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Medical Aid Options

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    We’ve partnered with Momentum to offer our members affordable medical aid solutions for the South African market. There are three medical aid cover plans available and each plan provides a wide range of in-and-out of hospital benefits.

     

    Ingwe
    Option
    Evolve
    Option
    Custom
    Option
    In-hospital Benefit
    Hospitalisation
    Hospital accounts are covered in full at the rate agreed upon with the hospital group. Accounts for specialists are covered up to 100% of the Momentum Medical Scheme Rate. You have unlimited cover for hospitalisation. Hospital accounts are covered in full at the rate agreed upon with the hospital group. Accounts for
    Associated specialists are covered in full. Accounts for other specialists are covered up to 100% of
    the Momentum Medical Scheme Rate. You are covered for hospitalisation at the Evolve Network of
    private hospitals (see page 23 for a list of these hospitals).
    The sub-limits specified apply per year. Should you not join in January, your sub-limits will be adjusted
    pro-rata (which means it will be adjusted in line with the number of months left in the year).
    Hospital accounts are covered in full at the rate agreed upon with the hospital group. Accounts for
    Associated specialists are covered in full. Accounts for other specialists are covered up to 100% of the
    Momentum Medical Scheme Rate. You have either chosen to have access to any hospital, or you chose
    to use Associated hospitals (see pages 26 and 27 for the list of Associated hospitals).
    The sub-limits specified apply per year. Should you not join in January, your sub-limits will be adjusted
    pro-rata (which means it will be adjusted in line with the number of months left in the year).
    Hospital provider
    Any hospital, Ingwe Network hospitals or State hospitals Evolve Network hospitals. Certain procedures are only covered in day facilities
    (view a list of these procedures on page 22). If you do not use a day facility, you
    will have a co-payment of 30% on the hospital account
    Any or Associated hospitals.
    Health Platform Benefit
    Emergency Cover
    Emergency evacuation in South Africa by Netcare 911. International emergency cover is not available on
    this option.
    Emergency evacuation in South Africa by Netcare 911. International emergency cover by ISOS, covered up
    to R5 million per 90-day journey.
    Emergency evacuation in South Africa by Netcare 911. International emergency cover by ISOS, covered up
    to R7.66 million per 90-day journey.
    Preventative and early detection tests

    Baby immunisations: covered in private facilities for baby’s first year,
    limited to R2 800. After baby’s first year, or once the limit has been
    reached, immunisations are available at the Department of Health
    baby clinics
    Flu vaccines Tetanus diphtheria injection

    Dental consultation (including sterile tray and gloves) Pap smear consultation (nurse or GP) Pap smear (pathologist)
    – Standard or LBC (Liquid Based Cytology) or – HPV PCR screening test
    (If result indicates high risk, then a follow-up LBC is also covered)
    General physical examination (GP consultation) Prostate specific antigen (pathologist) Health assessment available at Dis-Chem, Clicks or MediRite
    pharmacy clinics: blood pressure test, cholesterol and blood
    sugar (finger prick tests), height, weight and waist circumference
    measurements
    Cholesterol test (pathologist)* Blood sugar test (pathologist)** HIV test (pathologist)

    Baby immunisations, Flu vaccines, Tetanus diphtheria injection, Pneumococcal vaccine.

     Dental consultation (including sterile tray and gloves) Pap smear consultation (nurse, GP or gynaecologist) Pap smear (pathologist)

    – Standard or LBC (Liquid Based Cytology) or – HPV PCR screening test (If result indicates high risk, then a follow-up LBC is also covered) Mammogram DEXA bone density scan (radiologist, GP or specialist) General physical examination (GP consultation) Prostate specific antigen (pathologist) Health assessment available at Dis-Chem, Clicks or MediRite pharmacy clinics: blood pressure
    test, cholesterol and blood sugar (finger prick tests), height, weight and waist circumference
    measurements
    Cholesterol test (pathologist)* Blood sugar test (pathologist)** Glaucoma test HIV test (pathologist)

    Baby immunisations, Flu vaccines, Tetanus diphtheria injection, Pneumococcal vaccine

    Dental consultation (including sterile tray and gloves) Pap smear consultation (nurse, GP or gynaecologist) Pap smear (pathologist)
    – Standard or LBC (Liquid based cytology) or – HPV PCR screening test
    (If result indicates high risk, then a follow-up LBC is also covered)
    Mammogram DEXA bone density scan (radiologist, GP* or specialist) General physical examination (GP* consultation) Prostate specific antigen (pathologist) Health assessment available at Dis-Chem, Clicks or MediRite pharmacy clinics: blood
    pressure test, cholesterol and blood sugar (finger prick tests), height, weight and waist
    circumference measurements
    Cholesterol test (pathologist)** Blood sugar test (pathologist)*** Glaucoma test HIV test (pathologist)

