Health4Me | Focus on the product rules | Momentum Knowledge Base

Cover options

Employee only; or
Employee, spouses (up to two dependants) and children (up to six dependants)

Terminology

Term	Definition
Employee	An employee in service of the employer - uninterrupted, active employment with the employer, for twenty hours or more per week
Spouse	An employee’s lawful partner in any of the following partnerships: A marriage in terms of the marriage act (marriage certificate); A civil partnership as described in the civil union act (marriage certificate); A customary marriage as described in the recognition of customary marriages act (marriage certificate); A union recognised as a marriage by any Asiatic religion of the member (marriage certificate); or A permanent life partnership - provided that Momentum receives satisfactory proof that a permanent life partnership exists, as well as proof that the partners in the relationship have been living together for at least the last six months (affidavit)
Child/Child student or mentally or physically disabled child	Member’s natural child (birth certificate) Member’s legally adopted child (proof of adoption/letter from social worker or court order stating that the child is in the legal care of the member) Financially dependent child that is not the member’s natural or legally adopted child (affidavit or proof of guardianship); or Child student or mentally or physically disabled child, aged 21 to 26 years (proof of studies from a tertiary institution, or a medical report)

Cover ages

Member	Entry age	Age rules
Employee	18	No termination age
Spouse	18	No termination age
Child	0	No termination age (adult dependant rate charged from age 21)
Child student or mentally or physically disabled child	21	No termination age (adult dependant rate charged from age 26)

Cover will cease

In the event that the member is absent from Southern Africa for a period of twelve consecutive months;
In the event that the member no longer satisfies the eligibility criteria for cover under the policy;
In the event of cessation of service with the employer;
In the event of cessation of the payment of premiums;
Upon the policy termination date; or
For all dependants (spouses and children) upon the death of an employee

Waiting periods

Compulsory membership: No waiting period applied
Voluntary membership: Three-month waiting period applied in respect of the following benefits:
- Specialist visits
- Chronic benefit
- HIV benefit
- Basic and emergency dentistry
- Basic optometry
- Hospital cash benefit (all hospitalisation reasons, excluding childbirth)
- Funeral benefit (natural causes of death)
Compulsory and voluntary membership: 12-month condition specific waiting period applied in respect of childbirth as reason for hospitalisation

Rules regarding membership changes

Membership change type	Membership change rules
Option changes	New members (employees) who are added to a group, either from policy inception date, or ad-hoc, will have a three-month window period from inception date of cover, in which they will be allowed to exercise a benefit option change (provided that more than one benefit option has been selected by the employer)

	Option changes not exercised within the window period stated above will only be allowed under the following circumstances: 1 January - annual changes to benefit options will be allowed effective 1 January of every year; or Annual salary increase - an option change will be allowed during a benefit year upon a member’s annual salary increase, provided that proof is supplied to Momentum (annual salary increase letter)
Addition of dependants	New members (employees) who are added to a group, either from policy inception date, or ad-hoc, will have a three-month window period from inception date of cover, in which they will be allowed to add dependants (provided that dependant cover has been selected by the employer)

	Addition of dependant changes not exercised within the window period stated above will only be allowed under the following circumstances: Effective 1 January of every year; A birth - a new child is born or officially adopted (within three months of the child’s birth date, or within three months of the child’s official adoption date); A marriage - a new spouse (within three months of the marriage date); or Annual salary increase - an addition of dependant will be allowed during a benefit year upon a member’s annual salary increase, provided that proof is supplied to Momentum (annual salary increase letter)
Termination of membership	If the membership of an employee or an employee’s dependant(s) is terminated during the course of a benefit year, the employee, or the employee’s dependant(s) in question, will only be allowed to be placed back on benefit effective 1 January of the upcoming year, should they wish to continue with cover (unless there was a break in service in terms of the membership of the employee)

Disclaimer: Momentum Health4Me is administered by Momentum Health, registration number 1969/016884/07, a Juristic Representative on the Momentum Healthcare Distribution Limited FSP license 27728 and the product is underwritten by Momentum Metropolitan Life Limited, registration number 1904/002186/06, an authorised insurer and financial services provider number 6406. The product terms and conditions apply.

Health4Me | Focus on the product rules