Choosing an entry level medical aid
Starting out? We’ve got a medical aid plan just for you!
Our Evolve medical aid option is for digitally savvy individuals looking for affordable hospital cover and virtual GP visits, with the ability to manage their membership from their device in the comfort of their homes. Covers hospitalisation from the Evolve Network of private hospitals (no overall annual limit) with 2 virtual doctors’ consultations.
- Hospitalisation from the Evolve
- Network of private hospitals. Access to 2 virtual consultations per beneficiary per year from the G
- Virtual Consultation Network, which includes Hello Doctor.
- Preventative care with early detection tests.
Medical aid resources
Helpful guides and articles to help you understand your cover and make informed choices.
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Bloom Ingwe medical aid benefits
A co-payment applies per hospital authorisation, and certain procedures must be done in a day hospital.
In-hospital Benefits
The Evolve Option provides cover for hospitalisation at the Evolve Network of private hospitals (see page 40 for this list). There is no overall annual limit for hospitalisation. A co-payment of R2 000 per authorisation applies to Major Medical Benefits, including for non-emergency Prescribed Minimum Benefits, except for motor vehicle accidents, maternity confinements, emergency treatment, and when you involuntarily use a non-designated Service Provider. An additional co-payment may apply for certain specialised procedures
Hospital Choice
Associated specialists covered in full
Other specialists covered up to 100% of Momentum Medical Scheme Rate
Hospital accounts are covered in full at the rate agreed upon with the hospital group No overall annual limit applies
Hospitalisation
Benefit
Associated specialists covered in full
Other specialists 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
No overall annual limit applies
Oncology
R200 000 per beneficiary per year, thereafter a 20% co-payment applies. Momentum Medical Scheme Reference Pricing will 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 850 per scan and pre-authorisation
Mental health
– incl. psychiatry and psychology
– drug and alcohol rehabilitation
Limited to Prescribed Minimum Benefits at Evolve Network hospitals
Trauma benefit
Covers certain day-to-day benefits 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
Specialised Procedures/Treatment
Certain specialised procedures/treatment covered, when clinically
appropriate, in- or out-of-hospital
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.
Chronic Benefits
The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. The Chronic Benefit includes cover for the 26 Chronic Disease List (CDL) conditions, which form part of the Prescribed Minimum Benefits (PMBs). Chronic benefits are subject to registration and approval.
Network
Chronic Benefit formulary:
State formulary
Benefit
26 conditions – no annual limit applies
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.
Day-to-day
This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medication. You have the choice of adding more day-to-day cover through the HealthSaver+.
Savings
You may add the HealthSaver+ to provide cover for your day-to-day healthcare expenses
Benefit
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.
+ You may choose to make use of additional products available from Momentum Metropolitan Holdings Limited (Momentum), to seamlessly enhance your medical aid. Momentum is not a medical scheme and is a separate entity to Momentum Medical Scheme.
The complementary products are not medical scheme benefits. You may be a member of Momentum Medical Scheme without taking any of the complementary products.
Health Platform Benefits
The Health Platform Benefit encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection and a leading maternity programme.
Network Provider
Available from: any provider.
Benefit
Preventative care includes:
Baby immunisations (On Ingwe Option, baby immunisations are covered in private facilities for baby’s first year, limited to R3 100. Once the limit is reached, immunisations are available at the Department of Health baby clinics
Flu vaccines
Tetanus diphtheria injection
Pneumococcal vaccine
Early detection tests include:
Health assessment: Blood pressure test, Cholesterol and Blood sugar (finger prick tests), height, weight and waist circumference All principal members and adult beneficiaries Once a year
Preventative dental care covered up to R500 per beneficiary at any dental provider
Pap smear consultation (nurse, GP* or gynaecologist)
Pap smear (pathologist)
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
FIT (Faecal immunochemical testing) test
DEXA bone density scan (radiologist, GP* or specialist)
General physical examination (GP* consultation)
Prostate specific antigen (pathologist)
Cholesterol test (pathologist)**
Blood sugar test (pathologist)***
Glaucoma test
HIV test (pathologist)
Maternity programme
Doula benefit
Antenatal visits (Midwives, GP* or gynaecologist)
Nurse home visit
Urine tests (dipstick)
Pathology tests – Blood group, full blood count and Rhesus factor, Creatinine, Glucose strip, Haemoglobin estimation, Urinalysis, Urine tests (microscopic exams, antibiotic susceptibility and culture)
Scans
Paediatrician visits
Health line
24-hour emergency health advice
For more information on this option, download the relevant document below.
See Our Medical Aid Options
Ingwe Option
From R699 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
Custom Option
From R2639 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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