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Momentum Health 2018 Extender Option - Associated Hospital & Any Chronic

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Type of Medical Aid Plan: 
Threshold
Medical Aid Year: 
2018
Day to day Benefits: 

General rule applicable to Day-to-day Benefits. 25% of your contribution is available to cover day-to-day expenses. This is known as Savings. If this component is not enough to cover your annual day-to-day expenses, you will have a self-funding gap to pay out of your own pocket, up to the Threshold determined by your family size. Once you have reached this Threshold, your claims will be paid by the Scheme from Extended Cover. Claims add up to the Threshold and are paid from Extended Cover at the Momentum Health Rate subject to the sub-limits specified below. The sub-limits apply before and after the Threshold is reached. You can choose to make use of the HealthSaver for additional day-to-day expenses and to pay for out-of-pocket expenses before your Extended Cover is activated. HealthSaver is a complementary product offered by Momentum that lets you save for medical expenses. The Health Platform Benefit provides cover for a range of benefits, such as preventative screening tests, certain check-ups and more.

Co-payments: 
Co-payments may apply for specialist referral procedures.
In Hospital Benefits
Hospital Rate of Payment: 
Hospital accounts are covered in full at the rate agreed upon with the hospital group. No overall annual limit applies.
Hospitals: 

The Extender Option provides cover for hospitalisation at private hospitals. There is no overall annual limit for hospitalisation. You can choose to have access to any hospital, or you can choose to receive a discount on your contribution by selecting to use a specific list of private hospitals

Casualty / Emergency Visits: 
Subject to Day-to-day Benefit.
Specialists: 
Associated specialists covered in full. Other specialists covered up to 200% of Momentum Health Rate.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited within the provisions of the General Rule mentioned above.
Radiology and pathology: 
No annual limit applies, subject to R2 150 co-payment per scan and pre-authorisation.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
In-hospital: Paid by Scheme R1300 co-payment per authorisation applies. Out-of-hospital: Paid by Scheme R0 co-payment. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.
MRI and CT scans: 
No annual limit applies, subject to R2 150 co-payment per scan and pre-authorisation.
ICU and High Care: 
No annual limit applies.
Dialysis: 
Renal dialysis. No annual limit applies. Beneficiaries who have selected State as their chronic provider need to make use of State facilities for renal dialysis.
Organ Transplants: 
Organ transplants (recipient), No annual limit applies. Organ transplants (donor), Only covered when recipient is a member of the Scheme. R18 600 cadaver costs. R37 700 live donor costs (incl. transportation).
Oncology / Cancer: 
R500 000 per beneficiary per year, thereafter a 20% co-payment applies. The Momentum Health medicine rate applies to chemotherapy and adjuvent medication.
Neck and Back Operations: 
Can only be performed in-hospital. Paid by Scheme, R1 300 co-payment per authorisation applies. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.
Joint Replacements: 
Can only be performed in-hospital. Paid by Scheme, R1 300 co-payment per authorisation applies. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.
Prosthesis: 

Prosthesis – internal (incl. knee and hip replacements, permanent pacemakers etc.) Cochlear implants: R166 000 per beneficiary, maximum 1 event per year. Intraocular lenses: R6 500 per beneficiary per event, maximum 2 events per year. Other internal prostheses: R62 800 per beneficiary per event, maximum 2 events per year. Prosthesis - external (such as artificial arms or legs etc.) R21 800 per family.

Medical and Surgical Appliances: 
Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) R6 300 per family.
Maternity Confinements: 
No annual limit applies
In Hospital Dentistry: 
Ltd to maxillo-facial surgery(excl implants), impacted wisdom teeth & general anaesthesia for children <7. Hospital accounts paid from Major Medical Benefit R1650 co-payment. Dental, dental specialist & maxillo-facial surgeon accounts paid from Savings.
Take home Medicine: 
7 days’ supply.
Rehabilitation, Hospice and Step-down facilities: 
R47 900 per family.
Treatment for Mental Health: 
Mental health incl. psychiatry and psychology - drug and alcohol rehabilitation. R34 400 per beneficiary, 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment at preferred provider.
HIV / AIDS: 
Immune deficiency related to HIV. Anti-retroviral treatment. HIV related admissions. At your chosen network provider. No annual limit applies. R65 900 per family.
Ambulance Service: 
Netcare 911
International Travel Benefit: 
International emergency cover & evacuation by ISOS. R8.22 million. Includes R1500 for emergency optometry, R15500 for emergency dentistry and R765000 terrorism cover. A R1550 co-payment applies per out-patient claim. Per beneficiary per 90-day journey.
Day-to-day benefits
GP consultations: 

Depending on the chronic provider selected Any or State provider: Unlimited within the provisions of the General Rule mentioned above Associated providers: 100% of Momentum Health Rate for Associated GPs. 70% of Momentum Health Rate for non-Associated GPs.

