 Sira’GO Baby | A lump sum of R2,500 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. |
| 🟦 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 R5,800 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 R33,000 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 pay out for accidental death at R15 000 for adult dependants and R6 000 for child dependants registered on the policy. |
| 🟨 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. The Overall Annual Limit (OAL) governs this benefit. |
| 🟦 Cancer Boost | If your medical scheme for cancer has a set dollar amount, you may be eligible for this benefit. After the initial rand limit is met, Sirago will cover ongoing treatment costs according to the medical scheme’s registered treatment plan. |
| 🟪 Cancer Breast Reconstruction | Sirago will pay for reconstructive surgery on the amputated breast after a mastectomy if your medical aid allows it. Up to R40 000 will be paid for the reconstruction of the unaffected breast if there is no payment by the scheme. They will also pay up to R4 000 of the R40 000 sub-limit for artificial prosthesis, including but not limited to wigs, breast implants, and post-mastectomy bra prosthesis, should the medical scheme not cover this at all. This benefit is only available within the first 18 months of the initial mastectomy. There is no benefit for any costs related to PMB services, treatments, or medical interventions, unless otherwise stated. |
Sirago Ultimate Gap Exclusions and Waiting Periods
Ultimate 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, and weight management.
- ✅ Body Mass Index (BMI), unless defined as a benefit under this policy.
- ✅ Diagnostic procedures, treatments, or surgical procedures on assisted reproduction.
Ultimate 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.
Sirago Ultimate Gap vs Other Gap Cover Plans
| 🔎 Provider | 🥇 Sirago Ultimate Gap | 🥈 Turnberry Optimal Gap Cover | 🥉 Linksave Gap 500 Plus |
| 🟥 Years in Operation | 31 years | 23 years | 10 years |
| 🟧 Underwriters | GENRIC Insurance Company Limited (FSP: 43638) | Lombard Insurance Company | Renasa Insurance Company Limited |
| 🟨 Market Share in South Africa | >10% | <5% | <1% |
| 🟩 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 | R583 | R445 | Individual quoted |
| 🟥 Oncology Benefit | ✅ Yes | ✅ Yes | None |
| 🟧 In-Hospital Benefit | ✅ Yes | ✅ Yes | None |
| 🟨 Out-of-Hospital Cover | ✅ Yes | ✅ Yes | None |
| 🟩 Maternity Benefit | ✅ Yes | None | None |
| 🟦 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 | None |
| 🟩 Premium Waiver | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟦 Non-DSP Co-Payment | ✅ Yes | ✅ Yes | ✅ Yes |
| 🟪 Prostheses | ✅ Yes | None | None |
| 🟥 Travel Cover Extender | None | ✅ Yes | None |
| 🟧 Accidental Death/ Permanent Disability | ✅ Yes | ✅ Yes | ✅ Yes |
