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Incentive: Any Hospital - Any Chronic 2021

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Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2021
Day to day Benefits: 

Subject to available Savings, which are 10% of total contribution. Claims are paid at cost. You may add a HealthSaver to provide extra cover for your day-to-day healthcare needs

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited at 200% Momentum Health Rate(MHR)
Hospitals: 

Any

Upfront Payments to hospitals: 

An upfront payment of R3 290 may apply to admissions where specialised procedures are required

Casualty / Emergency Visits: 
Subject to available Savings
Specialists: 
Full cover for Associated specialists. Other specialists at 200% of MHR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of MHR
Radiology and pathology: 
100% of MHR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Subject to pre-authorisation. Specialised procedure co-payment of R3 290 applies if performed in-hospital. No co-payment if performed out-of-hospital. Anaesthetists are covered up to R1 000
MRI and CT scans: 
Unlimited at 100% of MHR. Subject to pre-authorisation and co-payment of R2 480 per scan
ICU and High Care: 
Unlimited at 200% of MHR
Dialysis: 
Unlimited at 100% of MHR
Organ Transplants: 
Recipient: Unlimited at 100% of MHR. Donor is covered only if a member of Momentum Health: R22 400 for cadaver or R45 300 for live donor
Oncology / Cancer: 
R400 000 per beneficiary per annum, thereafter a 20% co-payment applies
Neck and Back Operations: 
100% of MHR. Specialised procedure co-payment of R3 29 0applies. Subject to prosthesis limit
Joint Replacements: 
100% of MHR. Specialised procedure co-payment of R3 290 applies. Subject to prosthesis limit
Prosthesis: 

Internal: (including knee and hip replacements, permanent pacemakers etc.) R53 000 per beneficiary, per event, limited to 2 events per annum; Intraocular lenses: R6 970 per beneficiary, per event, limited to 2 events per annum; Cochlear implants: R174 700 per beneficiary, limited to 1 event per annum. External: R23 900 per family

Medical and Surgical Appliances: 
In-hospital: R6 820 per family. Out-of-hospital: Subject to available Savings
Maternity Confinements: 
Unlimited at 100% of MHR
In Hospital Dentistry: 
Maxillofacial surgery only; impacted wisdom teeth & general anaesthesia for children < 7. Covers hospital and anaesthetist accounts only, with a co-payment of R1 500. Dental specialist and maxillofacial surgeon paid from available Savings
Take home Medicine: 
7 days supply
Rehabilitation, Hospice and Step-down facilities: 
R55 000 per family
Treatment for Mental Health: 
Subject to treatment at a preferred provider: R39 500 per beneficiary. Includes psychiatry and psychology. Drug and alcohol rehabilitation sub-limited to 21 days
HIV / AIDS: 
Any provider. Anti-retroviral treatment unlimited. HIV related admissions limited to R75 600 per family
Ambulance Service: 
Netcare 911 in an emergency
International Travel Benefit: 
R8m emergency cover, per beneficiary per 90-day journey. Includes R15 500 each for emergency optometry and dentistry and R765 000 terrorism cover. A co-payment of R1 780 applies per out-patient claim
Day-to-day benefits
GP consultations: 

Subject to available Savings

Specialist consultations: 

Subject to available Savings

Acute medicine: 

Subject to available Savings

Over-the-counter (OTC) Medicine: 

Subject to available Savings

Optometry benefits: 
Subject to available Savings
Basic dentistry: 
Subject to available Savings
Specialised Dentistry: 
Subject to available Savings
Orthodontics: 

Subject to available Savings

MRI and CT Scans (Out of Hospital): 
100% of MHR. Subject to pre-authorisation and co-payment of R2 480 per scan
Radiology and Pathology: 
Subject to available Savings
Pregnancy benefits: 
Subject to registration on the Maternity Management programme between 8-20 weeks: 12 antenatal consults with midwife, GP or gynaecologist. 2x 2D scans, pathology and 3 home nurse visits after return from hospital. 2 paediatrician visits in baby's 1st year
Physiotherapy and Occupational Therapy day to day: 
Subject to available Savings
Chronic Conditions
Provider: 
Any GP. Clicks, Dischem or Medipost pharmacies
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the PMB Chronic Disease List, issued by the Council for Medical Schemes. Subject to registration on the Chronic Management Programme, Scheme approval and the Incentive specific formulary

Additional Chronic Conditions: 
6 additional conditions. Limited to R10 700 per family per annum
Preventative Care Benefits
Preventative Benefits: 

From Health Platform Benefit, payable up to a maximum Rand amount per benefit. Health assessment screening(without pre-notification). The following benefits require pre-notification: dental consult, and age and frequency specific tests for pap smear, mammogram, DEXA bone density scan, general physical exam, prostate specific antigen, glaucoma, HIV test, flu and pneumococcal vaccines, tetanus diphtheria injection and paediatric immunisations as required by the Department of Health

Total Contributions
Total Contribution Main Member: 
3899.00
Total Contribution Adult: 
3168.00
Total Contribution Child*: 
1520.00
Any Hospital - Any Chronic
Annual Medical Savings Account
Annual Medical Savings Main Member: 
46806.00
Annual Medical Savings Adult: 
3804.00
Annual Medical Savings Child*: 
1824.00
Monthly Medical Savings
Savings Child*: 
152.00
Savings Adult: 
317.00
Savings Main Member: 
390.00
Risk Contributions
Risk Contribution Main Member: 
3509.00
Risk Contribution Adult: 
28519.00
Risk Contribution Child: 
1368.00
Medical Aid Plan Name Term: 
Incentive Any Any