Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Upfront Payments to hospitals:
Co-payments may apply for specialised procedures.
Casualty / Emergency Visits:
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:
Subject to Savings, if available
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
Covered in and out of hospital
MRI and CT scans:
Covered in and out of hospital
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:
R400 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 anesthetist accounts paid from Major Medical Benefit, subject to R1 500 co-payment per authorisation. Dental, dental specialist and maxillo-facial surgeon accounts paid from Savings, if available
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 atpreferred 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 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.
