Compare Bloom Gap Options
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Bloom Gap cover is a way to ensure that you’re covered for medical expense shortfalls. Gap cover works in conjunction with your medical aid to provide you with better financial support when you need it.
We’ve partnered with Guardrisk to offer our members affordable gap healthcare solutions for the South African market. There are two gap category plans available and each plan provides a wide range of shortfall benefits.
|Primary Gap||Supreme Gap|
|Hospital Shortfall Benefits|
| Medical expense shortfall benefit for in-hospital procedures |
We cover the shortfall between what the specialist has charged and what your medical scheme has paid, up to 3 times the amount paid by your medical scheme towards in-hospital shortfalls. Prescribed Minimum Benefit (PMB) procedures are covered under this benefit.
| Medical expense shortfall benefit for out-of-hospital procedures |
We also cover certain medical procedures performed out of hospital, in day clinics or other registered facilities, up to 3 times the amount paid by your medical scheme. Prescribed Minimum Benefit (PMB) procedures are covered under this benefit.
| Robotic procedure shortfall benefit |
Should your condition require the use of robotic assisted surgery, our Robotic procedure shortfall benefit will cover the shortfalls charged by medical practitioners. This cover is up to 3 times the amount paid by your medical scheme.
| Robotic procedure co-payment benefit |
Add the menu to Should your condition require the use of robotic assisted surgery and your medical scheme levies a co-payment, we will cover up to R10 000 per policy per year.
| Co-payment benefit |
Co-payments and deductibles are commonly applied to radiology scans (MRI, CAT, PET) authorised hospital admissions and specialist referral procedures, depending on your medical scheme option. Our Co-payment benefit provides you with the peace of mind that if your medical scheme levies a co-payment for an approved in-hospital or out-of-hospital procedure, which you need to pay upfront out of your own pocket, we will cover this.
| Non-DSD co-payment benefit |
Certain medical scheme options stipulate the use of their preferred network hospitals for elective procedues. Should you need to use a non-network hospital and, your medical scheme imposes an additional rand value co-payment, we will cover this co-payment, subject to a limit of R5000 per policy per year.
| Oncology co-payment benefit |
Based on your medical scheme option, once the oncology treatment benefit limit has been reached for the year; a co-payment of up to 20% may be imposed by the medical scheme. If you are registered with your medical scheme oncology treatment programme and you deplete this limit for the year, we will cover the first 20% of the cost (including biological drugs and specialised medication) of each treatment paid thereafter, by you.
| Oncology extender benefit |
Where a medical scheme oncology benefit limit has been reached and no further benefits are available, we will pay 20% of the cost of each treatment (including biological drugs and specialised medication) paid by the insured person. Insured persons are required to register with the medical scheme oncology treatment progra me and specialised medication imposedon by your medical scheme.
| Internal prosthesis shortfall benefit |
If you undergo a medical procedure that requires the use of an internal prosthesis to replace a body part and you reach your medical scheme limit for the year; we will pay the shortfall up to R30 000 per family per year. Stents and pacemakers are covered up to R6000 per claim event and this aggregates to the R30 000 annual limit.
| Sub-limit benefit |
Certain medical schemes will only cover MRI/CT scans and scopes up to a specific limit. Our Sub-limit benefit will pay up to R10 000 per policy per year where your medical scheme limit has been exhausted.
| Casualty benefit |
If you need to visit an emergency casualty ward due to an accident, we will pay you up to R20 000 of all the costs paid by you. This benefit is limited to five casualty visits per family per year. Three of these visits may be for an emergency only, for a child that is 5 years old or younger limited to R3000 per policy per year, this aggregates to the R20 000 annual limit.
| Cancer assist benefit |
If you are diagnosed for the first time with minimum stage II, local and malignant cancer, we will pay you R5 000. If however, you are diagnosed with minimum stage II, regional and malignant cancer, we will pay you R20 000. In addition, if you are successful in claiming the R20 000 benefit and the extent of treatment that you need results in your medical scheme paying R200 000 or more for your oncology treatment within 12 months from the date of your diagnosis, we will pay you a further R15 000. This benefit assists in covering the unexpected costs which may arise as a result of the diagnosis.
| Breast reconstruction benefit for the non-affected breast |
If you need to visit an emergency Should you be diagnosed with breast cancer and require cosmetic breast reconstruction for the non-affected breast due to a mastectomy, we will provide assistance cover of R15 000 per policy per year. This can be used to recover the costs incurred for the treatment or related to the treatment.
| Accident assist benefit |
An amount of R55 000 will be paid if an insured dies or becomes permanently and totally disabled as a result of an accident while covered on this policy. The death benefit will be reduced if death relates to a minor. Subject to one claim per insured per lifetime. This benefit assists in covering unexpected costs which may arise as a result of the accident.
| Violent crime benefit |
If the accidental death or disability is as a result of a violent crime, we will double the accident assist benefit to cover the unexpected costs which may arise as a result of the violent nature of the incident. This benefit will be capped at legislated limits if the death relates to a minor.
| Premium waver benefit |
If you become permanently and totally disabled or you die as a result of an accident, we will pay R6 000 per month for 6 months, which can be used to cover the cost of your dependents’ medical scheme and gap cover premiums. The full amount of R36 000 for the 6 months will be paid upfront to the claimant.
| Trauma and bereavement counselling benefit |
If you are a victim of, or witness to, a traumatic accident, or if you lose an immediate family member, we believe that undergoing trauma and bereavement counselling is an important step in recovering from a event such as this. We will pay R800 towards the cost of each counselling session, limited to R30 000 per family per year.
| Baby bump benefit |
Having a baby can be very exciting, but it also comes with unexpected costs. If you are pregnant, we will pay an amount of R2 000 on diagnosis of pregnancy, to assist with unexpected pregnancy cost.