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Momentum Health 2019 Incentive Option - Associated Hospital & State Chronic

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

General rule applicable to Day-to-day Benefits. 10% of your contribution is available to cover day-to-day expenses. This is known as Savings. 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
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.
Hospitals: 

Associated hospital

Upfront Payments to hospitals: 

Certain specialist referral procedures: In hospital: R3000 Out of hospital: nil.

However; an additional R750 co-pay will apply if you did not obtain an appropriate GP referral.

R1 700 for Maxillo-facial surgery.

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 R3000 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 250 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. R20 500 cadaver costs. R41 500 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: 
R3000 co-payment per authorisation applies. An additional R750 co-payment will apply if you do not obtain an appropriate GP referral.
Joint Replacements: 
R3 000 co-payment 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: R160 000 per beneficiary, maximum of 1 event per annum. Intraocular lenses: R6 700 per beneficiary per event, maximum of 2 events per year. Other internal prosthesis: R48 700 per beneficiary per event, maximum of 2 events per year.

External: (such as artificial arms or legs) R22 500 per family.

Medical and Surgical Appliances: 
In-hospital (support stockings, knee and back braces etc.) R6 250 per family.
Maternity Confinements: 
No annual limit applies
In Hospital Dentistry: 
Maxillo-facial surgery only (no implants), impacted wisdom teeth & general anesthesia for children <7. Hospital & anesthetist acc's paid from Risk, with a co-pay of R1 700. Dental, dental specialist & maxillo-facial surgeon paid from available Savings.
Take home Medicine: 
7 days’ supply.
Rehabilitation, Hospice and Step-down facilities: 
R51 000 per family.
Treatment for Mental Health: 
Mental health incl. psychiatry & psychology - drug & alcohol rehabilitation. R36 100 per beneficiary. 21-day sub-limit applies to drug & 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 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: 

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: 
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
Orthodontics: 

Subject to available savings

MRI and CT Scans (Out of Hospital): 
Covered from Major Medical Benefit, subject to R2 250 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
Chronic Conditions: 

No benefit

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

Per annum: Health Assessment; blood pressure, cholesterol & blood sugar tests, height, weight & waist circumference. 1 dental consultation, pap smear. Per 2 years; mammogram, glaucoma test. Other tests; bone density test, general physical examination, prostate specific antigen,Hiv test, baby immunisations, up to 6 years. tetanus injections at specific intervals. Qualifying criteria for flu vaccines and pneumococal vaccines. Healthline for 24-hour energency health advice. Disease management programs for diabetes, hypertension, HIV/AIDS, oncology, drug & alcohol rehabilitation, chronic renal failure,organ transplants & cholesterol.

Total Contributions
Total Contribution Main Member: 
2006.00
Total Contribution Adult: 
1583.00
Total Contribution Child*: 
769.00
Incentive Option - Associated Hospital & State Chronic
Annual Medical Savings Account
Annual Medical Savings Main Member: 
2412.00
Annual Medical Savings Adult: 
1896.00
Annual Medical Savings Child*: 
924.00
Monthly Medical Savings
Savings Child*: 
77.00
Savings Adult: 
158.00
Savings Main Member: 
201.00
Risk Contributions
Risk Contribution Main Member: 
1805.00
Risk Contribution Adult: 
1425.00
Risk Contribution Child: 
692.00