What does it cover?
The Evolve Option provides cover for hospitalisation in the Evolve Network of private hospitals with no overall annual limit.
For chronic treatment, scripts and medication, you need to use State facilities.
Major Medical Benefit
This benefit covers hospitalisation as well as some out-of-hospital procedures that can be safely performed in a doctor's room, registered day clinic, or out-patient facility. A co-payment of R1 570 applies per authorisation, except for motor vehicle accidents, maternity confinements, and emergency treatment.
Major Medical Benefits are available at Evolve Network hospitals. Certain procedures are only covered in day facilities.
Our Health Platform Benefit provides cover for a range of benefits such as preventative screening tests, certain check-ups and more.
- Associated specialists are covered in full. Other specialists are covered up to 100% of the Momentum Health Rate. Hospital accounts are covered in full at the rate agreed upon with the hospital group.
- Oncology is covered at R200 000 per beneficiary per year, thereafter a 20% co-payment applies. Momentum Health reference pricing applies to chemotherapy and adjuvant medication. You need to get your oncology treatment and medication from the Evolve Network of Oncologists.
- Organ transplant and renal dialysis, limited to Prescribed Minimum Benefits* at State facilities.
- No annual limit for MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans. You will need to pay R2 620 per scan and obtain pre-authorisation.
- Medical rehabilitation, private nursing, hospice and step-down facilities limited to R45 900 per family per year.
- Trauma benefit for day-to-day claims that form part of your recovery following specific traumatic events.
- Seven days’ supply of take home medication.
- Certain specialised procedures/treatments are covered, when clinically appropriate, in and out of hospital.
This benefit takes care of certain life-threatening conditions, such as diabetes and heart disease, that need ongoing treatment.
It covers 26 conditions under Prescribed Minimum Benefits* according to the Chronic Disease List at State facilities.
Day-to-day needs such as GP visits, specialist visits, eye care, dentistry, prescribed medicine and mental health are paid by you or from HealthSaver+, if available.
Health Platform Benefit
A unique benefit that encourages health awareness, enhances quality of life and gives peace of mind through preventative care and early detection tests.
Includes baby immunisations, flu vaccines, as well as tetanus diphtheria injections.
Early detection tests
Includes pap smears, dental consultations, general physical examinations, prostate specific antigens, health assessments, cholesterol tests, blood sugar tests and HIV tests.
Women registered on our maternity programme get 12 antenatal visits which include a urine test, two pregnancy scans, and two visits to the paediatrician during the baby's first year.
Health management programme
For the management of diabetes, hypertension, HIV/Aids, oncology, drug and alcohol rehabilitation, chronic renal failure, organ transplants and cholesterol.
24-hour emergency health advice.
Emergency evacuation in South Africa by Netcare 911.
International emergency cover by ISOS, covered up to R5 million per 90-day journey.