GAP CORE COVER
Cover for the whole family.
Monthly premiums
Why choose Gap Core?
Gap Core is an affordable gap cover option designed with families in mind, offering essential protection against medical shortfalls without the high price tag. It covers the difference between what your medical aid pays and what healthcare providers charge for in-hospital procedures, and more. With a single, budget-friendly premium that extends to your dependants, Gap Core ensures your family is financially protected when it matters most. Simple, reliable, and cost-effective — it’s core cover for the people who matter most.
Key benefits
OAL per beneficiary per annum: R223 000 (from 1 April 2026)
In-hospital Benefits
Gap Cover
This covers the difference (the shortfall or the gap) between what the medical scheme pays and the doctors and specialists charge in hospital. We will settle claims up to 350% of the medical scheme rate up to a maximum of 450% or at the stated benefit value. For Robotic surgery claims that are reflected on the hospital account, we will cover up to a sub-limit of R18 000 per policy. Subject to the OAL.
Co-payments and Co-payments charges as a percentage
Co-payment cover is for the co-payments (including co-payments expressed as a percentage), excesses, or deductibles as stipulated, or imposed by a medical scheme, for specified procedures, cover for hospital admission fees, or surgical procedures. The co-payment must be part of your medical scheme rules which will be highlighted on the authorisation for your procedure. Subject to the OAL.
Refer to the Cancer Co-payment benefit for claims related to cancer.
Penalty Fee Co-payments
When you choose to use a hospital that is not on your medical scheme’s network, you may have to pay a stated amount or percentage of the accounts as specified by your medical scheme rules.
This benefit has a sub-limit of R11 500 per claim, with a maximum of 1 claim per policy, irrespective of whether a rand amount or percentage penalty fee is charged by the medical scheme. Note that this is for the voluntary use of a non-designated service provider or network hospital and includes the use of a partial cover network hospital.
Co-payments for administration charges are specifically excluded from cover on this option. Subject to the OAL.
Day Hospital/Clinic and/or In Room Surgical Procedures Cover
This benefit will cover the shortfall for any day hospital, clinic, or in-room procedures including acute hospitals if a policyholder elects to have the treatment that would normally be performed in hospital, done in a day hospital, clinic, or in a doctor’s room by a registered medical professional. Subject to the OAL.
Prescribed Minimum Benefit (PMB) Cover
Prescribed Minimum Benefits (PMB) give all scheme members access to certain minimum health benefits, regardless of your medical scheme option. Medical schemes are required to pay the full cost of diagnosis and treatment of a defined list of PMB medical conditions.
PMB Cover on this policy is only for the shortfalls resulting from the voluntary use of a non-designated service provider for a planned PMB procedure. This is not applicable in the event of an emergency. In the event of an emergency, PMB protocols should be adhered to. Subject to the OAL.
Hospital Account Shortfall
This benefit will cover any charges, like consumables or take-home medication, on the hospital account that the medical scheme has not paid.
We also cover take-home medication that the medical scheme has not paid from risk and the cost of upgrading to a private ward up to the benefit amount.
We pay up to R4 500 per policy, R950 per claim. A sub-limit of R1 000 is available for private room upgrades. Subject to the OAL.
Sub-limit Enhancer
This benefit has a sub-limit of up to R26 000 per policy, max R13 000 per claim. Medical scheme benefits available on the medical scheme option for MRI & CT scans, internal prostheses, and Transcatheter Aortic Valve Implantation (TAVI) procedure valves only.
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 up to the claim limit.
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.
Out-of-hospital Benefits
Casualty Benefit
There is a sub-limit of R2 000. This benefit covers the initial emergency at any registered casualty facility when you require immediate medical treatment due to an accident and trauma.
We 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.
Accident & Trauma Benefit
All costs related to the accident/trauma event will be covered up to the Emergency Room sub-limit, whether you are liable to pay the costs out of your own pocket or if your medical scheme pays from your savings.
Out of normal consultation hours means 18h00 to 07h00 on Monday to Friday, and all of Saturday, Sunday, and South African public holidays. Subject to the OAL.
Cancer Benefits
Cancer Co-payment Benefit
This benefit applies once 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. The ongoing treatment must be in line with the registered treatment plan of your medical scheme to access this benefit. Subject to the OAL.
Value-added Benefits
Sira'Go Baby
Sirago will pay out a lump sum of R1 500 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 to changes@sirago.co.za together with your baby’s birth certificate.
Sirago Medcare - Free Medical Scheme Alternative Dispute Resolution Service (ADR)
With this benefit, the policyholder will get access to MedCare’s free ADR service for all disputed PMB claims exceeding
R9 000. Policyholders can also access the MedCare service for all claims less than R9 000, including all potential medical scheme disputes, at a 60%, 20%, and/or 15% discounted rate depending on the required service.
Your broker can also access this service on your behalf and will subsequently have access to the MedCare website: siragomedcare.co.za.
Explore our gap products
Ultimate Gap Cover
Our most comprehensive option with an extensive range of benefits.
From
R645
per month
Exact Gap Cover
Get cover for specific procedures excluded by your medical scheme.
From
R227
per month
Exact with Gap & Co-pay Cover
Cover for specific procedures with additional gap and co-payment cover.