Health4Me Gold

Health4Me Gold

The premium health insurance option for comprehensive cover

Health4Me Gold is our premium yet affordable health insurance option.

Health4Me benefits include day-to-day benefits, value-added services like the More4Me monthly airtime stipend, MediTax tax rebates, and major medical events benefits. This option provides the most comprehensive benefits and you are granted the flexibility to structure your own benefits based on your individualised health needs.

Take a look at our other health insurance options

Partner with Health4Me for top-quality healthcare at an affordable price.
From entry-level to comprehensive day-to-day benefit cover, as well as a variety of major medical event benefit cover, we have a solution that suits your needs.

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    Day-to-day benefits

    GP visits

    Unlimited Network GP visits per member per year

    Network GP visits can either be face-to-face or video call (virtual) consultations

    Hello Doctor pre authorisation is not required

    GP in room procedures

    Minor medical procedures performed as part of a Network GP consult in rooms, such as stitching of wounds and nebulisation

    Hello Doctor

    Unlimited GP consultations with a Hello Doctor GP

    Hello Doctor consultations can either be via chat, phone call or video (virtual) call

    Hello Doctor consultations include scripting of formulary-based medication, in accordance with the Network prescribed acute medication formulary, rules and protocols are applied

    Hello Doctor consultations include referral for pathology, according to the applicable Health4Me pathology list

    Hello Doctor consultations include referral for radiology, according to the applicable Health4Me radiology list

    Specialist visits

    A maximum of 2 visits, limited to R1 220 per visit and up to R2 440 per member/family per year is applied Members may consult any specialist, subject to a Network GP referral and pre-authorisation

    The specialist may refer the member for pathology and radiology according to the applicable Health4Me pathology and radiology lists

    Shortfalls will be payable by the member

    Waiting periods apply

    Acute medication

    Provided in accordance with the Network prescribed acute medication formulary

    Rules and protocols are applied

    Chronic medication

    Provided in accordance with the Network prescribed chronic medication formulary

    Rules and protocols are applied

    27 Chronic conditions are covered as follows:
    Addison’s Disease, Asthma, Bipolar Mood Disorder, Bronchiectasis, Cardiac Dysrhythmias, Cardiac Failure, Cardiomyopathy, Chronic Obstructive Pulmonary Disease, Chronic Renal Disease, Coronary Artery Disease, Crohn’s Disease, Diabetes Insipidus, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, Epilepsy, Glaucoma, Haemophilia, HIV, Hyperlipidaemia, Hypertension, Hypothyroidism, Multiple Sclerosis, Parkinson’s Disease, Rheumatoid Arthritis, Schizophrenia, Systemic Lupus Erythematosus and Ulcerative Colitis

    Chronic medication is provided in accordance with the Network prescribed chronic medication formulary

    Pathology and radiology related to condition monitoring is provided according to the applicable Health4Me pathology and radiology lists

    Pre-authorisation is required

    Waiting periods apply

    Basic pathology

    Unlimited cover for pathology, when linked to a Hello Doctor or Network GP visit and referred by a Hello Doctor or Network GP, according to the applicable Health4Me pathology list

    Basic radiology

    Unlimited cover for black and white x-rays, when linked to a Hello Doctor or Network GP visit and referred by a Hello Doctor or Network GP, according to the applicable Health4Me radiology list

    Basic and emergency dentistry

    Covered at any dentist on the Dental Network
    Basic dentistry such as fillings, extractions, infection control, cleaning and polishing of teeth

    Specialised dentistry such as bridges, crowns, surgical extractions, implants, root canals, gold fillings, dentures and braces are not covered

    Provided in accordance with the Dental Network protocols and approved Health4Me dentistry list

    Waiting periods apply

    Basic optometry

    Covered at any optometrist on the Optometry Network

    Benefit available every 2 years

    1 Eye test and 1 pair of clear standard single vision lenses, or 1 pair of bi-focal lenses, with a standard frame Sunglasses, tinted lenses, hard coating and contact lenses are not covered

    Provided in accordance with the Optical Network protocols and approved Health4Me optometry list

    A 3 month waiting period applies

    HIV benefit

    Post-exposure prophylaxis (PEP) medication is provided in accordance with the Network prescribed HIV medication formulary, to prevent HIV infection in the event of accidental exposure to blood or fluids from an infected person, or by any other means

