Specialist Benefits

A maximum of 2 visits, limited to R1 350 per visit and up to R2 700 per member/family per year is applied

Members may consult any specialist, subject to a Network GP referral and pre-authorisation

If the specialist prescribes medicine or refers the member for pathology and radiology tests, only medicine on the Health4Me prescribed acute medication formulary and the tests on the applicable Health4Me pathology and radiology lists are covered

Shortfalls, as well as any medicine, pathology and radiology not covered by Health4Me, will be payable by the member

Waiting periods may apply

If you need to see a specialist, you must first visit your Network GP, who will give you a referral letter. You will need to call us on 0860 10 29 03 to get authorisation. The maximum amount we will pay per visit is R1 350, with a maximum for the year of R2 700 for you and your family, if they are also covered. This amount is for the visit and any medication that the specialist prescribes. The specialist may also send you for basic blood tests and black-and-white x-rays.

Example: Let’s say the specialist charges you R1 400 for a visit. The specialist will send the account
for R1 400 to Momentum for payment. Momentum will pay the specialist R1 350, and your benefit left for the year will reduce from R2 700 to R1 350. You will have to pay the additional R50 for the visit from your own pocket.

Specialist benefit disciplines covered

Please note that this benefit is only available on the Health4Me Gold option.

To download a copy of the Specialist benefit information click on the download button below.