    Maternity programme detection tests
    Antenatal visits (Midwives, GP or gynaecologist) Urine tests (dipstick) Nurse home visit Pathology tests
    Blood group, full blood count, Rhesus factor, haemoglobin
    estimation
    Urinalysis Urine tests (microscopic exams, antibiotic susceptibility and
    culture) Scans Paediatrician visits
    Doula benefit (your gynaecologist must be an Associated Specialist) Antenatal visits (Midwives, GP or gynaecologist) Nurse home visits Pathology tests
    Blood group, full blood count, Rhesus factor, creatinine, glucose strip, haemoglobin
    estimation
    Urinalysis Urine tests (microscopic exams, antibiotic susceptibility and culture) Urine tests (dipstick) Scans Paediatrician visits
    Doula benefit (your gynaecologist must be an Associated Specialist) Antenatal visits (Midwives, GP* or gynaecologist) Nurse home visits Pathology
    tests
    Blood group, full blood count, Rhesus factor, creatinine, glucose strip, haemoglobin
    estimation
    Urinalysis Urine tests (microscopic exams, antibiotic susceptibility and culture) Urine tests (dipstick) Scans Paediatrician visits
    Day-to-day Benefit
    Savings
    There is no savings built into this option, but you can add HealthSaver+ There is no savings built into this option, but you can add HealthSaver+ There is no savings built into this option, but you can add HealthSaver+
    General practitioners

    There is no limit to the number of times you may visit your network GP. However, please note all visits (whether virtual or in person) from the 11th visit onwards must be pre-authorised.

    You also get 3 virtual doctor consultations per beneficiary per year from the GP Virtual Consultation Network, which includes
    Hello Doctor. Consultations include scripting of schedule 1 to 4 medication where required

    2 virtual consultations per beneficiary per year
    from the GP Virtual Consultation Network,
    which includes Hello Doctor. Consultations
    include scripting of medication up to schedule 4, where required. Medication is subject to HealthSaver+, if available
    Subject to Momentum HealthSaver+, if available
    Eye care
    You get 1 eye test, 1 pair of clear standard or bi-focal lenses with standard frame, per beneficiary
    every 2 years. Spectacles will only be granted if your refraction measurement is more than 0.5.
    Not covered. You will pay out-of-pocket or use HealthSaver+ funds, if available. Not covered. You will pay out of your pocket or you can use HealthSaver+ funds, if available.
    Dentistry

    Examinations, fillings and x-rays as per the list of tariff codes. One dental consultation is covered per year per beneficiary. You need to call us for pre-authorisation if you need more than 4 fillings or 4 extractions

    Dental specialist accounts for extraction of
    impacted wisdom teeth in doctors’ rooms:
    Covered from Major Medical Benefit at 100% of the Momentum Medical Scheme Rate, subject to R1 830 co-payment and pre-authorisation. Other specialised dentistry: Subject to HealthSaver+if available

    Dental specialist accounts for extraction of
    impacted wisdom teeth in doctors’ rooms:
    Covered from Major Medical Benefit at 100% of the Momentum Medical Scheme Rate, subject to R1 830 co-payment and pre-authorisation. Other specialised dentistry: Subject to HealthSaver+if available
    Medicine
    Any prescribed medication from the list of medicine, referred to as the prescribed formulary. Prescribed and over-the-counter medication not covered. You will pay out of your pocket or you can use
    HealthSaver+ funds, if available.
    GP visits are not covered. You will pay out of your pocket or you can use HealthSaver+ funds, if
    available.
    Mental health
    Limited to Prescribed Minimum Benefits at State facilities. Subject to Momentum HealthSaver+ ,if available. Subject to Momentum HealthSaver+, if available.
    Specialist visits
    2 visits per family per year, limited to R1 290 per visit and up
    to a maximum of R2 580 per family per year. Covered at 100%
    of Momentum Medical Scheme Rate. Subject to referral by
    your Ingwe Primary Care Network or Ingwe Active Network
    provider and pre-authorisation. Psychologists and psychiatrists
    are limited to Prescribed Minimum Benefits at State facilities
    Subject to Momentum HealthSaver+ ,if available Subject to Momentum HealthSaver+, if available.
    Day-to-day provider
    Ingwe Primary Care Network or Ingwe Active Network Any provider, subject to HealthSaver+ funds,
    if available.
    Any provider, subject to HealthSaver+ funds,
    if available.
    Chronic Benefit
    Chronic cover
    26 conditions, according to the Chronic Disease List in the Prescribed Minimum Benefits (see page 19 for a list of conditions covered)

    26 conditions, according to the Chronic Disease. List in the Prescribed Minimum Benefits (see page 20 for a list of conditions covered)

    26 conditions, according to the Chronic Disease. List in the Prescribed Minimum Benefits (see page 23 for a list of conditions covered)
    Chronic provider
    Ingwe Primary Care Network or Ingwe Active Network Medipost courier pharmacy State Any, Associated or State
    Hello Doctor
    Expert advice from real doctors
    We give you a free subscription to Hello Doctor, where you can seek advice from a doctor, anytime,
    anywhere. Available 365/24/7.
    We give you a free subscription to Hello Doctor, where you can seek advice from a doctor, anytime,
    anywhere. Available 365/24/7.
    We give you a free subscription to Hello Doctor, where you can seek advice from a doctor, anytime,
    anywhere. Available 365/24/7.

    See Our Medical Aid Options

    Ingwe Option

    From R541 P/M

    It’s an affordable, entry-level medical aid plan, but you can still enjoy hospital cover, day-to-day and chronic illness benefits when you use the network providers.

    Terms and Conditions Apply

    Evolve Option

    From R1687 P/M

    For digitally savvy individuals who are looking for affordable hospital cover and virtual GP visits, with the ability to manage their membership from their device in the comfort of their own home.

    Terms and Conditions Apply

    Custom Option

    From R2149 P/M

    The Custom Option is the medical aid plan to choose if you are looking for
    an affordable hospital plan with customisable savings through HealthSaver+ and free preventative screening benefits.

    Terms and Conditions Apply

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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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