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Momentum Health Custom 2017

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Medical Aid Year: 
2017
Day to day Benefits: 

The Custom 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 (referred to as Associated hospitals, see page 24 for this list). For chronic treatment, you can choose to have access to any GP for your chronic scripts and any pharmacy for your chronic medication. Or you can choose to receive a further discount on your monthly contribution by selecting to use a list of Associated GPs for your chronic script and Medipost courier pharmacy for your chronic medication. Alternatively, you can choose to use State facilities for your chronic script and chronic medication to obtain the maximum contribution discount. The Health Platform Benefit provides cover for a range of range of benefits, such as preventative screening tests, certain check-ups and more. If you need cover for other day-to-day expenses like GP visits or prescribed medicine, you can choose to make use of the HealthSaver+. HealthSaver+ is a complementary product offered by Momentum that lets you save for medical expenses. There is a co-payment for Major Medical Benefits, except in the case of motor vehicle accidents, maternity confinements and emergency treatment.

In Hospital Benefits
Hospitals: 

Associated State: Associated specialists covered in full Other specialists covered up to 100% of Momentum Health Rate Hospital accounts are covered in full at the rate agreed upon with the hospital group No overall annual limit applies

Upfront Payments to hospitals: 

Any or Associated hospitals Co-payment 1200 per authorisation, except for motor vehicle accidents, maternity confinements and emergency treatment*. An additional co-payment may apply per authorisation for specialist referral procedures - see page 19

Specialists: 
Associated specialists covered in full
Radiology and pathology: 
100% of the Momentum health rate
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
100% of the Momentum health rate
MRI and CT scans: 
No annual limit applies, subject to 2030 co-payment per scan
Organ Transplants: 
No annual limit applies
Prosthesis: 

Intraocular lenses: 4770 per beneficiary per event, maximum 2 events per year Other internal prostheses: 42100 per beneficiary per event, maximum 2 events per year

Medical and Surgical Appliances: 
Subject to HealthSaver+ if available
Maternity Confinements: 
No annual limit applies
Take home Medicine: 
7 days’ supply
Treatment for Mental Health: 
32100 per beneficiary, 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment at preferred provider
International Travel Benefit: 
7.66million -This benefit includes 15500 for emergency optometry, 15500 for emergency dentistry and 765000 terrorism cover, on all options, except Ingwe. A 1470 co-payment applies per outpatient claim
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
MRI and CT Scans (Out of Hospital): 
Covered from Major Medical Benefit, subject to 2030 co-payment per scan
Chronic Conditions
Additional Chronic Conditions: 
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. biol
Preventative Care Benefits
Preventative Benefits: 

Baby immunisations (On Ingwe and Access, available at nearest State baby clinic) Children up to age 6 As required by the Department of Health Flu vaccines Beneficiaries under 18 Once a year Beneficiaries 60 and older High-risk beneficiaries Tetanus diphtheria injection All beneficiaries As needed Pneumococcal vaccine

Total Contributions
Total Contribution Main Member: 
1266.00
Total Contribution Adult: 
957.00
Total Contribution Child*: 
448.00
Associated State
Risk Contributions
Risk Contribution Main Member: 
1266.00
Risk Contribution Adult: 
957.00
Risk Contribution Child: 
448.00