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Momentum Health Summit 2017

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Medical Aid Year: 
2017
Income Level: 
N/A
Day to day Benefits: 

The Summit Option provides cover for hospitalisation
at any hospital. There is no overall annual limit for
hospitalisation. Extensive day-to-day and chronic
benefits are available from any provider.
Should you wish, you can choose to use the
HealthSaver+ to increase your day-to-day cover even
further. 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: 
None
In Hospital Benefits
Hospitals: 

Any hospital.
Hospital accounts are covered in full at the rate agreed upon with the hospital group.
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 - No annual limit applies
Casualty or after-hours visits - Subject to Day-to-day Benefit.
Neonatal intensive care - No annual limit applies

Upfront Payments to hospitals: 

None

Specialists: 
Associated specialists covered in full
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Other specialists covered up to 300% of Momentum Health Rate
Radiology and pathology: 
No overall limit
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Covered at 100% of the MT.
MRI and CT scans: 
No annual limit applies, subject to R2 030 co-payment per scan in or out of hospital.
Dialysis: 
No annual limit applies
Organ Transplants: 
Recipient; No annual limit applies, Donor; Only covered when recipient is a member of the Scheme; R17 600 cadaver costs, R35 700 live donor costs (incl. transportation)
Prosthesis: 

Cochlear implants: R157 000 per beneficiary, maximum 1 event per year
Intraocular lenses: R6 160 per beneficiary per event, maximum 2 events per
year
Other internal prostheses:(incl. knee and hip replacements, permanent pacemakers etc.) R59 500 per beneficiary per event, maximum 2 events
per year

Medical and Surgical Appliances: 
Subject to overall annual day-to-day limit of R22 300 per beneficiary. R25 900 per family. R15 100 sub-limit for hearing aids.
Maternity Confinements: 
No annual limit applies
In Hospital Dentistry: 
Limited to impacted wisdom teeth and general anaesthesia for children under 7. Hospital and anaesthetist accounts paid from Major Medical Benefit. Dental specialist accounts paid from day-to-day benefit.
Take home Medicine: 
7 days’ supply
Rehabilitation, Hospice and Step-down facilities: 
Medical rehabilitation, private nursing, Hospice and step-down facilities: R45 400 per family
Treatment for Mental Health: 
Incl. psychiatry and psychology; R32 600 per beneficiaryr
Day-to-day benefits
GP consultations: 

Subject to overall annual day-to-day limit of R22 300 per beneficiary

Specialist consultations: 

Subject to overall annual day-to-day limit of R22 300 per beneficiary

Acute medicine: 

R17 400 per beneficiary, R28 500 per family. Subject to overall annual day-to-day limit of R22 300 per beneficiary

Over-the-counter (OTC) Medicine: 

Not covered

Optometry benefits: 
Incl. contact lenses and refractive eye surgery: Overall limit of R3 910 per beneficiary. Frame sub-limit of R2 020 Subject to overall annual day-to-day limit of R22 300 per beneficiary
Basic dentistry: 
Basic and Specialised- Subject to overall annual day-to-day limit of R22 300 per beneficiary, Specialised: subject to sub-limit of R13 500 per beneficiary or R32 100 per family.
MRI and CT Scans (Out of Hospital): 
No annual limit applies, subject to R2 030 co-payment per scan
Pregnancy benefits: 
No annual limit applies,
Chronic Conditions
Additional Chronic Conditions: 
Cover for 62 conditions: 26 conditions according to Chronic Disease List in Prescribed Minimum Benefits - no annual limit, 36 additional conditions - accumulate to overall day-to-day limit of R22 300 per beneficiary.
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. Mammogram Women 38 and older Once every 2 years. DEXA bone density scan Prostate specific antigen.HIV test (pathologist). Maternity programme

Total Contributions
Total Contribution Main Member: 
7637.00
Total Contribution Adult: 
6108.00
Total Contribution Child*: 
1754.00
Annual Medical Savings Account
Annual Medical Savings Main Member: 
22300.00
Annual Medical Savings Adult: 
22300.00
Annual Medical Savings Child*: 
22300.00
Annual Threshold Amounts
Annual Threshold Main Member: 
0.00
Annual Threshold Adult: 
0.00
Annual Threshold Child*: 
0.00
Benefit: 
No annual limit applies