Staff Care Solutions

Quality, affordable healthcare solutions for the low-income market

Employer Guide 2018

 Why the need for low-income
healthcare solutions?
Access to healthcare is an integral component of an employee’s
health and wellbeing.
Private healthcare solutions, like medical schemes, remain
unaffordable for a large portion of the low-income workforce.
Momentum Staff Care Solutions allows employer groups to offer
cost-effective healthcare cover to their low-income staff.

What can we do for your employees?

Empower employees Empower employees to take care of their health, therefore improving their
lifestyle and ensuring a better life expectancy
Improve wellness Give employees access to private, quality healthcare on a daily basis to
dramatically improve the illness trends that cripple employer groups
Improve productivity Healthier employees are more productive
Reduce absenteeism Healthier employees take less time off from work
Encourage loyalty Employer groups that provide healthcare solutions to their employees,
foster loyalty among their employees
Reduce staff turnover Loyal employees stay with their employer longer, reducing staff turnover
How does it work? Who is eligible for this product offering?
In line with Momentum’s focus on innovation and flexibility, • Employees earning a monthly income of less than R16 000.
Momentum Staff Care Solutions follows a building block approach.
• Employees (employed full time) up to the age of 75 years old.
Employers can choose the combination of benefits most suitable to
their employees’ needs and available budget. • Employer groups with 5 or more employees.
Momentum Staff Care Solutions offers employer groups great value Momentum Health offers seven medical scheme options for employees
by applying our extensive experience and skill in the field, as well as earning above this threshold. Employees moving from a Momentum
our strong provider network partnerships, to facilitate cost-effective Staff Care Solutions option onto a Momentum Health option may be
provision of day-to-day benefits to your employees. subject to underwriting.

Momentum Staff Care Solutions Product Ranges

Health4Me Health Insurance offers cover to employer groups who wish to provide healthcare cover either for their employees or for their
employees and their dependants.
OCSACare Occupational Healthcare offers cover to employer groups who wish to provide healthcare cover for their employees only.

Health4Me Health Insurance OCSACare Occupational Healthcare

Day-to-day Benefits

Gold Gold

Silver Silver

Bronze Bronze

Major Medical Event Benefits

Standard

Base
 Health4Me and OCSACare Day-to-day Benefits

Benefit Bronze Silver Gold

GP visits Unlimited at a network GP* Unlimited at a network GP* Unlimited at a network GP*
No cover for out-of-network visits No cover for out-of-network visits No cover for out-of-network visits

GP in room procedures Minor medical procedures performed as part Minor medical procedures performed as part Minor medical procedures performed as part
of a network GP consult in rooms of a network GP consult in rooms of a network GP consult in rooms

Hello Doctor Access to telephonic consultations with Access to telephonic consultations with Access to telephonic consultations with
a registered GP and online/mobile health a registered GP and online/mobile health a registered GP and online/mobile health
information information information
Specialist visits Not covered Not covered 2 visits per member/family per year at any
specialist
Covered at the Momentum Rate**
R100 co-payment applicable
Maximum of R900 per visit and up to R1 500
per member/family per year
Subject to referral by a network GP and pre-
authorisation
Waiting periods may apply

Acute medication Unlimited when provided in accordance with Unlimited when provided in accordance with Unlimited when provided in accordance with
network prescribed formularies network prescribed formularies network prescribed formularies

Chronic medication Not covered Not covered 26 chronic conditions covered:

Addison’s disease, Asthma, Bipolar
mood disorder, Bronchiectasis,
Cardiac dysrhythmias, Cardiac failure,
Cardiomyopathy, Chronic obstructive
pulmonary disease, Chronic renal disease,
Coronary artery disease, Crohn’s 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
Unlimited when provided in accordance with
network prescribed formularies
Waiting periods may apply

Basic pathology Unlimited when linked to a GP visit and Unlimited when linked to a GP visit and Unlimited when linked to a GP visit and
referred by a network GP, according to referred by a network GP, according to referred by a network GP, according to
protocols protocols protocols
Basic radiology Unlimited cover for black and white x-rays, Unlimited cover for black and white x-rays, Unlimited cover for black and white x-rays,
when linked to a GP visit and referred by a when linked to a GP visit and referred by a when linked to a GP visit and referred by a
network GP, according to protocols network GP, according to protocols network GP, according to protocols
Basic and emergency Not covered Covered at any dentist on the dental network Covered at any dentist on the dental network
dentistry
Basic dentistry such as fillings, extractions, Basic dentistry such as fillings, extractions,
infection control, cleaning and polishing of infection control, cleaning and polishing of
teeth teeth
Provided in accordance with network protocols Provided in accordance with network protocols
Waiting periods may apply Waiting periods may apply
Basic optometry Not covered Covered at any optometrist on the optical Covered at any optometrist on the optical
network network
1 eye test and 1 pair of clear standard single 1 eye test and 1 pair of clear standard single
vision lenses or 1 pair of bifocal lenses, with a vision lenses or 1 pair of bifocal lenses, with a
standard frame standard frame
Benefit available every 2 years Benefit available every 2 years
Waiting periods may apply Waiting periods may apply
Maternity benefit 1 first trimester growth scan per pregnancy 1 first trimester growth scan per pregnancy 1 first trimester growth scan per pregnancy
Flu vaccination 1 flu vaccination per member per year at a 1 flu vaccination per member per year at a 1 flu vaccination per member per year at a
Dis-Chem, Clicks, MediRite or Pick n Pay Dis-Chem, Clicks, MediRite or Pick n Pay Dis-Chem, Clicks, MediRite or Pick n Pay
pharmacy clinic pharmacy clinic pharmacy clinic
Health assessment 1 health assessment (blood pressure test, 1 health assessment (blood pressure test, 1 health assessment (blood pressure test,
cholesterol and blood sugar finger prick tests cholesterol and blood sugar finger prick tests cholesterol and blood sugar finger prick tests
and body mass index screening) per member and body mass index screening) per member and body mass index screening) per member
per year at a Dis-Chem, Clicks, MediRite or per year at a Dis-Chem, Clicks, MediRite or per year at a Dis-Chem, Clicks, MediRite or
Pick n Pay pharmacy clinic Pick n Pay pharmacy clinic Pick n Pay pharmacy clinic
HIV benefit HIV ELISA screening blood test HIV ELISA screening blood test HIV ELISA screening blood test
Anti-retroviral medication and HIV treatment Anti-retroviral medication and HIV treatment Anti-retroviral medication and HIV treatment
from a State facility with a network GP referral from a State facility with a network GP referral from a State facility with a network GP referral

