Sirago Underwriting Managers

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Claims

We care that the claims process is seamless.
At Sirago we believe in treating customers fairly (TCF) and we will therefore assess your claim in a holistic manner.

How to submit a claim
Requirements for submitting a claim
Submit an online claim

How to
submit a claim

If you need any assistance submitting your claim, or any advice, please contact your broker or call our friendly customer service consultants. Should you be incapacitated and not be able to make contact, you may get someone to contact us on your behalf. Always consult your broker if in doubt.

Step 1

Report your claim

You need to report your claim to us as soon as possible.

Step 2

Submit Your documents

In order for you to prove a claim, all required relevant documents must be submitted to us within 180 (hundred and eighty) days after the event date. We shall not be liable for claims where the documentation is received outside of this period.

Step 3

Supporting Documents

  • A fully completed and signed Sirago claim form for each event
  • All hospital and related accounts substantiating your claim
  • 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 as requested if requested by our claims team
  • Completed medical reports substantiating the clinical information or any other documentation as requested if requested by our claims team
  • In the event of a value added benefit claim, all supporting documentation and certification are required by the Insurer, which would include a death certificate and/or a report from a registered medical practitioner confirming total permanent disability
  • In the event of a claim for Initial Cancer Diagnosis, we require a histology report

Requirements for
claiming specific benefits

  1. Sirago claim form

  2. Service provider’s invoice/Doctor’s account

  3. Hospital bill

  4. Medical scheme statement

  1. Sirago claim form

  2. Provider’s invoice/Doctor’s accounts

  3. Hospital account

  4. Proof of co-payment and/or medical scheme brochure or marketing material

  5. Detailed medical scheme statement that shows the co-payment applied, reason code and/or explanation for the shortfall

  6. In the event of a penalty fee co-payment, an authorisation letter from the Medical Scheme

  1. Sirago claim form

  2. Casualty/emergency room account

  3. Service provider’s invoice/Doctor’s account

  1. Sirago claim form

  2. Casualty/emergency room account

  3. Service provider’s invoice/Doctor’s account

  4. Medical Aid statement for service provider’s invoice/Doctor’s account and casualty/emergency room account –

    *Medical aid statement required for Gap Assist only when claiming to the EMERGENCY ROOM COVER – Illness Benefit*

  1. Sirago claim form

  2. Casualty/emergency room account

  3. Service Provider’s invoice/Doctor’s account

  4. Hospital bill

  5. Treating provider’s invoice

  6. Medical scheme statement  *Medical aid statement required for Gap Assist when claiming to the EMERGENCY ROOM COVER – Illness Benefit*

  1. Sirago claim form

  2. Death certificate

  3. Report BI-1663 Form

  1. Sirago claim form

  2. Hospital bill if admitted into hospital

  3. Treating provider’s invoice

  4. Medical scheme statement

  5. Authorisation letter confirming internal prosthesis/radiology limit

  1. Sirago claim form

  2. Accidental death certificate or permanent disability report

  3. Monthly medical scheme membership certificate

  4. Completed debit order authority form, if applicable

  1. Sirago claim form

  2. Accidental death certificate or permanent disability report

  3. Monthly medical scheme membership certificate reflecting membership status and monthly contributions

  1. Sirago claim form

  2. Confirmation of oncology programme registration

  3. Treating provider’s invoice

  4. Medical scheme statement

  1. Sirago claim form

  2. Histology report confirming date of diagnosis

  1. Sirago claim form

  2. Provider’s invoice

  3. Medical scheme statement

  1. Sirago claim form

  2. Service provider invoice Police report Report from service provider

  1. Sirago claim form

  2. Facility  invoice

  3. Medical scheme statement

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