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 |
2025 BENEFIT AMOUNTS & LIMITS | |
|---|---|---|---|
GapMAX |
GapCORE |
||
| TARIFF SHORTFALLS |
We cover medical specialists for treatment or surgery provided in hospital | Cover enhancement up to 600% subject to OAL | Cover enhancement up to 500% subject to AOL |
| We cover medical oncologists for treatment provided in or out of hospital | |||
| We cover medical specialists for out-patient procedures that would otherwise attract a co-payment if such procedures was performed in hospital | |||
| We cover gynaecologist consultations in the 2nd and 3rd trimester of pregnancy and gynaecologist / paediatrician consultations up to 90 days after birth | R700 per consultation R2,800 per pregnancy |
R465 per consultation R1,800 per pregnancy |
|
| ONCOLOGY CO-PAYMENTS | We cover the 20% co-payment after reaching the oncology threshold | 100% cover | Subject to OAL | 100% cover | Subject to OAL |
| We cover co-payments on approved precision medicines | R17,500 per claim Subject to OAL |
R14,500 per claim Subject to OAL |
|
| We cover co-payments applied on ex-gratia benefits for precision medicines | |||
| 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 | 100% cover | Subject to OAL |
| We cover other upfront payments (including robotic surgery) | R26,000 per event | R16,000 per event | |
| We cover upfront payments for voluntary use of a non-network hospital or clinic | R20,000 per event| Max 2 pa | R14,000 per event| Max 1 pa | |
| LIMIT EXTENDER | We cover shortfalls when a sub-limit applies to an internal prosthetic decive | R70,000 per event | R50,000 per event |
| WE cover shortfalls when a sub-limit applies to MRI/CT/PET scans,endoscopes or intra-ocular lenses | R8,200 per event | R6,500 per event | |
Extended Cover – Quick Summary
Benefit Category |
Extender Cover Benefit Description |
2025 BENEFIT AMOUNTS & LIMITS | |
GapMAX |
GapCORE |
||
| CASUALTY COVER | We cover emergency treatment at a casualty facility resulting from an accident | R19,000 per event Max 2 pa |
R15,000 per event Max 2 pa |
| If the accident was a sports injury, we will also cover shortfalls on rehabilitation consultations at a physiotherapist/biokineticist/chiropractor | R780 per consult Max 6 per event |
R540 per consult Max 6 per event |
|
| TRAVELING ABROAD | We cover the excess on your international travel insurance for medical emergencies | R4 000 per departure | R3 000 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 |
Stage 1 – R5,000 Stage 2 – R15,000 Stage 3 – R25,000 Stage 4 – R40,000 |
| If after diagnosis you upgrade your medical scheme benefit option at the first opportunity, we will provide a waiver for the additional contributions | R4,800 pm for 12 Months | R4,800 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 |
Tier 1 = R120 per day Tier 2 = R1,200 per day |
| We pay a lump sum for a birth that is 42 days or more premature | R22,000 per event | R16,000 per event | |
| ACCIDENT COVER |
In the event of accidental death or permanent disability caused by an accident |
R34,000 per person R34,000 per person |
R28,000 per person R28,000 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 | R8,400 pm – medical aid 100% on policy 6 months |
R6,000 pm – medical aid 100% on policy 6 months |
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 R235for GapMAX and R221for GapCORE, you get industry leading protection at competitive premiums.
Medical Second Opinion
When serious illness strikes you have access to a second opinion from the world’s leading medical minds to make sure you have the right diagnosis and treatment plan.
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.
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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