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Momentum Health 2018 Ingwe Option R11 700+ Ingwe Network Hospital

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Medical Aid Year: 
2018
Income Level: 
R11 700+
Day to day Benefits: 

For chronic treatment and day-to-day benefits, such as GP visits or prescribed medicine, depending on your provider choice, you need to consult Ingwe Primary Care Network providers or Ingwe Active Primary Care Network providers.
If you choose Any hospital, please note that you may only use GPs on the Ingwe Active Primary Care Network for your chronic and day-to-day benefits.
The Health Platform benefit provides cover for a range of preventative care benefits available from your chosen network provider.
If you need more day-to-day cover, you can choose to make use of the HealthSaver+. HealthSaver is a complementary product offered by Momentum that lets you save for medical expenses.

In Hospital Benefits
Hospital Rate of Payment: 
Hospital accounts are covered in full at the rate agreed upon with the hospital group Limited to R1 260 000 per family per year.
Hospitals: 

You have cover for hospitalisation up to R1 260 000 for your family per year. For your hospitalisation cover, you can choose to use either Any hospital, the Ingwe Network of private hospitals, or State hospitals for an even lower monthly contribution.
You need to phone for authorisation before making use of your Major Medical Benefits. For some conditions like cancer you will need to register on a Disease Management Programme. Momentum Health will pay benefits in line with the Scheme Rules and the clinical protocols that the Scheme has established for the treatment of each condition.

Casualty / Emergency Visits: 
Out-of-network GP, casualty or after-hours. 1 visit per beneficiary per year, subject to authorisation within 72 hours of the consultation, otherwise a 30% co-payment will apply. Max 2 visits per family per year, R100 co-payment per visit applies.
Specialists: 
Specialists covered up to 100% of Momentum Health Rate.
MRI and CT scans: 
Limited to Prescribed Minimum Benefits at State facilities.
ICU and High Care: 
High and intensive care, 10 days per admission.
Dialysis: 
Renal dialysis limited to Prescribed Minimum Benefits at State facilities.
Organ Transplants: 
Limited to Prescribed Minimum Benefits at State facilities.
Oncology / Cancer: 
Oncology limited to Prescribed Minimum Benefits at State facilities.
Prosthesis: 

Prosthesis – internal (incl. knee and hip replacements, permanent pacemakers, etc.) Intraocular lenses: R4 800 per beneficiary per event, maximum 2 events per year.
Other internal prostheses: R33 200 per beneficiary per event, maximum 2 events per year.
Prosthesis – external (such as artificial arms or legs etc.) Limited to Prescribed Minimum Benefits at State facilities.

Medical and Surgical Appliances: 
Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) R5 950 per family.
Maternity Confinements: 
No annual limit applies
In Hospital Dentistry: 
Not covered. Maxillo-facial trauma covered at State facilities, limited to Prescribed Minimum Benefits.
Take home Medicine: 
7 days’ supply.
Rehabilitation, Hospice and Step-down facilities: 
R45 900 per family.
Treatment for Mental Health: 
Mental health incl. psychiatry and psychology - drug and alcohol rehabilitation. R17 050 per beneficiary, 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment at preferred provider.
HIV / AIDS: 
Immune deficiency related to HIV - At your chosen network provider. Anti-retroviral treatment - R31 900 per family. HIV related admissions - R34 400 per family.
Ambulance Service: 
Emergency evacuation in South Africa by Netcare 911
Day-to-day benefits
GP consultations: 

There is no limit to the number of times you may visit your Primary Care Network GP.
However, please note all visits from the 11th visit onwards must be pre-authorised.

Specialist consultations: 

2 visits per family per year. Covered at 100% of Momentum Health Rate with a R100 co-payment per visit.
Subject to referral by your Ingwe Primary Care Network or Ingwe Active Primary Care Network provider and pre-authorisation.

Over-the-counter (OTC) Medicine: 

Not covered.

Optometry benefits: 
Optical and optometry (excl. contact lenses and refractive eye surgery) 1 eye test and 1 pair of clear standard or bi-focal lenses with standard frame as per formulary per beneficiary every 2 years. Refraction measurement must be more than 0.5
Basic dentistry: 
Examinations, fillings and x-rays as per the list of tariff codes. One dental consultation is covered per year per beneficiary. You need to call us for pre-authorisation if you have more than 4 fillings or 4 extractions
Specialised Dentistry: 
Not covered
MRI and CT Scans (Out of Hospital): 
Limited to Prescribed Minimum Benefits at State facilities.
Radiology and Pathology: 
Radiology (basic such as X-rays) - Specific list of black and white x-rays covered. Pathology (basic such as blood sugar or cholesterol tests) Specific list of pathology tests covered.
Pregnancy benefits: 
4 Antenatal visits (Midwives, GP* or gynaecologist), Urine tests (dipstick) included and 2 growth scans.
Physiotherapy and Occupational Therapy day to day: 
Physiotherapy included in the specialist limit. Occupational and Speech therapy limited to Prescribed Minimum Benefits at State facilities.
Chronic Conditions
Provider: 
Ingwe Primary Care Network or Ingwe Active Primary Care Network
Chronic Conditions: 

26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits.

Preventative Care Benefits
Preventative Benefits: 

Health Platform Benefit
Baby immunisations. Children up to age 6.
Flu vaccines once a year.
Children between 6 months and 5 years.
High-risk beneficiaries under 18
Beneficiaries 65 and older
High-risk beneficiaries
Tetanus diphtheria injection.

Total Contributions
Total Contribution Main Member: 
1903.00
Total Contribution Adult: 
1903.00
Total Contribution Child*: 
561.00
Ingwe Option R11 700+ Ingwe Network Hospital
Risk Contributions
Risk Contribution Main Member: 
1903.00
Risk Contribution Adult: 
1903.00
Risk Contribution Child: 
561.00