* Authorisation required after the 10th visit.

** Momentum Rate: Every year Momentum negotiates with specialists to determine the amount we will pay per treatment.
These amounts are called the Momentum Rate.
 Health4Me Major Medical Event Benefits

A major medical event benefit or combination of major medical event benefits can be taken in conjunction with Health4Me
day-to-day benefits.

Benefit Base Standard

Accident cover Emergency transportation, stabilisation and treatment Emergency transportation, stabilisation and treatment
cost paid in case of an accident that requires cost paid in case of an accident that requires
immediate medical treatment immediate medical treatment
Up to R150 000 per event covered at a private Up to R300 000 per event covered at a private
institution for accidents that fit the qualifying criteria institution for accidents that fit the qualifying criteria
Should the benefit limit be exceeded, and further Should the benefit limit be exceeded, and further
treatment be required, the member will be transported treatment be required, the member will be transported
to a state facility for further care to a state facility for further care
An accident shall mean a medical emergency that is An accident shall mean a medical emergency that is
an external, unexpected event that is not traceable, an external, unexpected event that is not traceable,
directly or indirectly, to a member’s state of mental or directly or indirectly, to a member’s state of mental or
physical health prior to the event physical health prior to the event
Medical emergencies that do not fit the qualifying Medical emergencies that do not fit the qualifying
criteria will warrant transportation, stabilisation and criteria will warrant transportation, stabilisation and
treatment at a state facility treatment at a state facility
Hospital cash benefit R500 per day in hospital, paid from day 1, provided R1 000 per day in hospital, paid from day 1, provided
that hospitalisation is longer than 48 hours that hospitalisation is longer than 48 hours
Maximum of 40 days per beneficiary per year Maximum of 20 days per beneficiary per year
Waiting periods may apply Waiting periods may apply
Funeral benefit Employee, spouse and children > 14: R10 000 Employee, spouse and children > 14: R15 000
Children 6 - 13 years: R5 000 Children 6 - 13 years: R7 500
Children 1 - 5 years: R2 500 Children 1 - 5 years: R3 750
Children < 1 year: R1 250 Children < 1 year: R1 875
Stillborn babies (past 28 weeks gestation): R750 Stillborn babies (past 28 weeks gestation): R1 125
Waiting periods may apply (natural causes of death) Waiting periods may apply (natural causes of death)

How does the on-boarding and servicing process work?

We require a fully completed company application form and membership template
(a list of employees you would like to provide cover for) to be completed and submitted
to us at [email protected] (Health4Me Health Insurance) or
[email protected] (OCSACare Occupational Healthcare).

We will activate your membership and arrange for a member education session to provide your
staff with training on how to access and use their benefits.

If you have signed up for Health4Me Health Insurance, employer web portal training will be
provided to show you how to manage your company profile online. You will be able to add and
remove members, do transfers between branches, draw member listings at any time during
the month, and close-off your billing whenever convenient for you. Once you have closed off
your billing, your invoice and pro-forma billing statement will be emailed to you immediately.
You can also lodge insurance claims from the employer web portal, look for providers on our
networks and access informational videos and printable information for your staff members.

Your staff members can also access product information via our website or call our call centre,
where our friendly agents are waiting to assist your staff with any questions or queries they
might have regarding their benefits.

Bi-annual reporting is also available to show you the value we offer your employees on
Momentum Staff Care Solutions.
Premiums

Health4Me Health Insurance

Benefit Member Type Bronze Silver Gold

Day-to-day Benefit Employee R211 R229 R251
Spouse R211 R229 R251
Child R106 R114 R126

Benefit Member Type Base Standard

Accident Cover Employee R52 R74
Spouse R52 R74
Child R31 R42

Hospital Cash Benefit Employee R61 R92

Spouse R61 R92
Child R30 R51

Funeral Benefit Employee R12.50 R14.50

Spouse R12.50 R14.50
Child R6 R7
Health4Me Health Insurance premiums are exempt from VAT.
Financial advisers selling Health4Me Health Insurance benefits are required to have a FAIS Category 1.3 Licence.

OCSACare Occupational Healthcare

Benefit Member Type Bronze Silver Gold

Day-to-day Benefit Employee (incl. VAT) R243.10 R263.20 R288.50

Premiums are negotiable for employer groups with more than 50 employees.
Onsite health assessments are available at an additional cost.

For more information and quotes, kindly email us on [email protected]

Version 2018_2

Momentum Staff Care Solutions is not a medical scheme product, and is not a substitute for medical scheme membership.
The information provided in this brochure does not constitute advice in terms of the Financial Advisory and Intermediary Services Act. Momentum is a division of MMI Group Limited.
MMI Group Limited is an authorised financial services provider (FSP 6406) and a wholly owned subsidiary of MMI Holdings Limited.
Reg. No. 1904/002186/06 Momentum, a division of MMI Group Limited, an authorised financial services and credit provider.

www.momentum.co.za