Monthly premium
By age band, as Sirago publishes it. 2027 premiums take effect on 1 January 2027.
| Policyholder’s age | 2026 | 2027 | Change |
|---|---|---|---|
| 0 to 64, just you | — | R240 | |
| 0 to 64, family | — | R290 |
What it covers
Exact Cover is new for 2027. It was not sold in 2026.
What it pays
Limits and joining
Who is covered
In Sirago’s own words.
- We cover policyholders and dependants of all ages on most options. The benchmark for premium determination is based on whether you join as an individual or as a family and the prospective policyholder’s age at the inception of the policy according to the following two age bands: 64 years or younger; 65 years or older. Sirago Gap Cover Solutions 2027, p5
- The base premium rate includes the policyholder and 4 (four) dependants. (A total of 5 {five} insured persons). All additional dependants added to the policy as listed on the Certificate of Membership (COM) will be charged an additional rate per dependant based on their age as indicated on page 6. Sirago Gap Cover Solutions 2027, p22
- A child is considered a child dependant up to the age of 21. Students: Cover for children can be extended to the age of 27 for full-time students on their own medical aid. Documented proof of full-time study enrolment is required to verify a dependant over the age of 21. On parents’ Medical scheme: Cover can also be provided for children over 21 by submitting the Certificate of Membership (COM) from your Medical scheme confirming that the dependant is still on the same Medical scheme. On own Medical scheme and not students: Children on their own Medical scheme and not a student are required to have their own Gap Cover policy. Sirago Gap Cover Solutions 2027, p5
- You may add your overage dependant to your policy if they are still on your Medical scheme membership, or if they are on their own Medical scheme and are a full-time student. Sirago Gap Cover Solutions 2027, p23
Procedures it covers
In Sirago’s own words.
The Exact Cover option provides access to a defined list of stated procedures when your Medical scheme option excludes those specific procedures over and above their standard exclusions. Sirago will negotiate with all service providers on your behalf and pay the claim directly, up to the stated amounts as listed below. The cost of the hospital and all service providers are included in the cover limit.
- OESOPHAGEAL REFLUX AND HIATUS HERNIA SURGERY - R100 000
- VARICOSE VEIN SURGERY- R100 000
- MRI AND CT SCANS DUE TO AN ACCIDENT - R10 000
- SKIN DISORDERS INCLUDING BENIGN GROWTH AND LYMPHOMAS - R100 000
- NON-CANCEROUS BREAST CONDITIONS - R100 000
- TONSILLECTOMY, GROMMETS, AND ADENOIDECTOMY - R12 000 per policy, R20 000 combined procedure
- ENDOSCOPIC PROCEDURES (Bronchoscopy, Colonoscopy, Cystoscopy, Enteroscopy, Gastroscopy, Hysteroscopy, Laparoscopy, Laryngoscopy, Mediastinoscopy, Sigmoidoscopy, Thoracoscopy, Pleuroscopy, Ureteroscopy) - R15 000 per policy
- ARTHROSCOPIC SURGERY - R100 000
- BACK, NECK, SHOULDER AND KNEE SURGERY - R100 000
- BUNION SURGERY - R100 000
- COCHLEAR IMPLANT, AUDITORY BRAIN IMPLANT AND INTERNAL NERVE STIMULATOR SURGERY INCLUDING THE DEVICE AND PROCESSOR - R100 000
- DENTAL PROCEDURES FOR RECONSTRUCTIVE PLASTIC SURGERY DUE TO AN ACCIDENT - R100 000
- DENTAL PROCEDURES FOR IMPACTED WISDOM TEETH FOR CHILDREN UNDER 18 YEARS OLD - R15 000
- FUNCTIONAL NASAL SURGERY - R100 000
- JOINT REPLACEMENT SURGERY - R100 000
Sirago Exact brochure 2027, p1
Waiting periods
In Sirago’s own words.
- 10-month waiting period applies where no claims can be submitted for a procedure or surgery related to our list of procedures. Sirago Exact brochure 2027, p1
- 12-month waiting period on pre-existing conditions, specific diseases and/or illnesses related to our list of procedures. Sirago Exact brochure 2027, p1
Before you join
Printed on Sirago’s forms.
