Gap Max
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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.
Features of Bloom Gap Cover
In-hospital cover
Comprehensive protection against shortfalls in your medical scheme cover – for medical specialists and surgeons
Oncology co-payment 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
Affordable Premiums
Starting at just R217 for Gap MAX and R188 for Gap CORE, you get industry-leading protection at competitive premiums
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
- Overall Annual Limit (OAL) for Gap Cover Benefits * R198,660 pppa
- 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 500% Subject to OAL
- We cover gynaecologist or GP consultations during the 2nd and 3rd trimester of pregnancy R400 per consult R1,600 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 OA
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 clinic2. – 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
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.
Gap Max
Primary Member
You or your spouse can be the principal
member on your Bloom Gap policy
From R278 P/M
Gap Max
Adult Dependant
You or your spouse can be the
principal member on your Bloom
Gap policy.
From R190 P/M
Gap Core
Primary Member
Child dependant will be charged child
premiums until they turn 24 and a maximum
of two children will be charged per family.
From R91 P/M
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 24and 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
Your journey to quality healthcare starts here.
Get a quote now
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View our Privacy Policy
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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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