Hospital Rate of Payment:
Hospital accounts are paid in full at the rate agreed upon with the hospital group. No overall annual limit applies.
Upfront Payments to hospitals:
Co-payments may apply for specialised procedures.
Casualty / Emergency Visits:
Subject to Day-to-day Benefit
Specialists:
Associated specialists covered in full. Other specialists covered up to 200% of Momentum Health Rate
Other healthcare professionals eg. Physio, Occupational, Dietician:
Covered up to 200% of Momentum Health Rate
Radiology and pathology:
Unlimited within the provisions of the General Rule applicable to Day-to-Day Benefits
Dialysis:
No annual limit applies. If you choose State as your chronic provider, you need to make use of State facilities for renal dialysis
Oncology / Cancer:
R500 000 per beneficiary per year, thereafter a 20% co-payment applies. If you choose State as your chronic provider, you need to obtain your oncology treatment from an oncologist authorised by the scheme and your oncology medication from Medipost
Medical and Surgical Appliances:
In Hospital Dentistry:
Hospital and anaesthetist accounts paid from Major Medical Benefit, subject to R1 500 co-payment per
authorisation. Dental, dental specialist and maxillo-facial surgeon accounts paid from Day-to-day Benefit
and accumulate towards limit
Rehabilitation, Hospice and Step-down facilities:
Treatment for Mental Health:
Includes psychiatry and psychology, drug and alcohol rehabilitation. R37 900 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 provider. Anti-retroviral treatment - No annual limit applies. HIV related admissions - R72 700 per family
International Travel Benefit:
R8.22 million emergency cover, per beneficiary per 90-day
journey. Includes R15 500 each for
emergency optometry and
emergency dentistry and
R765 000 terrorism cover. A co-payment of R1 710 applies per
out-patient claim.
