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Momentum Health Ingwe R650 - R6100 Any 2017

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Medical Aid Year: 
2017
Income Level: 
R650 - R6 100
Day to day Benefits: 

The Ingwe Any hospital/ Ingwe Active Primary Care network option provides affordable access to entry-level cover.
You have cover for hospitalisation up to R1 190 000 for your family per year at State hospitals
For chronic treatment and day-to-day benefits, such as GP visits or prescribed
medicine, you need to consult Ingwe Active Primary Care Network providers
The Health Platform benefit provides cover for a range of preventative care benefits available
from your Ingwe Active Primary Care Network provider.
If you need more day-to-day cover, you can choose to make use of the HealthSaver+.
a complementary product offered by Momentum that lets you save for medical expenses.

In Hospital Benefits
Hospitals: 

Any
Hospital accounts are covered in full at the rate agreed upon with the hospital group
Limited to R1 190 000 per family per year
You need to phone for authorisation before making use of your Major Medical
Benefits. For some conditions like cancer you will need to register on a
Disease Management Programme. Momentum Health will pay benefits in
line with the Scheme Rules and the clinical protocols that the Scheme has
established for the treatment of each condition.
High and intensive care 10 days per admission
Neonatal intensive care R54 200 per confinement

Upfront Payments to hospitals: 

None

Specialists: 
Covered up to 100% of Momentum Health Rate
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Covered up to 100% of Momentum Health Rate
MRI and CT scans: 
Limited to Prescribed Minimum Benefits at State facilities
Dialysis: 
Limited to Prescribed Minimum Benefits at State facilities
Organ Transplants: 
Limited to Prescribed Minimum Benefits at State facilities
Prosthesis: 

Limited to Prescribed Minimum Benefits at State facilities

Medical and Surgical Appliances: 
Not covered
Maternity Confinements: 
Limit for hospital account only. Only emergency Caesareans are covered R25 800 per uncomplicated delivery R37 800 for complicated delivery.
In Hospital Dentistry: 
Maxillo-facial trauma covered at State facilities, limited to Prescribed Minimum Benefits
Take home Medicine: 
7 days’ supply
Rehabilitation, Hospice and Step-down facilities: 
R11 260 per beneficiary
Treatment for Mental Health: 
Limited to Prescribed Minimum Benefits at State facilities
International Travel Benefit: 
Not covered
Day-to-day benefits
GP consultations: 

There is no limit to the number of times you may visit your Active Primary Care
Network GP. However, please note all visits from the 11th visit onwards must be
pre-authorised.
Out-of-network GP, casualty or after-hours visits 1 visit per beneficiary per year, subject to authorisation
within 72 hours of the consultation, otherwise a 30% co-payment will apply.
Maximum of 2 visits per family per year, R100 co-payment per visit applies

Specialist consultations: 

2 visits per family per year. Covered at 100% of Momentum Health Rate with
a R100 co-payment per visit. Subject to referral by your Ingwe Active Primary Care
Network provider and pre-authorisation

Acute medicine: 

Dispensed by network GP

Over-the-counter (OTC) Medicine: 

Not Covered

Optometry benefits: 
Excludes contact lenses and refractive eye surgery 1 eye test and 1 pair of clear standard or bi-focal lenses with standard frame as per formulary per beneficiary every 2 years. Spectacles will only be granted if your refraction measu
Basic dentistry: 
Basic - Examinations, fillings and x-rays as per the list of tariff codes. One dental consultation is covered per year per beneficiary. You need to call us for preauthorisation if you have more than 4 fillings or 4 extractions. Specialized - Not covered
MRI and CT Scans (Out of Hospital): 
Limited to Prescribed Minimum Benefits at State facilities
Pregnancy benefits: 
4 ante-natal visits, 2 growth scans, 1 before week 24 and 1 after.
Chronic Conditions
Additional Chronic Conditions: 
26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits
Preventative Care Benefits
Preventative Benefits: 

Health platform: Health Assessment (pre-notification not required): Body Mass Index, Blood pressure test, Finger prick test for Cholesterol and Blood sugar test. Dental consultation (incl. sterile tray and gloves) Pap smear. Prostate specific antigen. HIV test Maternity benefit

Total Contributions
Total Contribution Main Member: 
911.00
Total Contribution Adult: 
911.00
Total Contribution Child*: 
342.00
Benefit: 
Limited to Prescribed Minimum Benefits at State facilities