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

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

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

Emergency Room Cover (Accident Requirements)

Sirago claim form
Casualty/emergency room account
Service provider’s invoice/Doctor’s account

Emergency 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

Emergency Illness Benefit for Children under 8

Sirago claim form
Casualty/emergency room account
Service Provider’s invoice/Doctor’s account
Hospital bill
Treating provider’s invoice
Medical scheme statement

Accidental Death

Sirago claim form
Death certificate

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
Death certificate or permanent disability report
Monthly medical scheme membership certificate
Completed debit order authority form, if applicable

Medical Scheme Waiver

Sirago claim form
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

Submit an online claim

Step 1 of 5

Policyholder Details
Name*
Prefix First Last
Policy Number*
ID Number / Passport*
Date of Birth*
Date Format: MM slash DD slash YYYY
Email*
Home Phone Number
Work Phone Number
Cellphone Number*
Residential Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Postal Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Admission Date
Date Format: MM slash DD slash YYYY
Discharge Date
Date Format: MM slash DD slash YYYY

Banking Details for Refunds
SHOULD YOU NOT COMPLETE THIS SECTION IT WILL RESULT IN US USING YOUR DEBIT ORDER DETAILS
Name of Account Holder
First Last
Account Number
Bank
Account Type
Signature

Provider Details
Date of Service
Date Format: MM slash DD slash YYYY
Service Provider
Date of Service
Date Format: MM slash DD slash YYYY
Service Provider
Date of Service
Date Format: MM slash DD slash YYYY
Service Provider
Disclaimer: We at Sirago believe in Treating Customers Fairly (TCF) and therefore will assess your claim/s in a holistic manner.

Submitted Documents
Doctors Account
Medical Aid Statement
Hospital Account
Proof of Co-payment
Other
Drop files here or

Declaration by Applicant
I, the undersigned, hereby declare:
1. That I understand that this is an Accident and Health policy with stated benefits in terms of the Short-term Insurance Act 53 of 1998 and not a Medical Scheme product.
2. The sharing of claims information and underwriting information by Insurers is essential to enable the insurance industry to underwrite policies, assess risks fairly, reduce the incidence of fraudulent claims and protect the public interest in terms of limiting excessive premium increases. I hereby waive any right to privacy of any insurance information provided by me or on my behalf, in respect of any insurance policy or claims I lodge. I also consent to this information being disclosed to any other insurance company and/or verified against other legitimate source or a database.
3. I specifically consent to Sirago Underwriting Managers (Pty) Ltd contacting my current Medical Scheme and/or medical practitioner to verify any medical details as provided in my application form. I further consent to such information being disclosed to Sirago Underwriting Managers (Pty) Ltd for purpose of verifying the disclose as provided on my application form.
4. As part of the claims validation process, the services of a contracted third party is used in order to authenticate medical scheme membership, plan option type, relevant beneficiaries and agreed medical scheme option tariffs amongst other relevant information to validate the claim.
5. Sirago reserves the right to call for additional information of a clinical nature. In the event that Sirago requests a PMA (Post Medical Assessment) from my doctor as part of the claims assessing and authentication process.
6. I authorise Sirago Underwriting Managers to negotiate with service providers on my behalf for my medical claims and or bill and pay the provider directly.
7. In the event of a bereavement related claim the Insurer will pay the benefit into the principal or nominated beneficiaries account. The beneficiary must be noted on the policy prior to any loss. The insurer will require the full name, surname and ID to note the beneficiary. At the time of a claim the insurer will require the beneficiary’s ID and proof of bank. Should there be no beneficiary noted on the policy prior to the loss or should the insurer be unable to confirm the identity of the beneficiary, payment will always be made into the principal policyholder's account.
Name
First Last
ID Number / Passport
Signature
PLEASE NOTE:
Sirago Underwriting Managers (Pty) Ltd must be notified within 90 days of any occurance which may give rise to a claim. Claims will NOT be considered for assessment without the following documentation:
- A fully completed, signed claim form.
- Clear copies of all account statements.
- Medical Scheme statement showing all amounts paid by your Scheme.
- Proof of payment for amounts paid by the insured.
- Hospital account / Medical Scheme statement indicating co-payments imposed by the Medical Scheme.
- Cancer treatment plan if applicable.
All documents must be submitted within 90 days of payments by the Medical Scheme to qualify for payment. All policy terms apply to each claim submitted.

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Sirago Underwriting Managers (Pty) Ltd is an Authorised Financial Services Provider (FSP:4710). Underwriting Agency for GENRIC Insurance Company Limited (FSP:43638).
GENRIC is an Authorised Financial Services Provider and Registered Short-term Insurer.

Claims

How to
submit a claim

Report your claim

Submit Your documents

Supporting Documents

Requirements for
claiming specific benefits

Submit an online claim

Step 1 of 5

Policyholder Details

Banking Details for Refunds

Provider Details

Submitted Documents

Declaration by Applicant

Get a Gap Cover solution that's tailored for your unique requirements

Contact

Social Networks

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HOW CAN WE
HELP YOU?

WE ARE HERE TO HELP YOU.

HOW CAN WE
HELP YOU?

WE ARE HERE TO HELP YOU.

Claims

How to submit a claim

Report your claim

Submit Your documents

Supporting Documents

Requirements for claiming specific benefits

Submit an online claim

Step 1 of 5

Policyholder Details

Banking Details for Refunds

Provider Details

Submitted Documents

Declaration by Applicant

Get a Gap Cover solution that's tailored for your unique requirements

Contact

Social Networks

menu

HOW CAN WEHELP YOU?

WE ARE HERE TO HELP YOU.

HOW CAN WEHELP YOU?

WE ARE HERE TO HELP YOU.

How to
submit a claim

Requirements for
claiming specific benefits

HOW CAN WE
HELP YOU?

HOW CAN WE
HELP YOU?