Day-to-day benefits are highly beneficial for managing your healthcare needs on an ongoing basis. These benefits include cover for those visits to the doctor when you come down with the flu, or a consultation with a specialist, or any other healthcare professionals, if you need it. It also covers routine diagnostic tests and prescription medications. Bloom, together with their partner, Momentum Health4Me offers cost-effective health insurance and medical aid plans with day-to-day benefits. Find out all you need to know about day-to-day benefits as we discuss this in more detail.
Why day-to-day benefits matter and how to make the most of them
Day-to-day benefits refer to the range of medical and healthcare services that people need on a regular basis. These benefits are often used to maintain good health and manage pre-existing medical conditions. Benefits typically cover services like GP visits, specialist visits, diagnostic tests and prescription medications. Having access to day-to-day benefits is important because it means you can receive timely medical care and treatment, preventing more serious health complications down the line.
How day-to-day benefits differ from major medical events
Day-to-day benefits differ from other medical benefits, like major medical events benefits, in terms of scope and purpose. Day-to-day benefits are designed to cover routine and preventative healthcare services. This typically includes visits to GPs, specialists, laboratory tests, prescription medications, and other routine medical services that are necessary for maintaining good health and managing chronic conditions. Day-to-day benefits are meant to be used regularly. Major medical events, on the other hand, cover more serious services, like hospitalisation or surgery.
All you need to know about day-to-day benefits with Health4Me
Health4Me offers these day-to-day benefits, some of which are limited to certain healthcare plans only. You can expect to receive the following:
- GP Visits. Unlimited GP visits at a network-approved GP per member, each year on the Bronze, Silver and Gold plans.
- GP in-room procedures are available on the Bronze, Silver and Gold Plans. This includes minor medical procedures performed by a General Practitioner within their consultation room or clinic, like dressing a wound, rather than visiting a hospital or specialist facility.
- Unlimited GP consultations with the Hello Doctor GP on the Bronze, Silver and Gold Plans. This benefit can be accessed telephonically, via video call or app chat. The Hello Doctor consultations also include providing scripts for formulary-based medication, in accordance with the Networked-prescribed acute medication formulary. In addition, the Hello Doctor benefit includes providing official referrals for pathology and radiology services.
- Specialist benefit is available on the Health4Me Gold plan only. This includes a maximum of two visits per member, limited to R1,220 for each visit (and not exceeding R2,440) each year. The specialist can only be visited by the member once they have a Network-approved GP referral letter and authorisation.
- Acute medication. This day-to-day benefit is provided in accordance with the Network-prescribed acute medication formulary rules. It’s available to Bronze, Silver and Gold health plan members.
- Chronic medication. This benefit is also provided in accordance with the Network-prescribed chronic medication formulary rules and protocols. It is only available to Gold plan members.
- Chronic conditions benefit. This includes medication and treatment for the following 27 chronic conditions:
- Addison’s Disease
- Asthma
- Bipolar Mood Disorder
- Bronchiectasis
- Cardiac Dysrhythmias
- Cardiac Failure
- Cardiomyopathy
- Chronic Obstructive Pulmonary Disease
- Chronic Renal Disease
- Coronary Artery Disease
- Crohn’s Disease
- Diabetes Insipidus
- Diabetes Mellitus Type 1
- Diabetes Mellitus Type 2
- Epilepsy
- Glaucoma
- Haemophilia
- HIV
- Hyperlipidaemia
- Hypertension
- Hypothyroidism
- Multiple Sclerosis
- Parkinson’s Disease
- Rheumatoid Arthritis
- Schizophrenia
- Systemic Lupus Erythematosus
- Ulcerative Colitis
Chronic medication is provided in accordance with the Network-prescribed chronic medication formulary. Pre-authorisation is required for this benefit and waiting periods do apply.
- HIV day-to-day benefit is available to Gold plan members only. It includes post-exposure prophylaxis (PEP) medication provided in accordance with the Network-prescribed HIV medication formulary. This will help prevent HIV infection in the event of accidental exposure to blood or fluids from an infected person. In addition, antiretroviral medication is provided in accordance with the Network-prescribed HIV medication. Pre-authorisation is required for this benefit and waiting periods do apply.
