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Gap Options Benefits
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 Cinagi 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 benefits.
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| Gap Core | Gap Max | |
| A quick comparison of our Gap Cover benefits | ||
| Tariff Shortfalls | ||
| Overall Annual Limit (OAL) for Gap Cover Benefits | R198,660 pppa | R198,660 pppa |
| We cover medical specialists for treatment or surgery provided in hospital We cover medical oncologists for treatment provided in or out of hospital |
Benefit Enhancement up to 500% | Benefit Enhancement up to 600% |
| We cover medical specialists for out-patient procedures that would attract a co-payment if performed in hospital |
Subject to OAL | Subject to OAL |
| We cover gynaecologist or GP consultations during the 2nd and 3rd trimester of pregnancy | R425 per consult R1,700 per pregnancy |
R650 per consult R2,600 per pregnancy |
| Oncology Co-Payments | ||
| We cover the 20% co-payment applied after reaching the oncology threshold | Subject to OAL | Subject to OAL |
| We cover the 25% and 50% co-payments applied to approved precision medicines | R13,500 per claim Subject to OAL | R16,500 per claim Subject to OAL |
| If your medical scheme approves ex-gratia benefits for oncology medicines, we will provide additional cover for your portion of the costs |
R13,500 per claim Subject to OAL |
R16,500 per claim Subject to OAL |
| Upfront Payments | ||
| We cover fixed rand value upfront payments for MRI/CT/PET scans, in-hospital endoscopes, in-hospital basic dentistry and defined medical procedures |
Subject to OAL | Subject to OAL |
| We cover other upfront payments (including robotic surgery) | R15,000 per event | R24,000 per event |
| We cover upfront payments for voluntary use of non-network hospital/day clinic | R13,000 per event max 1 pa | R19,000 per event max 2 pa |
| Limit Extender | ||
| We cover shortfalls when a sub-limit applies to internal prosthetic devices | R46,000 per event | R68,000 per event |
| We cover shortfalls when a sub-limit applies to MRI/CT/PET scans, endoscopes and intra-ocular lenses | R6,200 per event | R7,500 per event |
| Gap Core | Gap Max | |
| Extender Cover | ||
| Casualty Cover | ||
| Cover for emergency treatment at a casualty facility resulting from an accident | R14,000 per event | max 2 pa | R18,000 per event | max 2 pa |
| If the accident was a sports injury, we will also cover shortfalls on rehabilitation consultations | R500 per consult | max 6 pe | R720 per consult | max 6 pe |
| Travel Cover | ||
| Cover for the excess on your international travel insurance for medical emergencies | R2,600 per departure | R3,600 per departure |
| Cancer Diagnosis | ||
| For a first lifetime cancer diagnosis made after inception of the policy and waiting periods. | R40,000 Lump Sum | R50,000 Lump Sum |
| If after diagnosis you upgrade your medical scheme benefit option at the first upgrade opportunity, we will provide a waiver for the additional contributions * |
R4,400 pm for 12 Months | R4,400 pm for 12 Months |
| Extra Cover | ||
| For an admission resulting from an accident and where the admission is 3 days or longer Daily Lump Sum Payable: Tier 1 pays from day 1 to 7 and Tier 2 pays from day 8 to 28 |
Tier 1 = R110 per day Tier 2 = R1,100 per day |
Tier 1 = R170 per day Tier 2 = R1,700 per day |
| For a premature Birth that is 42 Days or more earlier than the expected due date |
R16,000 per event | R22,000 per event |
| Accident Cover | ||
| In the event of accidental death or permanent disability caused by an accident | R28,000 per event | R34,000 per event |
| If the event was a direct result of a proven crime, an additional benefit is payable | R28,000 per event | R34,000 per event |
| Waiver Cover | ||
| In the event of accidental death or permanent disability of the principal member or spouse, we will cover the cost of the medical scheme contributions and gap cover premiums |
R5,800 pm – medical aid 100% on policy | R8,000 pm – medical aid 100% on policy |
In partnership with Cinagi
By joining forces with Cinagi, Bloom Financial Services strengthens its ability to meet the healthcare and insurance needs of our valued customers. Together, we will distribute a range of high-quality, relevant, and fairly-priced products to as many South Africans as possible. With our shared values of honesty, integrity, hard work, fairness, and customer-centricity, we are a perfect match to deliver exceptional healthcare solutions to the South African market.
We are thrilled to have Cinagi as our partner in this journey. With their expertise and our unwavering commitment to our customers, we are poised to become market leaders in the healthcare industry.
Experience the power of our partnership for quality healthcare. Contact us today to explore the wide range of products and services we offer. Together, let’s unlock a healthier future for South Africa.
Your journey to quality healthcare starts here.
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Momentum Health4Me is not a medical scheme product, and is not a substitute for medical scheme membership. The information provided on this website does not constitute advice in terms of the Financial Advisory and Intermediary Services Act. Momentum is a division of Momentum Metropolitan Life Limited, an authorised financial services provider (FSP 6406) and a wholly owned subsidiary of Momentum Metropolitan Holdings Limited.
Bloom Gap Cover is not a medical Scheme. Products that are offered are not the same as that of a medical scheme.
© Bloom Financial Services 2023. Bloom Financial Services (Pty) Ltd is an authorised financial services provider (FSP 50140). Bloom Gap is underwritten by Infiniti Insurance Limited a licensed non-life insurer and an authorised financial services provider (FSP No.35914)
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