SUBMIT A CLAIM
We care that the claims process is
seamless.
We care that the claims process is seamless.
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.
Report Your Claim
You need to report your claim to us as soon as possible.
Submit Your Documents
Submit all required relevant documents to us within 180 (hundred and eighty) days after the event date.
Submit Supporting Documents
Submit all the necessary documents to substantiate your claim.
Requirements for claiming specific benefits
Gap Cover Claims
Sirago claim form
Service provider’s invoice/Doctor’s account
Hospital bill
Medical scheme statement
Co-payment/Penalty Fee and Admission Fee Claims
Sirago claim form
Provider’s invoice/Doctor’s accounts
Hospital account
Proof of co-payment and/or medical scheme brochure or marketing material
Detailed medical scheme statement that shows the co-payment applied, reason code and/or explanation for the shortfall
- In the event of a penalty fee co-payment, an authorisation letter from the Medical Scheme
Casualty Room Cover (Accident Requirements)
Sirago claim form
Casualty/emergency room account
Service provider’s invoice/Doctor’s account
Casualty Room Cover (Illness Requirements)
Sirago claim form
Casualty/emergency room account
Service provider’s invoice/Doctor’s account
- 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*
Casualty Illness Benefit for Children under 12
Sirago claim form
Casualty/emergency room account
Service Provider’s invoice/Doctor’s account
Hospital bill
Treating provider’s invoice
Medical scheme statement *Medical aid statement required for Gap Assist when claiming to the EMERGENCY ROOM COVER – Illness Benefit*
Accidental Death
Sirago claim form
Death certificate
- Report BI-1663 Form
Sub-limit Enhancer
Sirago claim form
Hospital bill if admitted into hospital
Treating provider’s invoice
Medical scheme statement
Authorisation letter confirming internal prosthesis/radiology limit
Gap Premium Waiver
Sirago claim form
Accidental death certificate or permanent disability report
Monthly medical scheme membership certificate
Completed debit order authority form, if applicable
Medical Scheme Waiver
Sirago claim form
Accidental death certificate or permanent disability report
Monthly medical scheme membership certificate reflecting membership status and monthly contributions
Cancer Boost
Sirago claim form
Confirmation of oncology programme registration
Treating provider’s invoice
Medical scheme statement
Cancer Initial Diagnosis
Sirago claim form
Histology report confirming date of diagnosis
Cancer Benefit
Sirago claim form
Provider’s invoice
Medical scheme statement
Trauma Counselling
Sirago claim form
Service provider invoice Police report Report from service provider
Step-down Benefits
Sirago claim form
Facility invoice
Medical scheme statement