HEALTH4ME / GP & Specialists
GOLD DAY-TO-DAY / 01

GP & Consultation Benefits

Gold Day-to-Day Option

GP Benefit

  • 3 GP visits at a Network GP per member per year — no Hello Doctor pre-authorisation required
  • 2 additional Network GP visits per member per year for members on the Chronic, HIV or Maternity benefit programme (2 additional visits per benefit programme) — no pre-authorisation required
  • Hello Doctor pre-authorisation required from the 4th GP visit onward to unlock unlimited visits
  • Hello Doctor consultations can be via chat, phone call or video (virtual) call

Hello Doctor

  • Unlimited GP consultations with a Hello Doctor GP
  • Via chat, phone call or video (virtual) call
  • Referral for pathology according to the applicable Health4Me pathology list
  • Referral for radiology according to the applicable Health4Me radiology list
Unlimited

Hello Doctor Scripting

  • Unlimited scripting of Schedule 1 to Schedule 4, formulary-based medication
  • In accordance with the Network prescribed acute medication formulary
  • Rules and protocols are applied
Unlimited

GP In-Room Procedures

  • Minor medical procedures performed as part of a Network GP consult in rooms
  • Examples: stitching of wounds and nebulisation

Specialist Benefit

  • Maximum of 2 visits, limited to R1 425 per visit
  • Up to R2 850 per member/family per year
  • Any specialist, subject to Network GP referral and pre-authorisation
  • Specialist may refer for pathology and radiology per applicable Health4Me lists
  • Specialist may prescribe medication subject to the per event limit
  • Shortfalls are payable by the member
R2 850 max / year

Basic Pathology

  • Unlimited cover when linked to a Hello Doctor or Network GP visit
  • Must be referred by a Hello Doctor or Network GP
  • According to the applicable Health4Me pathology list
Unlimited

Basic Radiology

  • Unlimited cover for black and white x-rays
  • Linked to a Hello Doctor or Network GP visit
  • Must be referred by a Hello Doctor or Network GP
  • According to the applicable Health4Me radiology list
Unlimited
GOLD DAY-TO-DAY / 02

Medication Benefits

Gold Day-to-Day Option

Acute Medication

  • Provided in accordance with the Network prescribed acute medication formulary
  • Rules and protocols are applied

HIV Benefit

  • Post-exposure prophylaxis (PEP) medication to prevent HIV infection after accidental exposure to blood or fluids from an infected person, or by any other means — per the Network prescribed HIV medication formulary
  • Antiretroviral medication per the Network prescribed HIV medication formulary — rules and protocols applied
  • Pathology for condition monitoring per the applicable Health4Me pathology list
  • Pre-authorisation is required

Chronic Benefit & Medication — 27 Conditions Covered

  • Chronic medication per the Network prescribed chronic medication formulary — rules and protocols applied
  • Pathology and radiology for condition monitoring per the applicable Health4Me pathology and radiology lists
  • Pre-authorisation is required
Addison's DiseaseAsthma Bipolar Mood DisorderBronchiectasis Cardiac DysrhythmiasCardiac Failure CardiomyopathyChronic Obstructive Pulmonary Disease Chronic Renal DiseaseCoronary Artery Disease Crohn's DiseaseDiabetes Insipidus Diabetes Mellitus Type 1Diabetes Mellitus Type 2 EpilepsyGlaucoma HaemophiliaHIV HyperlipidaemiaHypertension HypothyroidismMultiple Sclerosis Parkinson's DiseaseRheumatoid Arthritis SchizophreniaSystemic Lupus Erythematosus Ulcerative Colitis

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 applied
  • Antenatal support (access to current and credible information on all topics related to parenthood) via Parent Sense
  • 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
GOLD DAY-TO-DAY / 03

Wellness & Additional Benefits

Gold Day-to-Day Option

Basic & Emergency Dentistry

  • Covered at any dentist on the Dental Network
  • Basic dentistry: fillings, extractions, infection control, cleaning and polishing of teeth
  • Per Dental Network protocols and approved Health4Me dentistry list
  • Not covered: bridges, crowns, surgical extractions, implants, root canals, gold fillings, dentures and braces

Basic Optometry

  • Covered at any optometrist on the Optical 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
  • Per Optical Network protocols and approved Health4Me optometry list
  • Not covered: sunglasses, tinted lenses, hard coating and contact lenses
Every 2 years