Specialist consultations: 

Unlimited within the provisions of the General Rule mentioned above.

Over-the-counter (OTC) Medicine: 

Over-the-counter medication (including prescribed vitamins and homeopathic medicine), Subject to Savings (does not accumulate to Threshold).

Optometry benefits: 
Optical and optometry (Incl. contact lenses and refractive eye surgery), Overall limit of R3 750 per beneficiary, Frame sub-limit of R2 050.
Basic dentistry: 
Dentistry – basic (such as extractions or fillings), Unlimited within the provisions of the General Rule mentioned above.
Specialised Dentistry: 
Dentistry – specialised (such as bridges or crowns), R12 200 per beneficiary, R31 900 per family. Both in-and out-of-hospital dental specialist accounts accumulate towards the limit.
MRI and CT Scans (Out of Hospital): 
Covered from Major Medical Benefit, subject to R2 150 co-payment per scan and pre-authorisation.
Radiology and Pathology: 
Unlimited within the provisions of the General Rule mentioned above.
Pregnancy benefits: 
12 Antenatal visits (Midwives, GP* or gynaecologist), Urine tests (dipstick) included, 2 pregnancy scans, 2 Paediatrician visits, 18-Month Subscription to online antenatal & postnatal classes & online video consultations with lactation specialist.
Physiotherapy and Occupational Therapy day to day: 
Unlimited within the provisions of the General Rule mentioned above.
Chronic Conditions
Provider: 
Any, Associated or State.
Chronic Conditions: 

Cover for 62 conditions: 26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits - no annual limit applies. —— Addison’s disease —— Asthma —— Bipolar mood disorder —— Bronchiectasis —— Cardiac dysrhythmias —— Cardiac failure —— Cardiomyopathy —— Chronic obstructive pulmonary disease —— Chronic renal disease —— Coronary artery disease —— Crohn’s disease (excl. biologicals such as Revellex*) —— Diabetes insipidus —— Diabetes mellitus Type 1 —— Diabetes mellitus Type 2 —— Epilepsy —— Glaucoma —— Haemophilia —— Hyperlipidaemia —— Hypertension —— Hypothyroidism —— Multiple sclerosis (excl. biologicals such as Avonex*, subject to protocols) —— Parkinson’s disease —— Rheumatoid arthritis (excl. biologicals such as Revellex and Enbrel*) —— Schizophrenia —— Systemic lupus erythematosus —— Ulcerative colitis On the Extender Option, an additional 36 conditions are covered, subject to a limit of R9 300 per family per year. —— Acne —— ADHD (Attention Deficit Hyperactivity Disorder) —— Allergic rhinitis —— Ankylosing spondylitis —— Aplastic anaemia —— Benign prostatic hypertrophy —— Cushing’s disease —— Cystic fibrosis —— Dermatomyositis —— Eczema —— Gout —— Hypoparathyroidism —— Immunosupression therapy for transplants —— Major depression —— Menopause —— Motor neuron disease —— Muscular dystrophy and other inherited myopathies —— Myasthenia gravis —— Narcolepsy —— Obsessive compulsive disorder —— Oncology - ancillary treatment —— Osteopenia —— Osteoporosis —— Other seizure disorders —— Paraplegia/Quadriplegia —— Pemphigus —— Pituitary microadenomas —— Post-traumatic stress syndrome —— Psoriasis —— Scleroderma —— Stroke —— Systemic sclerosis —— Thromboangiitis obliterans —— Thrombocytopenic purpura —— Unipolar disorder —— Valvular heart disease

Additional Chronic Conditions: 
36 additional conditions - limited to R9300 per family per year.
Preventative Care Benefits
Preventative Benefits: 

Health Platform Benefit Baby immunisations. Children up to age 6. Flu vaccines once a year. Children between 6 months and 5 years. High-risk beneficiaries under 18 Beneficiaries 65 and older High-risk beneficiaries Tetanus diphtheria injection. Pneumococcal vaccine, High-risk beneficiaries & Beneficiaries 60 and older (once a year)

Total Contributions
Total Contribution Main Member: 
5113.00
Total Contribution Adult: 
4081.00
Total Contribution Child*: 
1535.00
Extender Option - Associated Hospital & Any Chronic
Annual Medical Savings Account
Annual Medical Savings Main Member: 
15336.00
Annual Medical Savings Adult: 
12240.00
Annual Medical Savings Child*: 
4608.00
Monthly Medical Savings
Savings Child*: 
384.00
Savings Adult: 
1020.00
Savings Main Member: 
1278.00
Annual Threshold Amounts
Annual Threshold Main Member: 
18700.00
Annual Threshold Adult: 
16200.00
Annual Threshold Child*: 
5600.00
Risk Contributions
Risk Contribution Main Member: 
3835.00
Risk Contribution Adult: 
3061.00
Risk Contribution Child: 
1151.00