Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 200% Momentum Health Rate(MHR)
Upfront Payments to hospitals:
An upfront payment of R3 290 may apply to admissions where specialised procedures are required. If you use a hospital outside of the Associated Hospital Network, Momentum pays 70% of MHR and you are responsible for the other 30%
Casualty / Emergency Visits:
Subject to available Savings
Specialists:
Full cover for Associated specialists. Other specialists at 200% of MHR
Other healthcare professionals eg. Physio, Occupational, Dietician:
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
Subject to pre-authorisation. Specialised procedure co-payment of R3 290 applies if performed in-hospital. No co-payment if performed out-of-hospital. Anaesthetists are covered up to R1 000
MRI and CT scans:
Unlimited at 100% of MHR. Subject to pre-authorisation and co-payment of R2 480 per scan
Organ Transplants:
Recipient: Unlimited at 100% of MHR. Donor is covered only if a member of Momentum Health: R21 500 for cadaver or R43 600 for live donor
Oncology / Cancer:
R400 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 R3 290 applies. Subject to prosthesis limit
Joint Replacements:
100% of MHR. Specialised procedure co-payment of R3 290 applies. Subject to prosthesis limit
Medical and Surgical Appliances:
In-hospital: R6 820 per family
In Hospital Dentistry:
Maxillofacial surgery only; impacted wisdom teeth & general anaesthesia for children < 7. Covers hospital and anaesthetist accounts only, with a co-payment of R1 500. Dental specialist and maxillofacial surgeon paid from available Savings
Rehabilitation, Hospice and Step-down facilities:
Treatment for Mental Health:
Subject to treatment at a preferred provider; R39 500 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 R75 600 per family
Ambulance Service:
Netcare 911 in an emergency
International Travel Benefit:
R8m 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
