Frequently Asked Questions
Below you will find answers to frequently asked questions on the Health4me product and benefits and general health insurance information. Feel free to contact the Bloom team should you have any further inquiries.
Health Platform Benefits
How do I prove that I am a member?
You will receive a Health4Me membership certificate and membership card, which show the benefits you and your dependants
(if they are included on your membership) are covered for. Always make sure that you have your membership card with you when you need to use any of your benefits. Please store your card in a safe place, and don’t give it to anyone else to use, as this would be fraud.
What documents do I need to give when I request to add cover for my dependants?
You will need to provide us with a copy of each dependant’s identification document or birth certificate. If you have a child dependant who is between the ages of eighteen and twenty-six years of age, you will need to provide us with proof in the form of a letter from a tertiary institution (for a child student) confirming that the child is a student, or an affidavit (for a mentally disabled or physically disabled child).
Can I have my parents or brothers and sisters covered on my membership?
No you can’t, you may only cover your spouse and up to six of your own children under the age of twenty-six on your membership.
What do I do if I lose my Health4Me membership certificate or membership card?
You can call us on 0860 10 29 03 to ask us to send you a new membership certificate or membership card.
Can I get an additional Health4Me membership card if my dependants do not live with me?
Yes you can, you can get an additional membership card by calling us on 0860 10 29 03 and requesting one.
Will Health4Me give me a tax certificate?
Health4Me is an insurance product and the benefits are fully insured benefits. Health4Me does not give tax certificates to members, and members will not be able to claim tax credits on this product as they would in the case of retirement annuities or medical aid products.
What is the Employee Assistance Programme?
The Employee Assistance Programme provides you with access to professional counselling and wellness services. These services will help you to manage personal concerns that have an effect on your wellbeing, productivity and performance at work. Through the Employee Assistance Programme, you have access to confidential services, in a variety of languages, via a dedicated toll free contact centre, including the following telephonic counselling services:
- Psycho social counselling services Professional counselors will help you to detect, identify and resolve personal and health problems, that may negatively affect your wellbeing and your ability to perform at work. This service also provides support for children and teenagers, and is there to help them with any issues they may be facing, such as self-image problems, peer pressure, performance anxiety, bullying, depression or exposure to drugs.
- Trauma and critical incidence counselling services You have access to trauma support from experts and professionals 24 hours a day, 7 days a week. Assistance will be provided if you have experienced physical and/or emotional trauma, such as rape, hijacking, child abuse, death or suicide of a close family member, armed robbery or assault, domestic violence, kidnapping or abduction.
- Legal assist, credit health and debt management services If you need legal, debt or financial wellness advice, you can get assistance from fully qualified and experienced attorneys, financial consultants and debt rescue consultants.
- Managerial support services If you are a leader or a manager, you can also get support to assist and equip you to deal with the challenges you may face in the workplace.
Psycho social counselling, legal assist, credit health and debt management, as well as managerial support services, are available from Monday to Friday, from 08:00 until 16:00. You can access any of these services by calling 0800 22 93 55 and selecting option 4 for Momentum Health4Me.
What is Hello Doctor?
Hello Doctor is a benefit available to Health4Me members where a member can receive expert advice from qualified doctors without having to attend a physical, face-to-face consultation. This includes unlimited telephonic consultations and access to mobile/online medical information. Find out how it works.
General Health Insurance Information
What is health insurance?
Health insurance covers a list of preselected medical benefits with a monetary value attached to each of these.
What’s the difference between health insurance and medical aid?
Health insurance covers a list of preselected benefits with a monetary value attached to each of these. It’s best for day-to-day medical expenses and usually provides limited hospital cover, which is serviced through its network of approved providers. These policies can also include death and funeral cover. A medical aid scheme is registered with the Registrar of Medical Schemes and its members make a monthly contribution, or premium, to the scheme in exchange for a set of standardised minimum medical cover benefits. Please read our blog to learn more: Medical insurance vs medical aid.
What is the waiting period for health insurance?
The waiting period is dependent on the particular products for which a member is covered. That means each product can apply a different waiting period.
What is more affordable health insurance or medical aid?
Health insurance is more affordable than a medical aid scheme due to the flexibility of cover.
Why should I get health insurance?
Health insurance is a way to safeguard your personal finances. If you have health insurance, you will receive the best medical care should you require hospitalisation or other medical treatment.
How do I make a claim with health insurance?
Once you make a claim to your health insurance provider, the member is paid directly and they are then responsible for settling the bill with the medical service provider.
