Gap Cover
Providing a wide range of extensive Gap Cover benefits, each carefully designed to cater to every Medical Scheme option. This is paired with our unparalleled, individualised service delivery, ensuring a personalised and effective healthcare experience for all policy holders.
Gap Cover – Quick Summary
| Benefit Category | Gap Cover Benefit Description | 2026 BENEFIT AMOUNTS & LIMITS |
|---|---|---|
| Overall annual limit (OAL) per insured person | R219,800 | |
| TARIFF SHORTFALLS | We cover medical specialists for treatment or surgery provided in hospital | Total Cover Enhancement Subject to OAL |
| We cover medical oncologists for treatment provided in or out of hospital | ||
| We cover out-patient procedures that would otherwise attract a co-payment if performed in hospital | ||
| We cover gynaecologist and/or paediatrician consultations (2nd Trimester–90 days post birth) |
R730 per consultation R2,900 per pregnancy |
|
| ONCOLOGY CO-PAYMENTS | We cover the 20% co-payment after reaching the oncology threshold | 100% cover | Subject to OAL |
| We cover co-payments on approved precision medicines | R18,300 per claim Subject to OAL |
|
| We cover co-payments applied on ex-gratia benefits for precision medicines | R18,300 per claim Subject to OAL |
|
| UPFRONT PAYMENTS | We cover the upfront payment applied as a fixed rand value to MRI/CT/PET scans, in-hospital endoscopes, in-hospital basic dentistry and defined procedures | 100% cover | Subject to OAL |
| We cover other upfront payments (including robotic surgery) | R27,000 per event | |
| We cover upfront payments for voluntary use of a non-network hospital or clinic | R21,000 per event | Max 2 pppa | |
| LIMIT EXTENDER | We cover shortfalls when a sub-limit applies to an internal prosthetic device | R73,000 per event |
| We cover shortfalls when a sub-limit applies to MRI/CT/PET scans, endoscopes or intra-ocular lenses | R8,600 per event | |
Extended Cover – Quick Summary
Benefit Category |
Extender Cover Benefit Description |
2026 BENEFIT AMOUNTS & LIMITS |
|---|---|---|
| CASUALTY COVER | We cover emergency treatment at a casualty facility resulting from an accident We cover emergency after hours illness treatment in a casualty ward for children under 12 |
R20,000 per event Max 2 pppa R3,600 per event Max 2 pppa |
| If the accident was a sports injury, we will also cover shortfalls on rehabilitation consultations at a physiotherapist/biokineticist/chiropractor | R820 per consult Max 6 per event |
|
| TRAVELING ABROAD | We cover the excess on your international travel insurance for medical emergencies | R4 200 per departure |
| CANCER DIAGNOSIS | We will pay a once-off lump sum on a first lifetime diagnosis that is made after the policy inception and the expiry of all waiting periods | Stage 1 – R7,000 Stage 2 – R20,000 Stage 3 – R30,000 Stage 4 – R50,000 |
| If after diagnosis you upgrade your medical scheme benefit option at the first opportunity, we will provide a waiver for the additional medical scheme contributions | R5,200 pm for 12 Months | |
| EXTRA COVER | For an admission resulting from an accident and the admission is 3 days or longer we will pay a daily lump sum: Tier 1 from day 1 – 7 and Tier 2 from day 8 – 28 | Tier 1 = R180 per day Tier 2 = R1,800 per day |
| We pay a lump sum for a birth that is 42 days or more premature | R22,000 per event | |
| ACCIDENT COVER | In the event of accidental death or permanent disability caused by an accident If the event is a direct result of a proven crime, the above benefit doubles |
R24,000 per person |
| WAIVER COVER | In the event of accidental death or permanent disability of the principal member or spouse, we will cover the medical scheme contributions and gap cover premiums for 6 months | R8,600 pm – medical aid 100% on policy |
| TRAUMA COVER | If an insured member is a witness to or a victim of a violent crime, we will cover sessions with a counseling therapist | R1,000 per session Max R11,000 pppa |
Your monthly premiums explained
For private individuals, Cinagi premiums are structured on the entry age of the oldest person joining the policy as well as the family size. Our integrated Cover Pay Level (CPL) structure also recognises if you are on a richer medical scheme benefit option. If your benefit option covers medical specialists for in-hospital treatment at 200% or more of scheme tariff, then the CPL-200 premiums will apply to your cover. If the in-hospital medical specialist cover is at 100% of scheme tariff, then the CPL-100 premiums will apply.
Features
In-Hopital Cover
Comprehensive protection against shortfalls in your medical scheme cover for medical specialists and surgeons.
Oncology Cover
Our oncology cover offers you the most comprehensive industry-leading protection against oncology co-payments and tariff shortfalls.
Casualty Cover
Provides cover for emergency treatment at a casualty facility for accidents plus an additional rehabilitation benefit for sports injuries.
Upfront Payments
Full cover for upfront payments or deductibles on diagnostics and surgical procedures.
Financial Soundness
All Cinagi insurance products are underwritten by our exclusive business partner, Infiniti Insurance Ltd, an A credit rated underwriter.
Affordable Premiums
Starting at just R261for GapMAX, you get industry leading protection at competitive premiums.
Travel Cover
We will cover the excess payable on your travel insurance policy for claims on medical emergencies whilst traveling internationally.
Claim Optimiser
Don’t be out of pocket – our Claim Optimiser will guarantee upfront payments to providers, meaning no out-of-pocket costs for you.
Wellniciti Savings
Cinagi’s bespoke loyalty benefit offering discounts on a wide range of primary care healthcare providers as well as everyday grocery items at our selected retail partner.
Visit www.wellniciti.co.za/savings for more details.
Instaclaim – South Africas First “60-Minute” Gap Cover Claims Process
Groundbreaking innovation in the insurance industry where qualifying gap cover claims are paid within 60 minutes of submission.
Joining is Easy
Contact us form more information or speak to your healthcare advisor today about Cinagi Gap Cover.
Joining online is easy and you can have your cover in place in under 15 minutes!
About
At Cinagi, we are committed to excellence. Our many years of experience in the healthcare industry, combined with excellent service levels gives you the peace of mind that you have the best health insurance cover available.
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