Claim_Test

Claim Optimiser

Medical schemes have co-payments or upfront payments that apply to certain procedures or tests (eg MRI/CT scans) that must be paid by members before undergoing the treatment or tests.

To assist Cinagi members, we have established the Co-Payment Claim Optimiser, where we will guarantee the payment directly with the relevant facility prior to you having the procedure/treatment. This means that you do not need to make any out-of-pocket payments and we will pay the provider directly on your behalf.

Please note that this service is not available if your policy is still subject to a waiting period – kindly read the ‘Important Notes’ below on how and when the Co-Payment Claims Optimiser service can be utilised.

How does it work?

1. Obtain the pre-authorisation letter sent to you from your medical scheme.
2. Complete this form at least 72 hours before your admission by clicking on the ‘Next’ button at the bottom of this page.
3. Fill in the details on the form and upload the above pre-authorisation letter when requested.
4. Once your request has been reviewed and approved by us, we will provide a payment guarantee to the facility.
5. You will receive a confirmation letter from us which can be presented to the provider on the day of admission/treatment.

Important

• The Co-Payment Claim Optimiser is not available if your cover is still within a waiting period.
• This facility is only applicable to defined co-payments or upfront payments (as per your medical scheme rules) and that are covered in full by your Cinagi Gap Cover policy. Examples are:
• Radiology (eg, MRI and CT scans)
• Scopes (eg, gastroscopy, colonoscopy, sigmoidoscopy, proctoscopy, etc)
• Wisdom teeth extraction
• Defined Co-payments on specified surgical procedures
• Any additional shortfalls that arise after your procedure/treatment that are not covered by the Co-Payment Optimiser, will require you to submit a separate claim, you can intiate the claim HERE.
• By making use of this service you agree to cede to us the benefits relating to co-payments under your Cinagi Policy for this procedure. This only applies to co-payments or upfront payments that have been approved by Cinagi.

Policyholder Details

Procedure Details

Declaration & Submission

By providing the information in this form you agree that :

• Subject to approval by Cinagi, all benefits relating to the co-payment in question will be ceded to Cinagi.
• Any additional claim/s will be required to be submitted by yourself by means of the standard Cinagi Claims process.
• To assist Cinagi in obtaining any documentation relating to the fee/s charged by the facility (This could be required after discharge)
• Negotiate with any of my medical service providers on the fees that they have charged.
• Disclose this information to persons and entities that it is necessary to disclose this information to in order to provide you with the aforementioned services.
• Have the right to communicate with you electronically about any changes or general information relating administrative processes or changes to your policy benefits and premiums.
• Only transfer your personal information outside South Africa if you have provided an email address that is hosted outside South Africa or to administer certain services, for example, cloud services and/or the Medical Second Opinion service.

You further agree that:

• Cinagi is providing the Co-Payment Claim Optimiser guarantee based on full disclosure as required on your original application for cover. If Cinagi has provided any guarantee under this service and it is subsequently discovered that non-disclosure of pertinent information would have resulted in a waiting period being applicable to your cover, then you agree that the guarantee can be withdrawn or that if any payments have been made to a provider by us on your behalf, that such amounts will be paid back to us.
• That all details above as well as any supporting documentation supplied with this claim, are true and correct and that you are aware that any non-disclosure or misrepresentation of any details may result in this claim being rejected or your policy cancelled or voided from inception.
• By submitting your dependents’ relevant personal information, you hereby confirm that you are duly authorised to share such information with us. We will furthermore process their information for the purposes and in the manner as set out in our Privacy Statement
• If you are submitting this claim for a person under the age of 18 years (a minor), you confirm that you are a competent person and that you have the authority act on their behalf.

You also acknowledge that that you have read and agreed to the Cinagi Privacy Statement and the contents thereof.