Please view: Guide for Health4Me claims
Types of Health Insurance
What types of health insurance plans are available?
Bloom offers three health insurance plans under Momentum’s Health4Me insurance cover: These are: Health4Me Bronze, Health4Me Silver and Health4Me Gold options.
What is the difference between the Bronze, Silver and Gold plans?
The Bronze plan is the most standard and affordable plan, which offers basic cover. The Silver plan is the intermediary plan, which comes at a higher premium; and the Gold plan is the premium option, which offers the most benefits at the highest premium.
Costs of Health Insurance
How do I qualify for health insurance?
If you’re over the age of 18 and earn less than R40,000 per month but more than R8,000 per month, you will be eligible for health insurance.
What is the cost of health insurance?
The premiums of health insurance will differ from plan to plan. The cost of Health4Me health insurance starts at:
Bronze – R570 per month
Silver – R610 per month
Gold – R658 per month
Health Insurance Cover
Can I get health insurance for a family?
Yes, health insurance includes comprehensive options for affordable family health insurance plans.
Can I get health insurance for your parents or for the elderly?
Yes, you can get health insurance for your parents or the elderly by adding them, as dependents, onto your health insurance plan.
Can students get health insurance?
Students can get affordable health insurance with Momentum’s Health4Me provided they are employed and earn the minimum salary. Otherwise, they can remain on a principle member’s plan as a dependent until they turn 26.
Can smokers get health insurance?
Smoking is a high-risk health risk, but it is possible to get health insurance if you are a smoker. Please be aware though but there may be additional premiums to pay. Speak to a consultant for more information.
Can I get health insurance if you have a pre-existing condition?
This will depend on the type of pre-existing condition that you have. Certain conditions may exclude you from health insurance cover while others may involve a waiting period. Speak to a consultant for more information.
Can I get health insurance for children?
Yes, you can get health insurance for your children by placing them as dependents on a principal member’s plan. Please note that you cannot get health insurance exclusively for children.
Can I get health insurance without a job?
No. Unfortunately, if you are unemployed you will not be eligible for a health insurance plan.
Can I get health insurance if I’m working part-time?
Yes, you will be eligible for health insurance provided you meet the minimum salary requirements of R8,000 per month.
Can I get health insurance if I’m self-employed?
Yes, if you are self-employed and earn the minimum salary requirements, you will be eligible for health insurance.
Can I get health insurance if I'm pregnant?
While you can get health insurance if you’re pregnant, the current pregnancy and childbirth will not be covered due to the waiting period restrictions.
What is a health insurance exclusion?
An exclusion refers to any something which your insurance does not cover, which could be a certain type of medication or surgery. Exclusions will vary from plan to plan. Speak to a consultant to make sure you’re aware of what exclusions are included in your health insurance plan.
What is a health insurance waiting period?
A waiting period protects the insurer against members who join a plan or take out a policy, make a large claim and then cancel their cover. There are general waiting periods and specific waiting periods (like pregnancy or childbirth).
What benefits are covered by health insurance?
Health insurance offers limited cover, which is covered either as a Rand value per day or as an overall monetary limit per year. The policy provides day-to-day medical expenses and limited hospital cover and medical event benefits, which is serviced through a network of approved providers.
What is covered by day-to-day health insurance?
The exact cover of each benefit will differ slightly according a member’s individualised plan and its specific limitations, but day-to-day health insurance covers the following: GP visits and in-room procedures at a Momentum Network, maternity benefits (antenatal GP visits, scans and prenatal care), annual health assessments and flu vaccinations, specialist cover, basic pathology and radiology, acute and over-the-counter medication and road accident/workman’s compensation claims assistance.
General Practitioner
Can I go to any doctor (GP, dentist or optometrist)?
No you can’t, please remember to always make use of a Momentum CareCross Network GP, dentist and optometrist. To find out which Network providers are near you, you can call us on 0860 10 29 03, or find a provider using the following lists:
Health4Me Dental Network
Health4Me GP Network
Health4Me Optimetry Network
When you visit a Network GP, dentist or optometrist, please ask him/her to check your benefits to make sure that you are covered for the treatment that you need.
What is the difference between a dispensing and a non-dispensing GP?
