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Ingwe(<= R725)

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Medical Aid Year: 
2020
Day to day Benefits: 

Ingwe Primary Care Network
providers** or Ingwe Active
Primary Care Network providers** - Primary care (such as GP visits,
prescribed medicine, etc.)
Secondary care (Specialist visits)

In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Ingwe Network or Any hospital. If you choose Ingwe Network 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: 

Hospital accounts covered in full
at negotiated rate
No overall annual limit applies

Casualty / Emergency Visits: 
Combined with out-of-network GP and after-hours visit. 1 visit per beneficiary per year, subject to authorisation within 72 hours, otherwise a 30% co-payment will apply. A maximum of 2 visits per family per year. Co-payment of R100 per visit.
Specialists: 
Covered up to 100% of Momentum Health Rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Momentum Health will pay benefits in line with the Scheme Rules and the clinical protocols that the scheme has established for the treatment of each condition
Radiology and pathology: 
Pathology – basic (such as blood sugar or cholesterol tests) - Specific list of pathology tests covered. Radiology – basic (such as X-rays) - Specific list of black and white x-rays covered
ICU and High Care: 
10 days per admission
Dialysis: 
Limited to Prescribed Minimum Benefits at State facilities
Oncology / Cancer: 
Limited to Prescribed Minimum Benefits at State facilities
Joint Replacements: 
Limited to Prescribed Minimum Benefits at State facilities
Prosthesis: 

Limited to Prescribed Minimum Benefits at State facilities

Medical and Surgical Appliances: 
R5 400 per family
In Hospital Dentistry: 
Not covered. Maxillo-facial trauma covered at State facilities. Limited to Prescribed Minimum Benefits
Take home Medicine: 
7 days’ supply
Rehabilitation, Hospice and Step-down facilities: 
R13 300 per beneficiary
Treatment for Mental Health: 
Including: psychiatry and psychology, drug and alcohol abuse. Limited to Prescribed Minimum Benefits at State facilities. 21-day sub-limit applies to drug and alcohol rehabilitation
HIV / AIDS: 
Immune deficiency related to HIV - At your chosen network provider. Anti-retroviral treatment - R31 900 per family. HIV related admissions - R34 000 per family
International Travel Benefit: 
Not covered
Day-to-day benefits
GP consultations: 

There is no limit to the number of times you visit your Primary Care Network GP. All visits from
the 11th visit onwards must be pre-authorised

Specialist consultations: 

2 visits per family per year, limited to R1 050 per visit and up to a maximum of R2 100 per family per year. Covered
at 100% of Momentum Health Rate. Subject to referral by your Ingwe Primary Care Network or Ingwe Active
Primary Care Network provider...

Acute medicine: 

Subject to a list of medicine, referred to as a prescribed formulary

Over-the-counter (OTC) Medicine: 

Not covered

Optometry benefits: 
1 eye test and 1 pair of clear standard or bi-focal lenses with standard frame as per formulary per beneficiary every 2 years. Spectacles will only be granted if your refraction measurement is more than 0.5
Basic dentistry: 
Examinations, fillings and x-rays as per the list of tariff codes. One dental consultation is covered per beneficiary per year. You need to call for pre-authorisation if you have more than 4 fillings or 4 extractions
Orthodontics: 

Not covered

MRI and CT Scans (Out of Hospital): 
Limited to Prescribed Minimum Benefits at State facilities
Radiology and Pathology: 
Pathology – basic (such as blood sugar or cholesterol tests) - Specific list of pathology tests covered. Radiology – basic (such as X-rays) - Specific list of black and white x-rays covered
Chronic Conditions
Provider: 
Ingwe Primary Care Network or Ingwe Active Primary Care Network
Chronic Conditions: 

26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits

Total Contributions
Ingwe
Medical Aid Plan Name Term: 
Any