A Smooth Claims Process
We care that the claims process is seamless. If you need any assistance or advice in submitting your claim, please call Sirago's friendly customer service consultants at tel no 010 599 1163. Should you be incapacitated and not able to make contact, you may get someone to contact us on your behalf. Please always consult your broker/intermediary if in doubt.
Submitting your Claim
All required relevant documents must be submitted to us within 180 (hundred and eighty) days after the event date. Claims can be emailed to firstname.lastname@example.org.
This is a basic list of supporting documents required in order to submit a claim. Please note that other documents may be asked for in the process of assessing a claim.
- Sirago Gap Cover claim form completed and signed by the policyholder.
- Hospital and related accounts substantiating your claim.
- Medical scheme statement reflecting all the payments made by your medical scheme for the treatment dates of 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.
- Value Added Benefit claims: documentation and certification which may include a death certificate or a report from a registered medical practitioner confirming total permanent disability.
- Initial Cancer Diagnosis: we require a histology report.
When Will a Claim (Benefit) be Authorised for Payment?
- Once we have confirmed validity of your policy and dependants.
- Once we confirm your premium payments are up to date.
- Once we have validated your claim using sub-contracted administrators if required.
- Once we have confirmed benefits for the claim ICD-10 Coding.
- Upon all policy conditions having been met.
- Upon confirmation of a valid HPCSA practice number.
- Once all required documents have been received.
- Depending on the benefit design of your chosen medical scheme option:
- Hospital Plan: Benefits will be paid in the event that your option pays a portion of the claim.
- Savings Plan: Benefits will be paid in the event that your option pays a portion of the claim. However, the value settled by the Insurer will be limited to the Gap portion after the scheme has defrayed the scheme rate of the claim provided that there was an accumulated or allocated savings balance at the time of claim.
- Traditional Medical Scheme Option: Benefits will be paid in the event that your option pays a portion of the claim.