- Application forms may be underwritten and conditions may be excluded for longer than 10 months. Sirago application form 2027, p2
- The option change is only applicable on 1 January of every year. Sirago application form 2027, p1
- For options: Ultimate Gap, Plus Gap, Gap Assist, Gov Gap, Exact & Exact with Gap and Co-Pay: Dependants are: Spouse and/or dependant children up to the age of 21 years. Students up to the age of 27, if you are on a different medical scheme. Provide proof of enrolment for full time studies or medical scheme certificate. For families who belong to a single medical scheme and option, we cover the policyholder and dependants as listed by the scheme. All additional dependants added to the policy will be charged an additional rate per dependant based on their age as indicated. For further details, please refer to our website. Sirago application form 2027, p1
- Application forms may be underwritten and conditions may be excluded for longer than 10 months. Sirago additional dependants form 2027, p1
- By signing this affidavit, I hereby agree that should any claim be submitted within 90 days of inception of the Sirago Gap Cover policy, that Sirago reserves the right to re-underwrite this policy, backdated to inception of this policy. Sirago affidavit form 2027, p1
- If there’s been a break in cover for 30 days or more between the end date of cover with your current provider, and the cover start date of your new Sirago Benefits Gap Cover Policy, you’ll receive full waiting periods. Pre-existing condition waiting period applicable to like-for-like benefits and/or enhanced benefits: If your current Gap Cover Policy has been active for less than 12 months and a Waiting Period was applied, the balance of the waiting period will be carried over. If our Gap Cover Policy offers enhanced benefits, these benefit categories will have a 3-month General Waiting Period. During the 3-month General Waiting Period, there will be no cover on the enhanced benefit categories. Please submit a copy of your current Policy document - for underwriting purposes this should not be older than 30 days. By completing this form, you acknowledge and accept that your Policy will be subject to waiting periods on your new Sirago Policy Schedule. Sirago replacement confirmation form 2025, p1
How to claim
In Sirago’s own words.
On the website
Navigate to the Sirago website: https://sirago.co.za and select the “Submit a claim” button, which will take you to the claim form. Follow the step-by-step guide on submitting the claim. You will need the following information with you when you submit the claim: Your policy number, this will start with SIR/OMGC/SIRNG; Policyholder’s details. This is the person who holds the policy with Sirago; All claim requirements for the claim submission. (Refer to the “Required documents when claiming - Explanation table” on page 20)
Sirago Gap Cover Solutions 2027, p15
By email
Submit all the claim documents required to claims@sirago.co.za. Remember to include the following information in the submission: Your policy number, this will start with SIR/OMGC/SIRNG; The claim form needs to be fully completed and signed by the policyholder of the Sirago policy (Including disclaimers); All claim requirements for the claim submission. (Refer to the required documents list below.)
Sirago Gap Cover Solutions 2027, p15
Through your broker
Once you have accessed the specific policy, look for the applicable dependant and select Actions>Register Claim. Register your claim. (Use the link as a guide for registering a claim: https://support.sirago.co.za/support/solutions/articles/77000510865-submitting-a-claim-on-the-broker-portal). Once registered you can select the “view summary” button to access the claim to get the claim number. This will be required to submit the supporting documents. Upload supporting documents, including the claim form.
Sirago Gap Cover Solutions 2027, p15
When to send it
We must receive your claim with all supporting documentation within 180 days from date of admission.
Sirago Gap Cover Solutions 2027, p15
Documents to send
Sirago Gap Cover claim form completed and signed by the Policyholder; all approved claims will be paid into the bank account details registered with Sirago, unless alternative bank details are provided on the claim form. If the claim is related to a hospital admission, a detailed hospital account is always required. Your Medical scheme statement showing all the payments made by you or your Medical scheme for the health event. Completed medical reports substantiating the clinical information or any other documentation if requested by our claims team. Pre-authorisation letter from your Medical scheme for co-payment claims. Gap and Medical Scheme Premium Waiver claims: Accidental death certificate, SAPS accident report and/or a total permanent disablement certificate or reports from a registered medical practitioner. Value Added Benefit claims: A monthly Certificate of Membership from the Medical scheme is required for Medical Scheme Premium Waiver benefit, this needs to include the month and the monthly premium. Initial Cancer Diagnosis: Confirmation from the treating provider, the stage of cancer initially diagnosed with, including the histology report.
