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.
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.
Medical and Surgical Appliances:
Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) R5 950 per family.
In Hospital Dentistry:
Not covered. Maxillo-facial trauma covered at State facilities, limited to Prescribed Minimum Benefits.
Rehabilitation, Hospice and Step-down facilities:
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.