Flu Vaccination

  • 1 flu vaccination per member per year
  • At any pharmacy clinic — preferably Dis-Chem, Clicks or MediRite

COVID-19 Screening Test

  • 1 COVID-19 screening test per member per year
  • Subject to a Hello Doctor, Network GP or specialist referral
  • Can also be performed as part of a Network GP or specialist consultation in rooms

On-Site Wellness Days

  • Basic health and wellness screening offered on site by qualified nurses
  • Minimum of 50 employees per site required
  • A completed on-site wellness request form is required

Health Assessment

  • 1 health assessment per member per year
  • Includes: blood pressure, cholesterol and blood sugar finger-prick tests, height, weight and waist circumference screening
  • On site at a Wellness Day or at a pharmacy clinic (preferably Dis-Chem, Clicks or MediRite)
  • Employer groups with more than 50 employees per site can arrange an on-site wellness day

Employee Assistance Programme (EAP)

  • Counselling and support services for adults, teenagers and children
  • Trauma and critical incidence counselling services
  • Legal assist, credit health and debt management services
  • Advice for road accident claims and injury on duty claims
  • Managerial support services
  • Telephonic counselling and on-site trauma and critical incidence support

Multiply Engage

  • Free access to Multiply Engage via the Momentum App
  • Digital health and fitness assessment — immediate health insights from day one
  • Rewards from partners: Checkers, Nu Metro, Amazfit, Virgin Active, Zone Fitness and more
Free access

More4Me Rewards

  • R50 per year for digital engagement and completing a digital health assessment
  • A scratch card after completing the annual health assessment in person at a Momentum Wellness Day
  • Up to R80 per month based on Healthy Heart Score — received at a Momentum Wellness Day or Dis-Chem, Clicks or MediRite pharmacy clinic
  • Redeem as airtime, data, Shoprite and Checkers vouchers, or Takealot vouchers
Up to R80 / month
STANDARD MAJOR MEDICAL / 04

Major Medical Event Benefits

Standard Benefits Option — Pre-authorisation required for all benefits
1

Accident Cover

Covered at a private hospital for accidents requiring immediate medical treatment that meet the qualifying criteria
Casualty Benefit
R30 000 per event
In-Hospital Benefit
R1 500 000 per event
An accident means 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.
2

Emergency Cover — Heart Attack or Stroke

Covered at a private hospital for qualifying emergency events requiring immediate medical treatment
Casualty Benefit
R30 000 per event
In-Hospital Benefit
R500 000 per event
An emergency means the sudden and, at the time, unexpected onset of a medical condition requiring immediate medical or surgical treatment, where failure to treat would result in serious impairment to bodily functions, serious dysfunction of a body organ or part, or would place the member's life in serious jeopardy. For this benefit, emergency includes, and is limited to, accidents, heart attacks and strokes.
3

Emergency Booster Benefit (optional employer add-on)

Your employer has chosen to add this benefit to Accident and Emergency cover
Casualty Benefit
R30 000 per event
In-Hospital Benefit
R425 000 per event

Covered at a private hospital for emergency events requiring immediate medical treatment that meet the qualifying criteria and relate to one of the following 11 conditions:

Acute Appendicitis Acute Asthma / Respiratory Disorders Acute Pancreatitis Acute Pneumonia Cholecystitis Gastroenteritis with Dehydration Diabetic Ketoacidosis Ectopic Pregnancy Kidney Stones Pulmonary Embolism Acute Investigation & Stabilisation of Fits / Seizures
4

Emergency Transportation Cover

Included with Accident and Emergency cover
  • Emergency transportation, stabilisation and treatment cost paid in the case of an accident or an emergency (heart attack, stroke — or one of the 11 Emergency Booster conditions if that cover applies) requiring immediate medical treatment
  • Also covers: diagnostic scans (MRI and CT scans), take-home medication, prosthetics, assistive devices and rehabilitation services including wound care, physiotherapy and occupational therapy — subject to clinical approval and the respective per-event limits
  • 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
Pre-authorisation is required for all major medical event benefits. Subject to clinical approval and per-event limits.
Annual maximum payable — all major medical event benefits combined
R5 000 000 per member per year
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