    Antiretroviral medication is provided in accordance with the Network prescribed HIV medication formulary

    Pathology related to condition monitoring is provided according to the applicable Health4Me pathology list

    Pre-authorisation is required

    Waiting periods apply

    Maternity benefit

    2 Foetal growth 2D scans per member per pregnancy

    Antenatal pathology tests linked to a Network GP visit and referred by a Network GP, according to the applicable Health4Me pathology list

    Antenatal vitamins in accordance with the Network prescribed acute medication formulary, rules and protocols are applied

    Antenatal support (access to current and credible information on all topics related to parenthood) via BabyYumYum

    Support post-partum from a nurse/midwife at home with bathing, swaddling, latching and feeding Nurse/midwife home visits on day 2 and week 2 after the birth of the baby

    Pre-authorisation is required

    Flu vaccination

    1 Flu vaccination per member per year at any pharmacy clinic, preferably at a Dis-Chem, Clicks, MediRite or Pick n Pay pharmacy clinic

    Health assessment

    1 Health assessment (blood pressure test, cholesterol and blood sugar finger-prick tests, height, weight and waist circumference screening) is provided per member per year at a pharmacy clinic, preferably at a Dis-Chem, Clicks, MediRite or Pick n Pay pharmacy clinic

    EAP telephonic services

    Counselling and support services for adults, teenagers and children.

    Trauma and critical incidence counselling.

    Legal assist, credit health and debt management services.

    Managerial support services.

    Road accident claims

    Advice for road accident claims (via EAP services).

    Workman’s compensation claims

    Advice for injury on duty claims (via EAP services).

    Multiply Engage

    Multiply Engage is free and offers rewards from a range of partners
    Members get great discounts on big brands like Makro, Nando’s, Intercape and FlySafair, as well as on the Multiply online shop

    Additional Value Added Services included in Policy

    More4Me incentivises members with monthly airtime, data, Shoprite and Checkers vouchers or Takealot vouchers, based on their Healthy Heart Score
    Participating members will receive the following benefits:

    Activation airtime
    Activation reward: Up to 500MB data/R50 airtime, R50 Shoprite and Checkers voucher or R50 Takealot voucher

    Monthly airtime
    Based on their Healthy Heart Score, members will receive monthly rewards for a period of 12 months, until their next health assessment is due

    Green: Up to 1GB data/R80 airtime, R80 Shoprite and Checkers voucher or R80 Takealot voucher

    Amber: Up to 500MB data/R50 airtime, R50 Shoprite and Checkers voucher or R50 Takealot voucher

    Red: Up to 250MB data/R25 airtime, R25 Shoprite and Checkers voucher or R25 Takealot voucher

    Members can save up their rewards and redeem even larger

    Members can qualify for tax rebates for qualifying medical expenses and claim these expenses on their annual tax returns.

    Bloom’s Meditax product includes completing a full breakdown of the taxpayer’s qualifying additional medical expenses to assist customers with claiming these amounts back from SARS in your annual income tax return.

    Also included is the cost of submitting your tax return.

    For this benefit to be available, you will need to be up to date on your monthly fees for the year of assessment.

    A nominal amount will be debited to cover the cost of submitting your return if your paid fees do not cover the full assessment period.

    Premiums

    Main Member

    from R598 / per month

    Spouse

    from R598 / per month

    Child

    from R348 / per month

    Major medical event benefits

    Major medical event benefits are added onto the Health4Me day-to-day benefits options, and include cover for accidents and emergencies to ensure that you and your loved ones receive high quality care when you really need it. Accident and emergency cover provides in-hospital benefits for qualifying accidents and emergencies at a private hospital. A hospital cash and maternity lump-sum benefit, as well as a funeral benefit are also included to ensure that you are covered holistically.

    Take a look at our other health insurance options

    Partner with Health4Me for top-quality healthcare at an affordable price.

    From entry-level to comprehensive day-to-day benefit cover, as well as a variety of major medical event benefit cover, we have a solution that suits your needs.

    Bronze

    from R 517 / per month
    • Our entry-level option is designed to cover day-to-day needs and includes unlimited GP visits, acute medication, maternity benefits and more.

    Silver

    from R 554 / per month
    • Our balanced option covers the essentials as well as additional benefits such as maternity benefits, dentistry, optometry and more.

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