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Specialist Benefit

▪ Up to 2 visits, limited to R1 000 per visit and up to R2 000 per member/family per year

▪ Members may consult any specialist, subject to a Momentum CareCross Network GP referral and pre-authorisation (at approved specialist disciplines only)

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

▪ Members need to pay any shortfalls

▪ A 3 month waiting period applies

If you need to see a specialist, you must first visit your Network GP, who will give you a referral letter. You will need to call us on 0860 10 29 03 to get authorisation. You have cover for two specialist visits per year. The maximum amount we will pay per visit is R1 000, with a maximum for the year of R2 000 for you and your family, if they are also covered.

Example: Let’s say the specialist charges you R1 200 for a visit. The specialist will send the account for R1 200 to Momentum for payment. Momentum will pay the specialist R1 000, and your benefit left for the year will reduce from R2 000 to R1 000. You will have to pay the additional R200 for the visit from your own pocket.

Specialist benefit disciplines covered

Health4me Specialist Health Insurance Benefit

Please note that this benefit is only available on the Gold option.

To download a copy of the Specialist benefit information click on the download button below.