Sirago Gap Cover Solutions 2027, p15
What each document is for
| Document | Where to get it | Why Sirago needs it | Note |
|---|---|---|---|
| Sirago Claim Form | You can obtain this from our website: www.sirago.co.za/download/. You can contact one of our friendly customer experience centre consultants on 010 599 1163. You can WhatsApp one of our friendly customer extperience centre consultants on 076 562 1340. | Verify the correct policy to register a claim. Allows us to update information. Validates account details for claim payments once assessed. | This document needs to be completed and signed by the Sirago policyholder. All disclaimers and information needs to be completed to process the claim. |
| A detailed Hospital account | This is obtained from the hospital where you were admitted, whether it be one day admission or a lengthy stay in hospital. | The length of stay in hospital and the specific provider or practice details. Patient details. ICD-10 (Diagnosis) Code. Detail and summary of the costs for the hospital stay. The discounts applied by the hospital, where applicable. | A summary Hospital account will regrettably not suffice. |
| Service provider’s invoice / Doctor’s invoice | This is obtained from the treating provider’s accounts department who performed the procedure. | The provider’s name, practice number and type of provider seen. Patient’s details. Date which the patient saw the provider. ICD-10 (Diagnosis) Code the patient was treated for. | The amounts charged on this account need to correspond with the charged amounts on the Medical scheme statement. |
| Completed medical reports | This can be obtained from the doctor whom first diagnosed/treated you for symptoms. | Date of awareness of symptoms. When the provider was first seen. The history of the condition. | |
| Confirmation of pre-authorisation | You can obtain this from your Medical scheme. | Date of expected admission. The patient details. The hospital and length of stay. The benefit the scheme has on the client’s specific options; this includes: Benefit limits or sub-limits on specific benefits; The deductibles/co-payments that the client is liable for; The reason for the Scheme imposed co-payment. | |
| Facility Account (Step down benefits) | This is obtained from the accounts department from the facility the patient was admitted in as a step-down facility. | The length of stay at the specific facility the patient was admitted to. The patient’s details. The ICD-10 (Diagnosis) Code. The details and summary of the costs for the stay at the step-down facility. Discounts applied by the facility, where applicable. | |
| Casualty facility Invoice (Casualty Benefits) | This is obtained from the accounts department from the Casualty facility you visited. | Date and time the patient was admitted to the emergency facility. Patient details. ICD-10 (Diagnosis) Code. Detail and summary of the costs for the casualty visit. Discounts applied by the hospital, where applicable. | |
| Confirmation of oncology registration programme | This can be obtained from your Medical scheme. | Cancer treatment approved by the Medical scheme. The frequency of the specific treatment for each specific provider/doctor. | |
| Death certificate | This can be obtained from Home Affairs. | The identity of the demised person. The date of the demise. The category of cause of death. | |
| Fully completed DHA1663 Form / BI-1663 Form | This is provided by the medical practitioner/forensic pathologist. | This document provides particulars of the demise of the person, which assists us in the assessing of the claim under specific benefit of entitlements. | |
| SAPS accident report | SAPS that you reported the accidental death to. | This provides us with specific information to validate your claim against the benefits on your chosen option. | |
| Medical Scheme membership certificate | This can be obtained from your Medical scheme, monthly. | Monthly active membership. Monthly contribution on the active membership. | |
| Completed debit order authority form (if applicable) for the death of the policyholder | You can obtain this from our website: https://www.sirago.co.za/downloads-copy/. You can contact one of our friendly customer experience centre consultants on 010 599 1163. You can WhatsApp one of our friendly customer experience centre consultants on 076 562 1340. | The policyholder’s details. New debit order account details. |
Sirago Gap Cover Solutions 2027, p16-17
Words used
As Sirago defines them.
