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:
R1 570 co-pay applies per authorisation, except for motor vehicle accidents, maternity confinements and emergency treatment. An additional co-pay may apply for specialised procedures.
Casualty / Emergency Visits:
Subject to HealthSaver, if available
Specialists:
Associated specialists covered in full. Other specialists covered up to 100% of Momentum Health Rate
Other healthcare professionals eg. Physio, Occupational, Dietician:
Covered up to 100% of Momentum Health Rate
Radiology and pathology:
Subject to HealthSaver, if available
Dialysis:
Limited to Prescribed Minimum Benefits at State facilities
Oncology / Cancer:
R200 000 per beneficiary per year, thereafter a 20% co-payment applies. Momentum Health Reference Pricing willapply to chemotherapy and adjuvant medication. You need to get your oncology treatment and medication from theEvolve Network of Oncologist...
Medical and Surgical Appliances:
In Hospital Dentistry:
Not covered. Maxillo-facial trauma covered at State facilities, limited to Prescribed Minimum Benefits
Rehabilitation, Hospice and Step-down facilities:
Treatment for Mental Health:
.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 any provider. Anti-retroviral treatment - No annual limit applies. HIV related admissions - R37 900 per family
International Travel Benefit:
R5 million emergency cover, per beneficiary per 90-dayjourney. Includes R15 500 each foremergency optometry andemergency dentistry andR765 000 terrorism cover. A co-payment of R1 710 applies perout-patient claim.
