Evolve Option

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

Certain specialised procedures/treatment covered, when clinically
appropriate, in- or 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.

26 conditions – no annual limit applies

(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 may add the HealthSaver+ to provide cover for your day-to-day healthcare expenses

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 (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