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Momentum Health 2018 Incentive Option - Associated Hospital & Any Chronic

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Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2018
In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
Hospital accounts are covered in full at the rate agreed upon with the hospital group. No overall annual limit applies.
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: 
Unlimited
Radiology and pathology: 
Unlimited
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: 
No annual limit applies.
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: 
R400 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: 
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: 
R1 300 co-payment per authorisation applies. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.
Medical and Surgical Appliances: 
In-hospital (support stockings, knee and back braces etc.) R5 950 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: 
R46 6400 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: 
Emergency evacuation in South Africa by Netcare 911.
International Travel Benefit: 
International emergency cover & evacuation by ISOS. R8 million. Includes R1500 for emergency optometry, R15 500 for emergency dentistry and R765 000 terrorism cover. A R1 550 co-payment applies per out-patient claim. Per beneficiary per 90-day journey.
Day-to-day benefits
Optometry benefits: 
Optical and optometry (Incl. contact lenses and refractive eye surgery), Subject to Savings, if available.
Basic dentistry: 
Subject to available savings
Specialised Dentistry: 
Subject to available savings
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: 
Subject to available savings
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 consultation with lactation specialist.
Physiotherapy and Occupational Therapy day to day: 
Subject to available savings
Chronic Conditions
Provider: 
No benefit
Total Contributions
Total Contribution Main Member: 
1834.00
Total Contribution Adult: 
1439.00
Total Contribution Child*: 
711.00
Incentive Option - Associated Hospital & State Chronic
Annual Medical Savings Account
Annual Medical Savings Main Member: 
2196.00
Annual Medical Savings Adult: 
1728.00
Annual Medical Savings Child*: 
852.00
Monthly Medical Savings
Savings Child*: 
71.00
Savings Adult: 
144.00
Savings Main Member: 
183.00
Risk Contributions
Risk Contribution Main Member: 
1651.00
Risk Contribution Adult: 
1295.00
Risk Contribution Child: 
640.00