- Maternity benefits. The day-to-day maternity benefits include one foetal growth 2D scan, per member per pregnancy, as well as antenatal pathology tests linked to a Network GP and referral. Antenatal vitamins, as stipulated in the Network-prescribed acute medication formulary. Expectant mums can also enjoy access to the leading parental support resource – BabyYumYum, as well as assistance post-partum from a registered nurse or midwife.
- Basic pathology. This benefit is provided to Bronze, Silver and Gold plans. This will include cover for a range of diagnostic laboratory tests that are necessary for the diagnosis and management of a medical condition. Examples of these include urine samples or blood work. The benefit has to be linked to a Hello Doctor or Network GP referral according to the official Health4Me pathology list.
- Basic radiology. This day-to-day benefit is available to Bronze, Silver and Gold plan members and includes unlimited cover for x-rays when linked to a Hello Doctor or Network GP referral, according to the official Health4Me radiology list.
- Basic and emergency dentistry is available to Silver and Gold plan members. This includes routine dentistry services, like attending to fillings, infection control, extractions and teeth cleaning. Specialised dentistry services, like crowns, bridges, extractions, implants or root canal work are not included. Services must be provided in accordance with the Dental Network protocols and approved Health4Me dentistry list.
- Basic optometry. This benefit is available to Silver and Gold plan members. Members are eligible for one eye test and a pair of standard single-vision lenses (or one pair of bifocals with a standard frame) every two years. Prescription sunglasses and contact lenses are not included in the benefit. The day-to-day optometry benefits are provided in accordance with the Optical Network protocols and approved Health4Me optometry list.
- Flu vaccination. This is available to Bronze, Silver and Gold plans. It includes one flu vaccination per member at a participating pharmacy or clinic, like Dischem, Clicks or MedRite.
- COVID-19 screening test. This is available to Bronze, Silver and Gold plans. It is subject to a Hello Doctor, Network GP or specialist referral.
- Health assessment. This is available to Bronze, Silver and Gold plans. Members can have the assessment done at a participating pharmacy or clinic. It includes a blood pressure test, cholesterol and blood sugar finger-prick tests, and height, weight and waist circumference screening.
- Employee Assistance Programme offers counselling support services for Bronze, Silver and Gold plan members. Telephonic counselling services and onsite trauma and critical event services, as well as Legal Assist, credit health and debt management assistance, are also provided.
- Road accident claims advice is offered to Bronze, Silver and Gold plan members via EAP services and Workman’s Compensation Claims for injury on duty.
- Multiply Engage. This is a free rewards programme offered to Bronze, Silver and Gold plan members, who can enjoy discounts and promotional offers from participating brands, like Makro, Nando’s and FlySafair.
- More4More. This day-to-day benefit incentivises members with monthly airtime, data and Shoprite Checkers or Takealot vouchers, based on the Healthy Heart Score. It’s available to Bronze, Silver and Gold members.
How to choose the best day-to-day benefits for your lifestyle and health
When it comes to exploring the different types of day-to-day benefits available to your, we’d like to draw your attention to all you need to know about day-to-day benefits and priorities. Use this guideline to make a decision:
- Understand your healthcare needs. Consider everyone on your healthcare plan, along with their medical conditions, age and health status.
- Assess your budget, and decide how much you can afford to contribute each month and budget accordingly.
- Research the different healthcare plan options. Health4Me offers three plans: Bronze, Silver and Gold. Take a look at what benefits are provided in each plan, relative to your needs.
Get affordable day-to-day health benefits from Bloom
Now that you are aware of all you need to know about day-to-day benefits, you will no doubt want to make sure that you and your family are covered by a comprehensive health insurance plan. Bloom will ensure you have access to good quality medical care at an affordable premium. Get yourself covered by contacting our team of trained consultants. Contact us for more information or to get a free, no-obligation quote.
Medical Content Disclaimer
You understand and acknowledge that all users of the Bloom website are responsible for their own medical care, treatment, and oversight. All content provided on the website, is for informational purposes only and does not constitute medical advice. Neither is it intended to be a substitute for an independent professional medical opinion, judgement, diagnosis or treatment.
