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Momentum Health 2019 Custom Option - Any Hospital & State Chronic

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Type of Medical Aid Plan: 
Hospital
Medical Aid Year: 
2019
Day to day Benefits: 

Subject to HealthSaver, if available.

Co-payments: 
R1 500 per authorisation, except for motor vehicle accidents, maternity confinements and emergency treatment. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.
In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Hospital accounts are covered in full at the rate agreed upon (100% of tariff) with the hospital group. No overall annual limit applies.
Hospitals: 

Any hospital

Upfront Payments to hospitals: 

R1 500 per authorisation, except for motor vehicle accidents, maternity confinements and emergency treatment. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.

Casualty / Emergency Visits: 
Casualty or after-hours 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: 
Unlimited.
Radiology and pathology: 
Unlimited.
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
In-hospital: Paid by Scheme. Co-payment of R4500 per authorisation applies. Out-of-hospital; co-payment of R1500 applies. An additional co-payment of R750 will apply if you do not obtain an appropriate GP referral.
MRI and CT scans: 
No annual limit applies, subject to R2 500 co-payment per scan and pre-authorisation. In or out of hospital.
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.
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: 
R300 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: 
Paid by scheme. Co-payment of R4 500 per authorisation applies. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.
Joint Replacements: 
Paid by scheme. Co-payment of R1 300 per authorisation applies. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.
Prosthesis: 

Internal (includes knee & hip replacements, pacemakers, etc) Cochlear implants: Intraocular lenses: R5 200 per beneficiary per event, maximum of 2 events per year. Other internal prosthesis: R44 400 per beneficiary per event, maximum of 2 events per year. External: (such as artificial arms or legs) R21 500 per family.

Medical and Surgical Appliances: 
In-hospital (such as support stockings, knee and back braces etc.) R6 130 per family.
Maternity Confinements: 
No annual limit applies
In Hospital Dentistry: 
Maxillofacial surgery only (no implants); impacted wisdom teeth & general anaesthesia for children <7. Hospital accounts are paid from Risk: co-payment of R1500. Dental, dental specialist & maxillofacial surgeon accounts paid from HealthSaver.
Take home Medicine: 
7 days’ supply.
Rehabilitation, Hospice and Step-down facilities: 
R48 700 per family.
Treatment for Mental Health: 
Mental health incl. psychiatry and psychology - drug and alcohol rehabilitation. R33 900 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. At your chosen network provider. Anti-retroviral treatment. No annual limit applies. HIV related admissions. R65 900 per family..
Ambulance Service: 
Emergency evacuation in South Africa by Netcare 911.
International Travel Benefit: 
International emergency cover & evacuation by ISOS. R7.66 million. Includes R15 500 for emergency optometry, R15 500 for emergency dentistry and R765000 terrorism cover. A R1630 co-payment applies per out-patient claim. Per beneficiary per 90-day journey.
Day-to-day benefits
GP consultations: 

Subject to Healthsaver, if available.

Specialist consultations: 

Subject to Healthsaver, if available.

Acute medicine: 

Subject to Healthsaver, if available.

Over-the-counter (OTC) Medicine: 

Subject to Healthsaver, if available.

Optometry benefits: 
Subject to Healthsaver, if available.
Basic dentistry: 
Subject to HealthSaver, if available.
Specialised Dentistry: 
Subject to HealthSaver, if available.
Orthodontics: 

Subject to Healthsaver, if available.

MRI and CT Scans (Out of Hospital): 
Covered from Major Medical Benefit, subject to R2 5000 co-payment per scan and pre-authorisation.
Radiology and Pathology: 
Subject to HealthSaver, if available.
Pregnancy benefits: 
12 Antenatal visits - Must be registered on programme (Midwives, GP* or gynecologist), Urine tests (dipstick) included, 2 pregnancy scans & 2 Pediatrician visits.
Physiotherapy and Occupational Therapy day to day: 
Subject to HealthSaver, if available.
Chronic Conditions
Provider: 
State.
Chronic Conditions: 

No benefit

Additional Chronic Conditions: 
No benefit
Preventative Care Benefits
Preventative Benefits: 

Health Platform: Health Assessment; Blood pressure test, Choleaterol, blood sugar, height, weight and waist circumference. Dental Consultation, Pap smear <15 years+, Mammogram >38 years+, Bone density scan >50 years +, Prostate Specific Antigen- men >40+ years, Flu and Pneumococcal vaccines as per protocols, Maternity program, Baby immunisations < 6 years, Tetanus Diphtheria injections, Disease Management Program and Healthline: 24 hour emergency health advice. 

Total Contributions
Total Contribution Main Member: 
1938.00
Total Contribution Adult: 
1462.00
Total Contribution Child*: 
710.00
Custom Option - Any Hospital & State Chronic
Risk Contributions
Risk Contribution Main Member: 
1938.00
Risk Contribution Adult: 
1462.00
Risk Contribution Child: 
710.00