Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 100% Momentum Health Rate(MHR)
Upfront Payments to hospitals:
R1 570 standard upfront payment applies per admission, except for motor vehicle accidents, maternity confinements and emergency treatment. An additional upfront payment of R3 150 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 720 applies if performed in-hospital. Standard co-payment of R1 570 if performed out-of-hospital. Anaesthetists are covered up to R480
MRI and CT scans:
Unlimited at 100% of MHR. Subject to pre-authorisation and co-payment of R2 620 per scan
Dialysis:
Unlimited at 100% of MHR. As you chose State as your chronic provider, you need to use State facilities
Organ Transplants:
Recipient: Unlimited at 100% of MHR. Donor is covered only if a member of Momentum Health: R19 500 for cadaver or R39 600 for live donor
Oncology / Cancer:
R300 000 per beneficiary per annum, thereafter a 20% co-payment applies. As you chose State as your chronic provider, you need to obtain your oncology treatment from a Scheme authorised oncologist and oncology medication from Medipost
Neck and Back Operations:
100% of MHR. Specialised procedure co-payment of R4 720 applies. Subject to prosthesis limit
Joint Replacements:
100% of MHR. Specialised procedure co-payment of R4 720 applies. Subject to prosthesis limit
Medical and Surgical Appliances:
In-hospital: R6 310 per family
In Hospital Dentistry:
Maxillofacial surgery only; impacted wisdom teeth & general anaesthesia for children < 7. Covers hospital and anaesthetist accounts only, with standard co-payment of R1 570. 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: R35 600 per beneficiary. Includes psychiatry and psychology. Drug and alcohol rehabilitation sub-limited to 21 days
HIV / AIDS:
At a State provider. Anti-retroviral treatment unlimited. HIV related admissions limited to R67 200 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 710 applies per out-patient claim