Your GP can prescribe medication for you from a list of approved medicines called a formulary. Your GP will either dispense the medicine to you after your consultation (this is a dispensing GP), or give you a prescription that you can take to a pharmacy to get your medicine (this is a non-dispensing GP). You can go to any pharmacy, but we suggest you go to a Dis-Chem, Clicks, MediRite or Pick n Pay pharmacy, as other pharmacies might charge an extra fee, which you will have to pay. Your Network GP may also send you for basic blood tests and black-and-white x-rays. We will pay the account if the doctor is on the GP Network, and if the blood tests or x-rays you have done are on the approved list that we cover. If a non-dispensing GP prescribes medicine that is not covered on our list of approved medicines (formulary), you will be asked to pay cash for that medication at the pharmacy. If a dispensing GP does not have the specific medicine that you need, they might give you a prescription to take to a pharmacy. It is important to remember that the pharmacy will ask you to pay cash for the medicine, as Momentum pays an additional fee to dispensing GPs to provide the required medicine directly to our members.
What is Hello Doctor?
Hello Doctor offers you easy to understand health and medical services, letting you talk to a GP in any language, any time you need to for free. If you need to speak to a GP, simply dial *120*1019# from your cellphone and choose the relevant option to “ask a doctor to call you”. A registered GP will call you back within an hour. You can also download the free Hello Doctor app from the app store on your cellphone, or go to hellodoctor.co.za. The app and website will allow you the option of texting the GP instead of talking over the phone. The Hello Doctor helpline is available during business hours if you experience any technical problems. You can find the Hello Doctor helpline number in your member guide under Hello Doctor.
How should I register for the Hello Doctor benefit?
You will need to contact us and provide us with your cellphone number, so that we can register you for the Hello Doctor benefit, and send you your unique user name and password.
Acute Medication
What is acute medication?
Acute medication is medicine, like antibiotics, that you need to take for a few days only.
Learn more here: What is acute medication
Chronic Medication
What is chronic medication?
Chronic medication is medicine that you need to take daily on an ongoing basis. If you have one of the twenty-six chronic conditions listed in your member guide, you will have access to the chronic medication benefit.
How should I register for the chronic medication benefit?
You will need to visit a Network GP. If your GP diagnoses one of the twenty-six chronic conditions, they will need to call us on 0860 10 29 03 to register you for the chronic benefit. They can do this by completing the chronic benefit application form, and emailing it to health4mechronic@momentum.co.za. We will review the request from your GP and we will tell your GP if we need more information, such as blood test results, before we can confirm your benefit. If we approve the benefit, your GP will give you a prescription for your chronic medication, according to an approved list of chronic medicines.
Where can I get my chronic medication from?
You need to fax or email your prescription to Medipost Pharmacy, and then call them to let them know where they must deliver your medication every month. You can fax your prescription to 0866 82 33 17 or email it to mhealth@medipost.co.za. You can call Medipost Pharmacy on 012 426 4000. We can only pay for your chronic medication if we have approved it and if your GP has prescribed it from the approved list of chronic medicines. You will need to get a new script from your Network GP every six months, and send it to Medipost Pharmacy. Please note that this benefit is only available if you are on the Silver or Gold option.
What chronic diseases are covered by health insurance?
The following 26 diseases and conditions are covered: Addison’s Disease, Asthma, Bipolar Mood Disorder, Bronchiectasis, Cardiomyopathy, Chronic Obstructive Pulmonary Disease, Diabetes Insipidus, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Epilepsy, Glaucoma, Haemophilia, Hyperlipidaemia, Hypertension, Hypothyroidism, Multiple Sclerosis, Parkinson’s Disease, Rheumatoid Arthritis, Schizophrenia, Systemic Lupus Erythematosus and Ulcerative Colitis.
HIV
What is covered under the HIV benefit?
You may go for one HIV ELISA screening blood test per year at a Network GP. If your screening blood test result is positive for HIV, your GP will need to call us to register you for the HIV benefit. The HIV benefit also includes post-exposure prophylaxis treatment, to prevent HIV infection, in the event that you are accidentally exposed to blood or fluids from an infected person, or by any other means.
How should I register for the HIV medication benefit?
Your GP will need to call us on 0860 55 56 09 to register you for the HIV benefit. They can do this by completing the HIV benefit application form, and emailing it to health4mehiv@momentum.co.za. We will review the request from your GP and tell your GP if we need more information, such as blood test results, before we can confirm your benefit. If we approve the benefit, your GP will give you a prescription for your HIV medication, according to an approved list of antiretroviral medicines.
Where can I get my HIV medication from?
