Evolve Option

Provider
Major Medical Benefits are available at Evolve Network hospitals.
Certain procedures are only covered in day hospitals.

Benefit
Associated specialists are covered in full. Other specialists are covered up to 100% of the Momentum Medical Scheme Rate.
Hospital accounts are covered in full at the rate agreed upon with the hospital group.
Oncology
Covered up to R200 000 per beneficiary per year, thereafter a 20% co-payment applies.Momentum Medical Scheme reference pricing applies to chemotherapy and adjuvant (supplementary) medication.You need to get your oncology treatment and medication from the Evolve Network of Oncologists.
Organ transplant and renal dialysis
Limited to Prescribed Minimum Benefits* at State facilities.
MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans
No annual limit
You will need to pay R2 900 per scan.
Medical rehabilitation, private nursing, Hospice, and step-down facilities
Limited to R52 600 per family per year.
Trauma benefit
Certain day-to-day claims that form part of your recovery following specific traumatic events
Take-home medication
7 days’ supply

Certain specialised procedures or treatments covered
Certain specialised procedures or treatments covered when clinically appropriate in- and out-of-hospital.

(PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide members with continuous care to improve their health and well-being and to make healthcare more affordable.

Provider
State facilities

Cover
26 conditions under Prescribed Minimum Benefits* according to the Chronic Disease List.

(PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide members with continuous care to improve their health and well-being and to make healthcare more affordable.

Medical Savings Account
No built-in savings.
You can add HealthSaver+ to supplement your day-to-day benefits.

GP Visits

• 2 virtual consultations per beneficiary per year from the GP Virtual Consultation Network, which includes Hello Doctor. Consultations include scripting of medication where required. Medication is subject to HealthSaver+, if available.
• If you need cover for other day-to-day expenses, like additional GP visits or prescribed medicine, you can choose
  to make use of the HealthSaver.

Available from: any provider.

Preventative care includes:
baby immunisations covered up to the age of 6,
pneumococcal vaccines
flu vaccines,
tetanus-diphtheria injections, and more.
Early detection tests include:
mammograms,
bone density scans,
pap smears,
dental consultations,
general physical examinations,
prostate specific antigens,
health assessments,
cholesterol tests,
blood sugar tests, and
HIV tests.
Maternity programme
12 antenatal visits which include:
a urine test
certain antenatal pathology tests,
2 pregnancy scans,
2 doula visits,
2 nurse home visits after returning home from hospital, and
2 paediatrician visits in baby’s first year.
Health management programmes for the management of the following conditions:
diabetes,
hypertension,
HIV/Aids,
oncology,
drug and alcohol rehabilitation,
chronic renal failure,
organ transplants, and
cholesterol.
Health line
24-hour emergency health advice.
Emergency evacuation
Emergency evacuation in South Africa by Netcare 911.
International emergency
International emergency cover by ISOS, covered up to R5 million per 90-day journey.