Primary Gap Cover
Bloom’s Primary Gap cover is the affordable answer to unexpected medical expenses. It covers the gap between what your medical aid covers and what hospitals and specialists charge – sometimes almost 5x your medical aid rate.
We offer three Primary Gap options suited to your lifestyle and budget.
If you want a more comprehensive cover, head to our Supreme Gap offering.
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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.
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.
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
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 Waiver 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.
Premiums
from R195 / per month
from R344 / per month
from R575 / per month
Primary Millenial
Gap Cover
Cover for you, your spouse, your children, and your parents* who are registered as dependents on your medical scheme and that are eligible for cover at the date of your joining.
Monthly family premiums for under 30s
R344.00 per month
Terms & Conditions Apply.
Primary
Gap Cover
Cover for you as an individual, if you are 29 or younger at the date of joining
Monthly family premiums for under 65s
R195.00 per month
Terms & Conditions Apply.
Primary Pensioner
Gap Cover
Cover for you as an individual, if you are 65 or older at the date of joining.
Monthly family premiums for over 65s
R575.00 per month
Terms & Conditions Apply.
Claiming Made Easy
Bloom Gap Claim Form
The sections that are relevant to your claim must be completed in full
Medical Aid Statement Reflecting the procedure/s for which you are claiming
Specialist Invoices
From the specialist for whom you are claiming
Hospital Accounts
For the period during which you were hospitalised
Pre-Authorisation Letter
(if claiming a co-payment) Reflecting the co-payment
