Gap cover is a type of short-term insurance created to offer additional financial security to people who already have medical aid. It pays the difference between the actual rates charged by healthcare experts and your medical scheme’s tariff (MST).
In South Africa, medical aid schemes now pay healthcare providers 100%, 200%, or 300% of the plan rate. However, professional healthcare practitioners may bill up to five times the standard rate.
Taking out gap cover protects yourself and your family against this financial disparity, potentially avoiding significant out-of-pocket healthcare expenses.
Should you get gap cover?
Yes. Gap cover can make up the difference if you need to undergo an expensive medical procedure or suffer from a condition that isn’t fully covered by your medical aid.
Medical care costs exceed what medical aids are ready to pay, and many healthcare professionals, like specialists, charge higher fees. Therefore, even if you have medical aid, a hospital stay or illness could leave you with a hefty expense.
Gap cover offers insurance that pays for some of the shortfalls medical aid doesn’t. It essentially closes the gap, ensuring you can afford the medical care you and your family need.
Who is eligible for gap cover?
Anyone who’s an active member of a registered South African medical aid scheme qualifies for gap cover.
Depending on the plan you choose, the benefits extend to your spouse and dependent children up to a certain age.
Waiting periods
As with conventional medical aid schemes and health insurance, waiting periods and exclusions apply to gap cover.
Below are the specific waiting periods for Bloom Gap cover, but please note that these can change according to the provider you choose.
3-Month general waiting period
If you are an individual, not part of a group, a 3-month general waiting period will apply. During this period, you cannot claim for any benefits.
9-Month pre-existing medical condition waiting period
Within the first nine months of cover, a waiting period will apply where no claims can be submitted for any procedure or surgery relating to any pre-existing condition for which you have received advice or treatment 12 months prior to your cover start date.
12-Month birth, pregnancy or cancer-related waiting period
Within the first 12 months of cover, a waiting period will apply where no claims can be submitted for any cancer, birth or pregnancy-related medical issues.
How do you decide which plan is for you?
First, consider the medical aid plan you’re on, work out where the shortfalls could be and compare gap cover plans until you find one that meets your needs.
There are tons of medical aid and gap cover options, so chat with a knowledgeable insurance advisor before deciding.
How do you claim?
Gap cover requires you to fill in a claim form attached to a statement of account that reflects the procedures for which you are claiming. Once the claim is assessed, they will pay you directly if approved.
Always confirm that you have provided all the required documentation to ensure the claim process goes as smoothly as possible.
Bloom Gap Product Range
1. The Bloom Gap Supreme Range
- Bloom Gap Supreme
The premium gap plan provides cover for the primary policyholder and all those registered on the plan, such as a spouse or partner or children who are eligible for cover at the date of joining. The premiums start at R412 per month.
- Bloom Gap Supreme Millennial
The ideal plan for young singles who are under the age of 30 at the time of joining. Monthly premiums start at R244 per month.
- Bloom Gap Supreme Pensioner
The plan focuses on providing specialist cover for those who are over the age of 65 at the time of joining. Monthly premiums start at R617 per month. Terms & conditions apply*
2. Gap Bloom Primary Range
- Bloom Gap Primary
The plan provides balanced cover for the primary policyholder and all those registered on the plan, such as a spouse or partner and children who are eligible for cover at the date of joining. The premiums start at R344 per month. Conditions apply.
- Bloom Gap Primary Millennial
Suited for young singles who are under the age of 30 at the time of joining and who are conscious of value and budget. Monthly premiums start at R194 per month.
- Bloom Gap Primary Pensioner
The plan focuses on providing affordable cover for those who are over the age of 65 at the time of joining. Monthly premiums start at R575 per month. Terms & conditions apply*
The bottom line
With gap insurance, you can feel more secure and lower your risk of accruing a high medical cost that you cannot afford. As usual, do your research, consider your options, and choose the cover that will work best for you.
