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Sirago Gap Cover covers for hospitalisation shortfalls include gap cover, co-payment cover and cover for the voluntary use of non-designated service providers for prescribed minimum benefit conditions (except in the event of an emergency). Out-of-hospital benefits include cover for the shortfalls resulting from the difference between what medical schemes pay and what day-to-day specialist doctors charge, for appliances and for emergency room treatment as a result of accidents and emergency illness.
To claim, All required relevant documents must be submitted to Sirago within 180 (hundred and eighty) days after the event
date. Claims can be emailed to claims@sirago.co.za.
If you need any assistance submitting your claim or any advice, please call customer service at tel no 010 599 1163. Should you be incapacitated and not be able to make contact, you may get someone to contact us Sirago Gap Cover your behalf. Please always consult your broker if in doubt.
Documents Required: for Sirago Gap Cover Claims
- Sirago Gap Cover claim form completed and signed by the policyholder.
- Hospital and related accounts substantiating your claim.
- Medical scheme statement reflecting all the payments made by your medical scheme for the treatment dates of the health event.
- Completed medical reports substantiating the clinical information or any other documentation if requested
- Pre-authorisation letter from your medical scheme for co-payment claims.
- Value Added Benefit claims: documentation and certification which may include a death certificate or a report from a registered medical practitioner confirming total permanent disability.
- Initial Cancer Diagnosis: we require a histology report.
Please Note
- Hospital Plan Benefits will be paid in the event that your option pays a portion of the claim.
- Savings Plan: Benefits will be paid in the event that your option pays a portion of the claim.However, the value settled by the Insurer will be limited to the Gap portion after the scheme has defrayed the scheme rate of the claim provided that there was an accumulated or allocated savings balance at the time of claim.
- Traditional medical scheme option: Benefits will be paid in the event that your option pays aportion of the claim.
