GAP LIBERAL
For the younger generation.
Monthly premiums
Why choose Gap Liberal?
Gap Liberal is the perfect affordable gap cover option designed with young adults in mind. Whether you’re just starting your career, freelancing, or still figuring out medical aid plans, Gap Liberal has your back when those unexpected medical bills hit. It bridges the shortfall between what your medical aid pays and what specialists or hospitals actually charge—without draining your budget. With low monthly premiums and solid cover for major procedures, Gap Liberal gives you the peace of mind you need to focus on building your life, not stressing over medical surprises. It’s smart, simple protection—because adulting is hard enough already.
Key benefits
OAL per beneficiary per annum: R223 000 (from 1 April 2026)
In-hospital Benefits
Gap Cover
The Gap Cover benefit covers the difference between the medical scheme rate and the rate that service providers charge.
We cover up to 500% (five hundred percent) of the medical scheme rate, or at the amount above the medical scheme stated benefit value as determined by your medical scheme.
For robotic surgery claims that are reflected on the hospital account, we will cover up to toa sub-limit of R15 000 per policy. We will cover the shortfall on claims for BMI (Body Mass Index) codes 0018 and 0019 only. 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 R16 000 per policy with a maximum of 1 claim per 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 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 R5 000 per policy, and a maximum of R950 per claim. A R1 200 sub-limit is applicable to private room upgrades. Subject to the OAL.
Sub-limit Enhancer
This benefit has a sub-limit of up to R32 000 per policy, per annum. This benefit caters for all sub-limits. We will provide cover when there is a benefit on your medical scheme option for devices like MRI & CT scans, cochlear implants, intraocular lenses, internal prostheses, and Transcatheter Aortic Valve Implantation (TAVI) procedure valves. 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 depending on the Gap option you are on. 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
Specialist Consultation Fee
This benefit covers the shortfall on the consultation fee at a specialist outside of hospital (excluding Psychiatrist and Psychologist) up to R4 500 per policy, and R1 200 per claim. This benefit is only applicable to consultation codes 0190, 0191, and 0192. The medical scheme needs to make at least partial payment towards the consultation code mentioned above. Subject to the OAL.
Casualty Benefit
There is a sub-limit of R10 000 per policy. This benefit covers the initial emergency at any registered casualty facility when you require immediate medical treatment due to an accident and trauma, or illness. 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, whether you are liable to pay the costs out of your own pocket or if your medical scheme pays from your savings.
CHILD CASUALTY ILLNESS BENEFIT
All costs related to the initial emergency illness event will be covered and paid up to R2 500 per claim of the sub-limit, if you are liable to pay the costs out of your own pocket, or if paid from your medical scheme savings. This is applicable to any beneficiary 12 years and younger who needs emergency illness treatment outside of normal consultation hours
.
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.
Trauma Counseling
Cancer Benefits
Cancer Co-payment Benefit
This benefit applies if 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. Ongoing treatment must be in line with the registered treatment plan of your medical scheme to access this benefit, Subject to the OAL.
Cancer Benefit - Boost
The Cancer Boost Benefit is applicable to policyholders whose medical scheme option has a defined rand limit for cancer treatment and the rand limit on the medical scheme has been reached.
We will cover the costs of ongoing treatment in line with the medical scheme’s registered treatment plan once the rand limit has been reached. Subject to the OAL.
Value-added Benefits
Gap Cover Premium Waiver
In the event of accidental death or total permanent disability of the Sirago policyholder, we will keep the premiums for your policy as a credit for 6 months. This benefit may be claimed by the surviving spouse or adult dependent on the Sirago policy.
Medical Scheme Premium Waiver
Sirago will pay the rand amount of the medical scheme premium, not higher than R4 000 per month for a 6-month period. This will be paid to the beneficiary for the upkeep of the medical scheme contributions in event of accidental death or total permanent disability of the Sirago policyholder and where all beneficiaries are linked to a single medical scheme.
This benefit is only payable for the medical scheme that the policyholder was on if there is dual medical scheme membership.
Cancer Cover (Initial Diagnosis)
This benefit will pay out a lump sum of R10 000 per beneficiary in the event where you are diagnosed with malignant cancer from stage 2 onwards. Any cancer prior to inception of the policy or pre-existing cancer is excluded. Skin cancer is specifically excluded from cover on this policy, except malignant melanomas.
Sira'Go Baby
Sirago will pay out a lump sum of R2 000 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 it to changes@sirago.co.za together with your baby’s birth certificate.
Sirago Medcare - Free Medical Scheme Alternative Dispute Resolution Service (ADR)
This benefit gives you access to MedCare’s free ADR service for all disputed PMB claims exceeding R9 000. You 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
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