You need to fax or email your prescription to Medipost Pharmacy, and then call them to let them know where they must deliver your medication every month. You can fax your prescription to 0866 82 33 17 or email it to mhealth@medipost.co.za. You can call Medipost Pharmacy on 012 426 4000. We can only pay for your HIV medication if we have approved it and if your GP has prescribed it from the approved list of antiretroviral medicines. You will need to get a new script from your Network GP every six months, and send it to Medipost Pharmacy. If you are already receiving antiretroviral medication from a State facility for your condition on a
monthly basis, we suggest that you continue to get your treatment from State. This means that you would not need to re-register on the State HIV benefit programme, if you ever stop your benefit cover.
Maternity
What is covered under the maternity benefit?
You will have cover for two maternity visits, which includes one 2D growth scan or ultrasound (Health4Me Bronze and Health4Me Silver options) and two 2D growth scans or ultrasounds (Health4Me Gold option), per pregnancy. You will need to visit a Network GP who is certified to do growth scans, or be referred by a Network GP to a gynaecologist (Gold option only). If you do consult a gynaecologist, the scan will be paid from this benefit, but the visit will be paid from your specialist benefit.
Dental
What is covered under the dental benefit?
You may visit any dentist on the Dental Network. You have benefits for basic dentistry, such as fillings, extractions, infection control and cleaning and polishing of teeth. The dentist will send the account to us for payment. Specialised dentistry, such as bridges, crowns, surgical extractions, implants, root canals, gold fillings, dentures and braces, is not covered. If a specific dental procedure is not covered, the dentist will let you know and you will need to pay for it from your own pocket.
If the dentist prescribes antibiotics for me, can I get these from a pharmacy?
Yes you can, but only if the dentist prescribes antibiotics that are on the list of approved medicines (formulary).
Please note that this benefit is only available if you are on the Silver or Gold option.
Optometry
What is covered under the optical benefit?
You may visit any optometrist on the Optometry Network. You will have cover for one eye test and one pair of clear standard single vision lenses, or one pair of bi-focal lenses, with a standard frame, every two years.
The optometrist will test your eyes and tell you if you need glasses. If your eye test shows a reading of 0.75 or more, the optometrist will show you a range of frames which you can choose from.
If you choose a frame that is not part of this range, you will need to pay the difference in the price. The lenses that we cover are standard quality white CR39 lenses, single vision or bi-focal where appropriate.
The optometrist will send the account to us for payment. If your eye test shows that you do not need glasses (a reading of less than 0.75), the optometrist will need to send us a motivation letter, to let us know why you need glasses. If the optometrist does not send us the motivation letter, then we will pay for the visit only.
We do not cover sunglasses, tinted lenses, hard coating or contact lenses.
Upgrades or services outside the list of covered benefits will be for your own pocket.
Vaccinations and Health Assessments
Can I go for a flu vaccination?
Yes you can, strengthening your immune system to protect yourself from the flu virus is important.
1 Flu vaccination per member per year at any pharmacy clinic, preferably at a Dis-Chem, Clicks, MediRite or Pick n Pay pharmacy clinic
Can I go for a health assessment?
Yes you can, you may go for one health assessment per year, which includes a blood pressure test, cholesterol and blood sugar finger prick tests, as well as height, weight and waist circumference measurements. These tests will show you the state of your health, and if you are at risk of developing a long-term condition. You can go to any pharmacy clinic to do your health assessment, but we suggest you go to a Dis-Chem, Clicks, MediRite or Pick n Pay pharmacy clinic, as other pharmacies might charge an extra fee, which you will have to pay.
Accident and Emergency Cover
Will health insurance cover a hospital emergency?
Yes, health insurance will cover accident and emergency cover, which includes the transportation, stablisation and treatment in case of an accident that requires emergency medical treatment.
What is covered under accident and emergency cover?
Accident and emergency cover
Emergency transportation, stabilisation and treatment cost paid in case of an accident or an emergency (heart attack or stroke) that requires immediate medical treatment If the benefit limit is exceeded, and further treatment is required, the member will be transported to a state facility for further care and treatment
Base option
Casualty benefit up to R30 000 per event
In-hospital benefit up to R500 000 per event
Covered at a private hospital for accidents that meet the qualifying criteria
An accident shall mean a medical emergency that is an external, unexpected event that is not traceable, directly or indirectly, to a member’s state of mental or physical health prior to the event
Standard option
Casualty benefit up to R30 000 per event
In-hospital benefit up to R1 500 000 per event
Covered at a private hospital for accidents that meet the qualifying criteria
An accident shall mean a medical emergency that is an external, unexpected event that is not traceable, directly or indirectly,
to a member’s state of mental or physical health prior to the event
An accident can happen at any time and it is important that you know who to call if you are involved in an accident, and you need immediate medical treatment. You have cover for accidents that are external, unexpected events, such as burns, fractures or the breaking of limbs due to an accident.
