Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 100% Momentum Health Rate(MHR)
Upfront Payments to hospitals:
R1 640 standard upfront payment applies per admission, except for motor vehicle accidents, maternity confinements and emergency treatment. An additional upfront payment of R3 290 may apply to admissions where specialised procedures are required
Casualty / Emergency Visits:
Subject to HealthSaver, if available
Specialists:
Full cover for Associated specialists. Other specialists at 100% of MHR
Other healthcare professionals eg. Physio, Occupational, Dietician:
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
Subject to pre-authorisation. Specialised procedure co-payment of R4 930 applies if performed in-hospital. Standard co-payment of R1 640 if performed out-of-hospital. Anaesthetists are covered up to R500
MRI and CT scans:
Unlimited at 100% of MHR. Subject to pre-authorisation and co-payment of R2 740 per scan
Organ Transplants:
Recipient: Unlimited at 100% of MHR. Donor is covered only if a member of Momentum Health: R20 300 for cadaver or R41 200 for live donor
Oncology / Cancer:
R300 000 per beneficiary per annum, thereafter a 20% co-payment applies. As you chose Associated as your chronic provider, you need to obtain your oncology medication from Medipost
Neck and Back Operations:
100% of MHR. Specialised procedure co-payment of R4 930 applies. Subject to prosthesis limit
Joint Replacements:
100% of MHR. Specialised procedure co-payment of R4 930 applies. Subject to prosthesis limit
Medical and Surgical Appliances:
In-hospital: R6 560 per family
In Hospital Dentistry:
Maxillofacial surgery only; impacted wisdom teeth & general anaesthesia for children < 7. Covers hospital and anaesthetist accounts only, with a standard co-payment of R1 640. Dental specialist and maxillofacial surgeon paid from HealthSaver, if available
Rehabilitation, Hospice and Step-down facilities:
Treatment for Mental Health:
Subject to treatment at a preferred provider: R37 000 per beneficiary. Includes psychiatry and psychology. Drug and alcohol rehabilitation sub-limited to 21 days
HIV / AIDS:
At an Associated provider. Anti-retroviral treatment unlimited. HIV related admissions limited to R69 900 per family
Ambulance Service:
Netcare 911 in an emergency
International Travel Benefit:
R7.66m emergency cover, per beneficiary per 90-day journey. Includes R15 500 each for emergency optometry and dentistry and R765 000 terrorism cover. A co-payment of R1 780 applies per out-patient claim
