Gap Cover
A cover option that takes care of the shortfalls
In reality, many medical professionals and facilities charge more than what your medical scheme will pay. This leaves you open to a variety of additional payments that you need to make from your pocket.
Bloom Gap is a way to ensure that these shortfalls are taken care of, leaving you with the peace of mind you need to focus on yourself and your loved ones.
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Our Primary & Supreme Gap Cover Options
Millennial Gap
Cover for you as an individual, if you are 29 or younger at the date of joining.
R194 per month
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Cover for you, your spouse, your children, and your parents* who are registered as dependents on your medical scheme and who are eligible for cover at the date of your joining.
R344 per month
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Pensioner Gap
Primary Pensioner Gap - cover for you as an individual, if you are 65 or older at the date of joining.
R575 per month
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Millennial Gap
Cover for you as an individual, if you are 29 or younger at the date of joining.
R244 per month
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Gap
Cover for you, your spouse, your children, and your parents* who are registered as dependents on your medical scheme and who are eligible for cover at the date of your joining.
R412 per month
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Pensioner Gap
Cover for you as an individual, if you are 65 or older at the date of joining.
R617 per month
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Cover your shortfall with gap cover
Bloom Gap offers a number of shortfall benefits with our Gap options. Please visit our compare options page or download the Gap brochure to view the complete list.
In-hospital shortfall
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.
Out-of-hospital shortfall
Shortfall benefit for out-of-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.
Co-payment benefit
Co-payments and deductibles are commonly applied to radiology scans (MRI, CAT, PET) 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.
Claiming made easy
Don't deal with the hassle that comes with insurance claims. With the submission of only a few documents when submitting a shortfall or co-payment claim, our claim process is simple and easy, so that you can get your claim paid out without the hassle. For more information on how to claim or for assistance with a claim, visit https://bloom.insure or call an agent on 0860 10 29 03.
Frequently Asked Questions
Gap cover is a short-term insurance policy that covers the shortfall of medical expenses from hospitals or healthcare professionals that are charged over and above medical aid rates.
Gap cover works by covering the difference between what the hospital or medical professional charges and what your medical aid pays out from your respective benefit option.
Many medical professionals charge over and above the medical aid benefit rate. This means the shortfall or difference will have to be covered by the member, out of pocket, which can become quite costly. Gap provides a financial guardrail against shortfalls and co-payments.
