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Understanding Health Insurance Benefits: An Easy Guide

There is now an affordable healthcare option for those facing significant financial challenges, which is especially relevant in today’s uncertain and unprecedented times. Given the growing need for good health insurance in South Africa, and in order to meet the demand for top-quality medical care, Bloom, in partnership with Momentum Health, is offering comprehensive health insurance plans that are suited for your personal needs and budget.

What is health insurance and why would you need it?

Health insurance is a relatively new concept in the country and has become the cost-effective alternative to medical aid. It is governed by the Short-Term and Long-Term Insurance Act and covers a list of preselected benefits with a monetary value attached to each of these. Bloom uses the Building Block approach for our Health4Me Bronze, Health4Me Silver and Health4Me Gold plans. This means that our members choose exactly what benefits they wish to be covered for relative to their available budget. The personalised and flexible approach to medical cover has proven to be extremely successful with both private individuals and corporate members.

Health insurance - the advantages of a personalised plan

Many South Africans don’t have medical aid and have no access to quality health care. According to a report by StatsSA, only 9.4 million South Africans, out of a population of roughly 57 million, belong to any sort of medical aid scheme. This low rate is attributed to high-living costs, unemployment and economic hardships.

But times are changing for the better. Bloom is pleased to report seeing an uptake in people taking out health insurance. Ordinarily, people who fell outside of a prescribed economic bracket would not have benefitted from private hospital stays or top-quality medical services. The reason being is that health insurance has the advantage of being more affordable than medical aid. It is also more flexible when it comes to selection. This means that members are only covered for (and pay) for their selected benefits.

Dependent on the plan you choose, you could:

  • Have additional healthcare savings
  • Include your spouse and children on your plan
  • Use a network of approved doctors or specialists
  • Have MediPost deliver chronic medication to your door
  • Receive comprehensive maternity cover if and when required

The benefits - so what does it cover exactly?

Health insurance is best for day-to-day medical expenses and provides limited hospital cover and medical event benefits (dependent on your particular plan), which is serviced through a network of approved providers. The following sectors are covered in our plans:

1) Day-to-day Cover

The exact particulars of each benefit will differ slightly according to your particular plan and its limitations.

  • GP visits and in-room procedures at a Momentum CareCross Network
  • Specialist benefits of up to R2000 per member
  • Acute medication in accordance with the Momentum CareCross Network
  • Basic pathology and radiology
  • Acute and over-the-counter medication
  • Basic dentistry and optometry (with emergency dentistry available for Gold Plan members)
  • Maternity benefits offering antenatal GP visits, scans, support and prenatal care
  • Health assessments and flu vaccinations for each member on the plan per year
  • EAP telephonic services offering professional counselling for adults, teenagers and children
  • Road accident and workman’s compensation claims assistance

2) Hello Doctor

Receive expert advice from qualified doctors without having to attend a physical, face-to-face consultation. We know that you’re busy, so if you need medical advice from a doctor and don’t want the hassle of taking time off , Hello Doctor is available to provide you with free access to qualified doctors, right from your cell phone, anytime, anywhere. This includes unlimited telephonic consultations and access to mobile/online medical information. 

Antiretroviral medication is provided in accordance with the Momentum CareCross Network prescribed HIV medication formulary. Pre-authorisations and waiting periods apply. 

4) More4Me

Earn up to 1GB of data and R80 airtime per month with the More4Me benefit. This deal incentivises our health insurance members with monthly airtime based on their Healthy Heart Score. The More4Me benefit is only available to members who also join Multiply within 12 months of signing-up.

5) Major Medical Events

Health insurance provides less in-hospital cover than a medical aid plan. If a health insurance member is scheduled for a surgical procedure, they need to provide the hospital with a guarantee of payment letter, before being permitted admission.

However, your health insurance in-hospital and medical events’ benefits will include:

  • Accident and emergency cover – including the transportation, stabilisation and treatment cost paid in case of an accident that requires emergency medical treatment.
  • Hospital cash benefit and maternity lump sum benefit of R500-R1000 paid per member per day (provided the hospital stay is no longer than 48 hours), and a maximum payout of R20,000 payable per member each year. Waiting periods do apply.
  • Funeral benefit of up to R20,000 (plan dependent), which includes repatriation costs and extends to the principal member, their spouse and children provided they are included on the plan. Waiting periods do apply.

Who is eligible and how much is it all going to cost?

Bloom Financial Services has partnered with Momentum’s Health4Me, which provides affordable healthcare cover.

The entry-level health insurance option starts at just R447 per month. So, If you’re 18 years or older and earn a minimum of R8000 per month (and less than R30,000), you qualify for one of our three health insurance options.

Choosing a plan that works for you

Health insurance has proven to be the more cost-effective option compared to a medical aid scheme and many cash-strapped South Africans are opting-in for affordable, comprehensive health insurance.

Bloom has a wide range of options from which to choose and we are committed to helping you find the right healthcare plan.

Contact our expert brokers for a free health insurance quote or for more information.

Medical Content Disclaimer

You understand and acknowledge that all users of the Bloom Financial Services 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.