Bloom’s Gap Max cover is the premium and comprehensive answer to unexpected medical expenses. This option covers the shortfall between what your medical aid covers and what hospitals and specialists charge, with many added benefits.

If you want a more affordable cover, head to our Gap Core offering.

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    Features of Bloom Gap Cover

    In-Hospital 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 diagnostic and surgical procedures

    Affordable Premiums

    Starting at just R217 for Gap MAX and R188 for Gap CORE, 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 travelling 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

    What does the Gap Max Option cover?
    Tariff Shortfalls
    1. Overall Annual Limit (OAL) for Gap Cover Benefits * R198,660 pppa
    2. We cover medical specialists for treatment or surgery provided in hospital, medical oncologists for treatment provided in or out of hospital , and medical specialists for out-patient procedures that would attract a co-payment if performed in hospital Benefit Enhancement up to 600%
    Subject to OAL
    3. We cover gynaecologist or GP consultations during the 2nd and 3rd trimester of pregnancy R600 per consult
    R2,400 per pregnancy
    Oncology Co-Payments
    1. We cover the 20% co-payment applied after reaching the oncology threshold Subject to OAL
    2. We cover the 25% and 50% co-payments applied to approved precision medicines R15,000 per claim Subject to OAL
    3. If your medical scheme approves ex-gratia benefits for oncology medicines, we will provide additional cover for your portion of the costs R15,000 per claim/
    R30,000 per medicine cycle Subject to OAL
    Upfront Payments
    1. 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
    2. We cover other upfront payments (including robotic surgery) R22,000 per event
    3. We cover upfront payments for voluntary use of non-network hospital/day clinic. R18,000 per event max 2 pa
    Limit Extender
    1. We cover shortfalls when a sub-limit applies to internal prosthetic devices R64,000 per event
    2. We cover shortfalls when a sub-limit applies to MRI/CT/PET scans, endoscopes and intra-ocular lenses R7,000 per event
    | Ω – Policy benefits are only paid where a shortfall exists between the medical scheme benefit and the charged amount | * The collective statutory limit for all gap cover benefit categories is R185,800 per person per annum (pppa). This limit will automatically increase from 1 April 2023 in line with CPI | # – Oncology Cover includes shortfalls on treatment with biological and precision medicines. Precision medicines are targeted therapies and immunotherapies based on genomic sequencing |
    EXTENDER COVER
    EXTENDER COVER
    Casualty Cover
    1. Cover for emergency treatment at a casualty facility resulting from an accident R18,000 per event, max 2 pa
    2. If the accident was a sports injury, we will also cover shortfalls on rehabilitation consultations R680 per consult, max 6 pe
    Travel Cover
    1. Cover for the excess on your international travel insurance for medical emergencies R3,400 per departure
    Cancer Diagnosis
    1. For a first lifetime cancer diagnosis made after inception of the policy and waiting periods ‡ R40,000 Lump Sum
    2. If after diagnosis you upgrade your medical scheme benefit option at the first upgrade opportunity, we will provide a waiver for the additional contributions * R4,000 pm for 12 Months
    Extra Cover
    1. 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 = R160 per day
    Tier 2 = R1,600 per day
    2. For a premature Birth that is 42 Days or more earlier than the expected due date R20,000 per event
    Accident Cover ¥
    1. In the event of accidental death or permanent disability caused by an accident R32,000 pppa
    2. If the event was a direct result of a proven crime, an additional benefit is payable R32,000 pppa
    Waiver Cover
    1. 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 R7,800 pm – medical aid 100% on policy
    | ‡ – Applies to a cancer diagnosis of stage 2 or higher – skin cancers are excluded except melanomas – benefit ceases at age 65 | * – If no upgrade is undertaken, no benefit is payable. The upgrade must be to the richest benefit option on the scheme or other benefit option agreed to with Cinagi. If the member downgrades within 12 months of upgrading, the monthly benefit ceases at the time of the downgrade. Upgrading is subject to the rules of the medical scheme | ¥ – Limited to a maximum benefit for two insureds per event |

    Your Monthly Premiums Explained

    Bloom 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.

    bloom gap max cover for primary member

    Gap Max
    Primary member

    From R278.00 per month

    Terms & Conditions Apply.

    happy woman on orange background

    Gap Max
    Adult member

    From R190.00 per month

    Terms & Conditions Apply.

    Gap Max
    Child

    From R91.00 per month

    Terms & Conditions Apply.

    Your Monthly Premiums Explained

    Important to know

    • The Cover Pay Level (CPL) is the percentage of the medical scheme tariff level at which your benefit option covers in-hospital medical specialists.
    • Your premium and benefit calculations depend on the CPL
    • Only your spouse and/or children are eligible as dependents on this policy and you must all be covered under the same medical scheme membership
    • You or your spouse can be the principal member on your Bloom Gap policy
    • A spouse dependent will be charged adult premiums
    • Child dependents will be charged child premiums until they turn 24
      and a maximum of two children will be charged per family
    • From 24 years, all children are charged adult premiums
    • The Entry Age category is determined by the oldest person covered under your policy
    • Premiums include VAT, broker commission and administration fees
    • Premiums are adjusted on 1 January of each year in line with medical inflation
    • Premiums are deducted in advance by debit order on the 1st working day of each month
    • Corporate accounts are underwritten on a group basis and premiums may differ from those above.
    • If you are a member of a corporate account, please contact us at bloom.insure/contact-us to confirm your premium

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