Sirago MedCare

Sirago MedCare

Your Free Medical Scheme Alternative Dispute Resolution Service

MedCare Costs

After assessment of a PMB claim and not meeting the requirements of Sirago for payment the policyholder will have access to a free ADR service via MedCare for all claims exceeding R12 000.

Policyholders will also be able to access the MedCare service for all claims that fall outside the R12 000.

Register today and take control of your medical claims

Register today and take control of your medical claims

How MedCare Works

A Comprehensive Alternative Dispute Resolution Service 

Legal action is expensive. The term alternative dispute resolution (ADR) refers to a procedure, agreed to by conflicting parties of a dispute, in which they use the services of a neutral party to assist them in reaching agreement and avoiding costly litigation. Section 29(1) (j) of the Medical Schemes Act compels medical schemes to contain the process how members can resolve complaints and/or disputes. Section 47 to 50 of the Medical Schemes Act also allow aggrieved parties to lodge complaints with the Registrar of Medical Schemes and allow for appeals if an aggrieved party is dissatisfied with a decision or ruling.

  • Step 1 - Free Information

    Free and comprehensive information is available on the information hub to all Sirago policyholders. Here is information about your rights as a member of a medical scheme, self-help guides, previous case law and templates to name a few resources.

  • Step 2 - Decide on a course of action

    You will have to decide if you want to lodge a dispute or complaint yourself if you want to use your broker or if you want to use the services of a MedCare ADR Practitioner.

  • Step 3 - Contact your ADR Practitioner

    Should you want to use your ADR practitioner then you can do so by clicking on the ADR practitioner button on the information protal. If your claim relates to a Gap cover claim and is above R 12 000 then the ADR services will be free of charge. Claims below R 12 000 or any other aspect relating to your medical scheme can still be referred to your ADR practitioner. However, there will be a fee applicable to those cases.


Information hub

You and your broker have full and unrestricted access to a full information hub. Here you will learn what your rights are as a member of a medical scheme, what is a Prescribed Minimum Benefit and how to lodge a complaint or dispute. There are also templates that can be used. This information hub is updated regularly.

Do it yourself

If you or your broker want to lodge a dispute or complaint yourself this section will guide you how to do so. We strongly recommend that you do not lodge the complaint or dispute yourself. Rather use the services of your broker or the services of your MedCare ADR practitioner.

Use your MedCare ADR Practitioner

Your MedCare ADR Practitioner will work with you and your broker (where applicable) to lodge complaints or disputes on your behalf.


What Our Policyholders Say About Us

Richard Pensioner

Even though not a GAP claim, MedCare helped me to resolve my short-term insurance claim. Your involvement increased my payout after my house burnt down with R300 000. I cannot thank you enough.

Charmaine HR Officer

Thank you MedCare team for taking on my husband's case with the CMS. My husband was hospitalised for Covid and MedCare you assisted in getting the short payment for a PMB paid. That saved us R16 000, and even better is that I did not have to claim it from our GAP cover. Excellent work done.

Waldo Student

Thank you MedCare for ensuring that my medical scheme refunded me for physiotherapy treatment. The amount was not huge, but it was the principle that was important. You guys ROCK!

David Business owner

My Claim of R 477 000 was fully paid as a PMB after MedCare took the matter to the CMS on my behalf. Thank you Medcare team!

Tobie Finance Manager

Thank you MedCare team for taking on my case with the medical scheme. I was hospitalised and had to use a hospital outside the network for a PMB. My claim was R5 000 was paid, and I did not need to claim from my GAP cover. Fantastic and competent, MedCare assisted me all the way.

Leonie Office Manager

Thank you, MedCare. Even though it was not a Gap claim, you helped me resolve my short-term insurance claim. Your involvement ensured that a car damage claim was paid in 48 hours, when the insurance procrastinated for more than a year and eventually refused to pay.