Health4Me: Health insurance benefits explained

South Africa’s public healthcare system is under severe strain. The COVID-19 pandemic has put even more pressure on the under-resourced capabilities of government hospitals and healthcare facilities. Bloom, together with their partner, Momentum Health4Me has a solution. We offer cost-effective health insurance plans for those who want affordable medical insurance cover with top-quality private healthcare.  Find out what sort of benefits you can expect to receive from the Momentum Health4Me health insurance plans.

Health insurance benefits explained

Health insurance can save you money by reimbursing you for the costs of a medical illness, condition or event; it can also ensure that you receive access to top-quality professional medical care and services. Many people put off getting a health insurance plan in order to “save money.” However, this is not a smart move because health insurance is a wise investment. Take a closer look at the reasons why medical insurance is so important with this breakdown of health insurance benefits:

  • Save money in the long run. This is because private healthcare can be very expensive, which means you can run into serious debt or be placed in the position of being unable to obtain quality medical care because you’re not covered by a health insurance policy.
  • Get access to quality healthcare. If you have a health insurance plan, you won’t have to delay going to see a doctor. Remember that early detection of certain diseases or chronic conditions will assist in a successful recovery plan.

What health insurance benefits does Bloom offer?

There are two main areas of health insurance benefits offered by the Momentum Health4Me cover options: day to day cover and major medical events cover. Let’s unpack these a little more so that you gain a clear understanding of these benefits.

  1. Day to Day Cover 
  • Specialist Benefits are available to members on the Momentum Health4Me Gold plan. This benefit includes two consultations with a specialist, like a psychiatrist, cardiologist, gynaecologist or dermatologist each year. This is subject to a Momentum CareCross Network GP referral and pre-authorisation. Each consultation is limited to a maximum of R1,000 (R2,000 per member, per year) and members will have to cover any shortfalls out of pocket.
  • GP Visits. There is no limit on the number of GP visits at a Network GP per member per year but a Hello Doctor pre-authorisation is required for every GP visit from the fourth visit onwards. These consultations can be in-office or via virtual consultations.
  • Dentistry Benefits are available for Momentum Health4Me Silver and Gold plans. Members may visit any dentist from the Momentum CareCross Dental Network. Basic dentistry is covered, which includes fillings, extractions, infection control, cleaning and polishing. Specialised dentistry, like bridges, crowns, implants, root canals and dentures are not covered. A three month waiting period does apply for this benefit.
  • Maternity Benefits include antenatal GP visits at a Momentum CareCross Network GP, two 2D foetal growth scans per member per pregnancy and antenatal pathology tests as prescribed by your network GP. You will also receive access to support during and after your pregnancy in the form of Hello Doctor and from leading parental portal, Baby Yum Yum. Maternity benefits are available for Momentum Health4Me Bronze, Silver and Gold options.
  • Optometry Benefits are available for Momentum Health4Me Silver and Gold plans. Members can visit any optometrist from the Momentum CareCross Optical Network. The benefit, which is available every two years, includes one eye test and one pair of standard, single-vision lenses or a pair of bifocal lenses in a standard frame. Prescription sunglasses and contact lenses are not covered. A three month waiting period does apply for this benefit.
  • HIV Benefits are available for the Momentum Health4Me Gold health insurance plan. Antiretroviral medication is provided in accordance with the Momentum CareCross Network prescribed HIV medication formulary. You will need to register for the HIV benefit and, once this has been approved, your HIV medication will be sent to a MediPost Pharmacy. A three month waiting period does apply for this benefit.
  • Chronic Disease Benefits are available to Momentum Health4Me Gold plan members. This benefit offers unlimited benefit when provided in accordance with the Momentum CareCross Network prescribed chronic medication formulary. The 26 conditions covered include 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. The benefit will cover the cost of the chronic medication provided it has been approved. You will need to fax or email your prescription through to a Medipost Pharmacy and let them know where to deliver the medication.
  1. Major Medical Events Cover

Health insurance in-hospital and medical events’ benefits will include:

  • Accident and emergency cover, like a vehicle accident or heart attack, would extend to the transportation, stabilisation and treatment cost paid in the event of such an unforeseen accident or emergency that requires immediate medical treatment.
  • Hospital and maternity lump sum benefits include a cash payment of between R500-R1000 paid per member per day (provided the hospital stay does not exceed 48 hours), with a maximum payout of R20,000 payable per member each year. Waiting periods do apply for this benefit.
  • Funeral benefit. This includes a payout of up to R20,000 should the principal member, their spouse or one of their children pass away, provided they are all on the medical insurance plan. The benefit will also help pay for funeral expenses as well as repatriation costs (if necessary). Waiting periods do apply.

What is a beneficiary for health insurance?

A beneficiary for health insurance is a person whom you name in your health insurance plan who will receive benefits as part of that particular plan. You can include more than one beneficiary on your plan. A beneficiary can be your spouse or partner, child, step-child or parent.

How much does health insurance cost?

Bloom offers a range of affordable health insurance plans. These include the Momentum Health4Me Gold, Silver and Bronze options. The entry-level costs start at just R517 per month. In order to qualify for health insurance cover, you need to be over the age of 18 years and earn a minimum of R8,000 per month and less than R30,000.

Get affordable health insurance when you need it

Comprehensive health insurance will ensure you have access to good quality medical care if you or a family member ever need it. Health insurance plans are designed to allow you to choose what cover you want so that you only pay for the benefits you need, saving you money. Get yourself covered with a health insurance plan by contacting our team of trained consultants. Contact us for more information or to get a free, no obligations quote.

Medical Content Disclaimer

You understand and acknowledge that all users of the Bloom website are responsible for their own medical care, treatment, and oversight. All content provided on the website, is for informational purposes only and does not constitute medical advice. Neither is it intended to be a substitute for an independent professional medical opinion, judgement, diagnosis or treatment.

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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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