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.
Although you and your family have medical scheme cover, unexpected medical costs can arise when your medical scheme only refunds you a portion of what your doctors have charged you for treatment.
Bloom Gap Cover is the industry-leading solution giving you comprehensive financial protection against these unforeseen medical costs.
Our Gap Cover Options
Gap Max
Primary Member
You or your spouse can be the principal
member on your Bloom Gap policy
From R261 P/M
Gap Max
Adult Dependant
You or your spouse can be the
principal member on your Bloom
Gap policy.
From R172 P/M
Gap Max
Child Dependant
Child dependant will be charged child
premiums until they turn 24 and a maximum
of two children will be charged per family.
From R73 P/M
Cover your shortfall with Gap Cover
Bloom Gap offers a number of shortfall benefits with our Gap options. Please download the Gap brochure to view the complete list.
Gap Cover
In-hospital cover
Comprehensive protection against shortfalls in your medical scheme cover – for medical specialists and surgeons
Specialist cover
If you are admitted to hospital or receive care for approved oncology treatment, your medical scheme may only refund
you a portion of what your specialists and surgeons charge for their services. When this happens, we will provide additional cover to pay for these shortfalls
Oncology co-payment cover
We cover 3 different categories of shortfalls for oncology. Across all 3 categories, we
include cover for modern biologicals and immunotherapies (i.e. precision medicines)
approved by your medical scheme:
• The 20% co-payment applied on all oncology costs
• The 25% or 50% co-payments applied on Precision Cancer Medicines
• Co-payments applied to precision medicines approved as an ex-gratia benefit by
your medical scheme
Upfront payments
If your medical scheme has fixed-value upfront payments on MRI/CT/PET scans,
in-hospital endoscopes, in-hospital basic dentistry or defined approved surgical
procedures, we will cover these in full. We also provide you with cover for co-payments
applied as a percentage of medical costs and where you voluntarily make use of a non-network hospital or day clinic
Limit extender
Should your medical scheme impose a rand limit on internal prosthetic devices (e.g. joint replacements, spinal fusions, pacemakers, etc), we will provide additional cover per procedure. Additional cover is also provided for sub-limits on MRI/CT/PET scans, endoscopes and lens implants
Maternity cover
We cover tariff shortfalls on consultations with a gynaecologist during the 2nd and 3rd trimester and gynaecologist or paediatrician consultations up to 90 days after birth
Extended Cover
Casualty cover
For an emergency caused by an accident, we will cover you for x-rays, blood tests, medicines, and fees of attending doctors at a casualty facility
Sports cover
If your treatment at a casualty facility was the result of a sports accident, we will also cover shortfalls on follow-up rehabilitation consultations for physiotherapy or chiropractic treatment
Travel cover
Covers the excess payable on your international travel insurance for medical emergencies while travelling outside the country
Cancer diagnosis
If you receive a first lifetime diagnosis after joining and expiry of any waiting periods, we will pay you a once-off lump sum to assist with any associated non-medical costs. We will also cover the cost of the additional medical scheme contributions if you upgrade your medical scheme option
Extra cover
If you are admitted to the hospital for 3 days or more after an accident, we will pay you a lump sum per day for up to 28 days. If you have a baby that is born 42 days or earlier than your original expected due date, we will pay you a lump sum.
Accident cover
For accidental death/permanent disability of an insured, a lump sum is payable – if caused by crime, the benefit doubles
Waiver Protector
Pays your medical scheme and gap cover for 6 months on accidental death/permanent disability of the main member or spouse
Frequently Asked Questions
Why do you need Gap Cover?
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.
What are the waiting periods for Bloom Gap?
- A 3-month general waiting period applies on all claims except for accidents
- A 12-month waiting period applies on all claims directly or indirectly related to the treatment of scopes (which include minimally invasive scopes, endoscopies, arthroscopies and hysteroscopies), endometrial ablations, hysterectomy, pregnancy and childbirth, cholecystectomy, wisdom teeth, dental treatment, cataracts, reflux surgery, tonsillectomy, grommets, adenoidectomy, nasal procedures, hernia procedures, joint replacements and spinal surgery
- A 12-month waiting period applies on any claims relating directly or indirectly to: – Any pre-existing medical condition you or any of your dependants had at the policy inception, or – Any advice, diagnosis, care or treatment you or any or your dependants received or was recommended to receive within the 12 month period prior to the policy inception
- Waiting periods apply to new dependents added to your policy after inception
- If you previously had a gap cover policy with similar benefits, with less than 90 days between the time you ended that policy and activated your policy with us, a 3-month general waiting period and/or the unexpired portion of any previous 12-month waiting period will apply
- Waiting periods for corporate groups may be waived or reduced based on eligibility criteria
Are there any exclusions?
- Gap Cover can only cover shortfalls on medical costs. Where a medical scheme excludes treatment, gap cover cannot provide any cover • Any claim for which your medical scheme has limited the benefit or imposed copayments because the scheme does not recognise the clinical efficacy or validity of the related procedure or treatment
- Any claim for specialised dentistry or elective maxillofacial surgery, eg bridges, implants, frenectomy, orthognathic surgery, etc. (This does not apply to basic in-hospital dentistry, such as wisdom teeth extractions or fillings for young children)
- Any co-payment, deductible or limitation applied to the medical scheme benefits as a penalty for non-adherence to the medical scheme rules or voluntary use of a non-network provider
- Any claim relating to weight-loss or bariatric surgery, obesity including related modifier codes, infertility and sleep studies • Any claim submitted more than 4 months after date of treatment
- Claims not recognised as medically necessary or paid as an ex-gratia / concession
- Experimental, unproven or unregistered treatments, medicines or practices
- Any claim that is incurred outside of South Africa (excl Travel Cover)
- Any claim that arises from a medical service provider and/or medical scheme not complying with prevailing legislation
- Casualty Accident Cover applies only to emergency treatment at a casualty facility within 12 hours of an accident, and excludes appliances, prosthetics and any subsequent treatment after the initial emergency visit to the casualty facility
- Shortfalls on hospital accounts, day clinics, step-down facilities or diagnostic services (pathology and radiology), other than co-payments/upfront payments shown on the benefit schedule
- Casualty Illness Child Cover applies only to emergency treatment for a child younger than 12 at a casualty facility after hours (Mon-Fri between 6pm and 6am plus any hours of a weekend or public holiday) – excludes appliances, prosthetics and any subsequent treatment after the initial visit to the casualty facility
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Health Insurance
Momentum Health4Me is not a medical scheme product and is not a substitute for medical scheme membership.
Medical Aid
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.
Gap Cover
Bloom Gap Cover is not a medical scheme and is not a substitute for medical scheme membership. Benefits offered are not the same as those of a medical scheme. Bloom Gap Cover is underwritten by Infiniti Insurance Limited, a licensed non-life insurer and authorised financial services provider (FSP 35914).
Momentum Gap Cover is not a medical scheme and is not a substitute for medical scheme membership. Benefits offered are not the same as those of a medical scheme. Bloom Gap Cover is underwritten by Guardrisk Insurance Company Limited (FSP 5394).
Mechanical Breakdown Insurance
Bloom mechanical breakdown insurance is underwritten by New National Assurance Company Limited, a licensed non-life insurer and authorised financial services provider (FSP 2603). Cover is subject to policy terms and conditions.
The information provided on this website does not constitute financial advice as defined by the Financial Advisory and Intermediary Services (FAIS) Act. © Bloom Financial Services 2026. Bloom Financial Services (Pty) Ltd is an authorised financial services provider (FSP 50140).
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