- Waiting period
- A “waiting period” is a defined period of time in which a policyholder may not claim any, or may only claim certain policy benefits. Sirago Gap Cover Solutions 2027, p18
- Overall Annual Limit (OAL)
- The Overall Annual Limit (OAL) of R232 000 per dependant per annum. Each benefit category adds up to the OAL, with certain benefit categories having sub-limits applicable within the OAL. All benefit categories are per policy, per annum. Sirago Gap Cover Solutions 2027, p8
- Individual Membership
- The premium for an individual will apply if there is one policyholder and no dependants on the policy. Sirago Gap Cover Solutions 2027, p5
- Family Membership
- This policy will cover the policyholder and the dependants who are listed on the Schedule of Insurance. Sirago Gap Cover Solutions 2027, p5
- Single Medical Scheme Membership
- We cover all members listed on the Medical Scheme Certificate of Membership (COM). Sirago Gap Cover Solutions 2027, p5
- Dual (two) Medical Scheme Membership
- Dual Medical scheme membership is when the policyholder and dependants belong to more than 1 (one) Medical scheme membership. Cover is limited to a maximum of 2 (two) adults and all the child dependants on 1 (one) policy if you belong to a dual Medical Scheme. We cover all members listed on both the certificates of membership (COM). Sirago Gap Cover Solutions 2027, p5
- Large loss claim
- A large loss claim is a claim where the shortfall is equivalent or greater than R85 000. These claims are to be signed off by the Insurer and sent for negotiation by a third-party provider who will assist in contacting the healthcare provider directly to get a discount on your behalf. Sirago Gap Cover Solutions 2027, p22
- Repudiation / falls out of the policy intention
- This means there is no cover available on your policy for the claimed event, according to your benefit entitlement. Sirago Gap Cover Solutions 2027, p22
- Split billing
- Should your gynaecologist request you to pay an upfront co-payment, this does not form part of the amount for a specific procedure code - this is called split billing. Therefore, this would fall under our policy specific exclusions as it does not fall within our co-payment benefits or any of the other benefits on the Sirago products. Sirago Gap Cover Solutions 2027, p22
- Accidental Death
- Death caused by an external, violent, unexpected and visible event. The accidental death benefit does not provide cover for suicide or death by natural causes. The death certificate must say “unnatural death”. We do not pay for natural death. For example, we will not pay if death is caused by an illness. We will however pay if the death was caused by a car accident and it is stated as an unnatural death on the death certificate and SAPS accident report. Sirago Gap Cover Solutions 2027, p23
- Exact Cover
- The Exact Cover option provides access to a defined list of stated procedures when your Medical scheme option excludes those specific procedures over and above their standard exclusions. Sirago will negotiate with all service providers on your behalf and pay the claim directly, up to the stated amounts as listed below. The cost of the hospital and all service providers are included in the cover limit. To access the exact cover benefits, policyholders are required to preauthorise the event with Sirago prior to incurring any expenses and admissions to hospital. Failure to do so will render the claim repudiated. Sirago Exact brochure 2027, p1
- Exact with Gap and Co-Pay Cover
- The Exact with Gap and Co-Pay option provides cover for specific procedures that your Medical scheme excludes, with additional Gap and Co-payment cover for the events that are covered by the Medical scheme. Sirago Exact with Gap and CoPay brochure 2027, p1
- ICD Augmentation (Initial Cancer Diagnosis Augmentation Cover)
- This optional add-on will payout a lump sum once your embedded initial cancer diagnosis benefit on your existing Sirago policy has paid out upon the initial diagnosis of malignant cancer from stage 2 onwards. Should your existing Sirago policy not provide cover for initial cancer diagnosis from Stage 2 onwards, claim requirements will be required to validate the claim. This benefit will be paid out as per occurrence on your option, 1, 2, 3 or 4 months after the initial embedded benefit or upon approval of initial cancer diagnosis. {Stage 2 onwards} Sirago ICD Augmentation brochure 2027, p1
Questions about Exact Cover
Answered from Sirago’s brochures.
How much does Exact Cover cost in 2027?
From 1 January 2027: R240 a month for one person, R290 for a family (policyholder aged 0 to 64).
Is Exact Cover new?
Yes. Sirago added Exact Cover to its range for 2027.
Can I join after 64?
No. New members join between 18 and 64.
Is there a waiting period?
Yes. 10 months general, and 12 months for conditions you had before joining.
Does Exact Cover cover cancer?
No. Exact Cover does not include cancer cover.
Is there a limit on what it pays?
Yes. R232 000 per person a year from 1 April 2027, and R223 000 before that.
Factual information from Sirago’s published brochures. It is not advice. Compiled by Eldon de Waal, CFA, the licensed advisor behind AURA. Catalogue v177, built 2026-10-19.