Evolve Option

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

Benefit
Associated specialists covered in full
Other specialists covered up to 100% of the Momentum Medical Scheme Rate
Oncology
R200 000 per beneficiary per year, thereafter a 20% co-payment applies. Momentum Medical Scheme reference pricing may apply to chemotherapy and adjuvant medication. You need to get your oncology treatment and medication from the Evolve Network of oncologists
Organ transplants
Limited to Prescribed Minimum Benefits at State facilities
MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans (in- and out-of-hospital)
No annual limit applies, subject to a co-payment of R3 050 per scan and pre-authorisation
Mental health
– including psychiatry and psychology
– drug and alcohol rehabilitation
Limited to Prescribed Minimum Benefits
Trauma benefit
Covers certain day-to-day claims that form part of the recovery following specific traumatic events, such as near drowning, poisoning, severe allergic reaction and external and internal head injuries. Appropriate treatment related to the event is covered as per authorisation
Take-home medication
7 days’ supply

Certain specialised procedures/treatment covered, when clinically
appropriate, in- or out-of-hospita

(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.

State

26 conditions, according to the Chronic Disease List in the Prescribed Minimum Benefits

(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.

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

Flu vaccines

Tetanus diphtheria injection

Pneumococcal vaccine

Early detection tests include:
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
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

Health line
24-hour emergency health advice.