You will need to call us on 0860 10 26 03 to get authorisation for emergency medical treatment.
For emergency ambulance transport, call Netcare 911 on 082 911.
Based on your injuries, the ambulance staff will decide on the most suitable hospital to take you to. If you have an authorisation number, the hospital will send the account to us for payment. We will pay up to the benefit option per event limit for casualty treatment, and up to the benefit option per event limit for in-hospital treatment, provided that the treatment is linked to an
accident that fits the qualifying criteria.
You are not covered for injuries that happen while you are under the influence of alcohol, or for claims for self-inflicted injuries, as well as injuries that you get while breaking the law or participating in civil unrest. Your emergency cover also includes a heart attack and stroke benefit. We will pay up to the benefit option per event limit for casualty treatment, and up to the benefit option per event limit for inhospital treatment, if you have a heart attack or a stroke.
If you are hospitalised at a private hospital, and the cost of your care exceeds the in-hospital treatment limit,
and you need further treatment, you will be transported to a State hospital for further care.
Please check on your Health4Me membership certificate if you and your family (if included) have accident cover,
and if you are on the Base or Standard option.
Hospital Cash and Maternity Lump Sum
What is covered under the hospital cash and maternity lump sum benefit?
Hospital cash and maternity lump sum benefit
Daily benefit amount paid per day spent in hospital, paid from day 1, provided that hospitalisation is longer than 48 hours
Maximum of R20 000 payable per member per year
Maternity lump sum benefit payable to a member if hospitalisation is due to childbirth, irrespective of the number of days that the member has been hospitalised
A 3 month waiting period applies
Base option
R500 per day in hospital
Maximum of 40 days payable per member per year
R10 000 maternity lump sum benefit (a 12 month condition specific waiting period applies)
Standard option
R1 000 per day in hospital
Maximum of 20 days payable per member per year
R20 000 maternity lump sum benefit (a 12 month condition specific waiting period applies)
The hospital cash benefit pays you a daily benefit amount per day spent in hospital, provided that you are in hospital for more than two days. This benefit helps you to pay for any unexpected costs that you may have due to being hospitalised, such as transport for your family to visit you while you are in hospital, or to supplement your income due to time taken off from work.
Funeral benefit
What is covered under the funeral benefit?
Hospital cash and maternity lump sum benefit
The funeral benefit will help pay for funeral expenses in the event of a death
Base option
We will pay the following amounts for you and your family, if they are included on your membership, if the cause of death is as a result of natural causes (a 3 month waiting period applies):
You, your spouse and children over 14 = R10 000
Children between 6 and 13 = R5 000
Children between 1 and 5 = R2 500
Children under 1 = R1 250
Stillborn babies past 28 weeks gestation = R750
We will pay the following amounts for you and your family, if they are included on your membership,
if the cause of death is as a result of unnatural causes:
You, your spouse and children over 14 = R20 000
Children between 6 and 13 = R10 000
Children between 1 and 5 = R5 000
Children under 1 = R2 500
Stillborn babies past 28 weeks gestation = R1 500
Standard option
We will pay the following amounts for you and your family, if they are included on your membership, if the cause of death is as a result of natural causes (a 3 month waiting period applies):
You, your spouse and children over 14 = R15 000
Children between 6 and 13 = R7 500
Children between 1 and 5 = R3 750
Children under 1 = R1 875
Stillborn babies past 28 weeks gestation = R1 125
We will pay the following amounts for you and your family, if they are included on your membership, if the cause of death is as a result of unnaturalcauses:
You, your spouse and children over 14 = R30 000
Children between 6 and 13 = R15 000
Children between 1 and 5 = R7 500
Children under 1 = R3 750
Stillborn babies past 28 weeks gestation = R2 250
How do I submit a hospital cash and maternity lump sum benefit or funeral benefit claim?
To submit a hospital cash and maternity lump sum benefit or funeral benefit claim, you can call us on 0860 10 29 03, or email us at health4me@momentum.co.za, and we will provide you with the relevant claim form. Once you have completed the claim form and have the documents we require as stated on the claim form, you can either email the documents to us at
To download a copy of our FAQ’s for your reference, click on the download button below.
Need Advice?
If you need any help regarding the above, please contact our team and a Bloom consultant will assist.
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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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