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Incentive (Associated Hospital / State chronic) 2020

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Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2020
Day to day Benefits: 

Savings is 10% of total contribution

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
200% of Scheme Rate
Hospitals: 

Associated hospital. If you choose Associated hospitals and do not use this provider, you will have a co-payment of 30% on the hospital account and Momentum Health will be responsible for 70% of the negotiated tariff.

Upfront Payments to hospitals: 

Co-payments may apply for specialised procedures.

Casualty / Emergency Visits: 
Subject to Savings
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
ICU and High Care: 
No annual limit applies
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
Joint Replacements: 
Covered
Prosthesis: 

Prosthesis – internal (incl. knee and hip replacements, permanent pacemakers etc.) Cochlear implants: R168 000 per beneficiary, maximum 1 event per year
Intraocular lenses: R6 700 per beneficiary per event, maximum 2 events per year
Other internal prosthesis: R51 100 per beneficiary per event, max 2 events per year

Medical and Surgical Appliances: 
R6 560 per family
Maternity Confinements: 
No annual limit applies
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
Take home Medicine: 
7 days’ supply
Rehabilitation, Hospice and Step-down facilities: 
R53 000 per family
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
Ambulance Service: 
Netcare 911
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.
Day-to-day benefits
GP consultations: 

Subject to Savings, if available

Specialist consultations: 

Subject to Savings, if available

Acute medicine: 

Subject to Savings, if available

Over-the-counter (OTC) Medicine: 

Subject to Savings, if available

Optometry benefits: 
Subject to Savings, if available
Basic dentistry: 
Subject to Savings, if available
Orthodontics: 

Subject to Savings, if available

MRI and CT Scans (Out of Hospital): 
Covered from Major Medical Benefit, subject to R2 370 co-payment per scan and pre-authorisation
Radiology and Pathology: 
Subject to Savings, if available
Pregnancy benefits: 
If registered on Maternity management programme: 12 visits GP, gynaecologist or midwife. Certain blood tests. 2 pregancy 2D scans. Babies up to 12 months registered on programme 2 Paediatrician visits in first year.
Physiotherapy and Occupational Therapy day to day: 
Subject to Savings, if available
Chronic Conditions
Provider: 
State
Chronic Conditions: 

No cover

Additional Chronic Conditions: 
No cover
Preventative Care Benefits
Preventative Benefits: 

Health assesment for blood pressure, diabetes, cholesterol, BMI. Papsmeer, mammogramme, prostate, glaucoma and DEXA bone density scans available. Also baby immunisations as prescroibed by the Department of Health.

Total Contributions
Total Contribution Main Member: 
2141.00
Total Contribution Adult: 
1690.00
Total Contribution Child*: 
821.00
Incentive
Annual Medical Savings Account
Annual Medical Savings Main Member: 
2568.00
Annual Medical Savings Adult: 
2028.00
Annual Medical Savings Child*: 
984.00
Monthly Medical Savings
Savings Child*: 
82.00
Savings Adult: 
169.00
Savings Main Member: 
214.00
Risk Contributions
Risk Contribution Main Member: 
1927.00
Risk Contribution Adult: 
1521.00
Risk Contribution Child: 
739.00
Principal Member Savings: 
2568.00
Per Adult Dependent Savings: 
2028.00
Child dependant Savings: 
984.00