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Ingwe Network hospital - Ingwe Primary Care Network: R7 451 - R9 850: 2021

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Type of Medical Aid Plan: 
Capitation
Medical Aid Year: 
2021
Income Level: 
R7 451 - R9 850
Day to day Benefits: 

Only available from the Ingwe Primary Care Network and subject to network protocols and the network's list of applicable tariff codes. You can choose to add a HealthSaver for more day-to-day cover

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
Hospital Rate of Payment: 
Unlimited at 100% Momentum Health Rate(MHR)
Hospitals: 

Ingwe Network hospital

Upfront Payments to hospitals: 

If you use a hospital outside of the Ingwe Hospital Network, Momentum pays 70% of MHR and you are responsible for the other 30%

Casualty / Emergency Visits: 
1 visit per beneficiary per annum, for out-of-network GP, casualty or after-hours visits. Subject to authorisation within 72 hours, otherwise a 30% co-payment will apply. A maximum of 2 visits per family per annum and a R100 co-payment per visit
Specialists: 
Covered up to 100% of MHR
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of MHR
Radiology and pathology: 
100% of MHR
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
No benefit
MRI and CT scans: 
Limited to Prescribed Minimum Benefits(PMBs) at State facilities
ICU and High Care: 
10 days per admission
Dialysis: 
Limited to PMBs at State facilities
Organ Transplants: 
Limited to PMBs at State facilities
Oncology / Cancer: 
Limited to PMBs at State facilities
Neck and Back Operations: 
Limited to PMBs at State facilities
Joint Replacements: 
Limited to PMBs at State facilities
Prosthesis: 

Limited to PMBs at State facilities

Medical and Surgical Appliances: 
In-hospital: R5 600 per family
Maternity Confinements: 
Unlimited at 100% of MHR. Only emergency caesareans are covered
In Hospital Dentistry: 
No benefit. Maxillofacial trauma limited to PMBs at State facilities
Take home Medicine: 
7 days supply
Rehabilitation, Hospice and Step-down facilities: 
R13 660 per beneficiary
Treatment for Mental Health: 
Limited to PMBs at State facilities. Includes psychiatry and psychology. Drug and alcohol rehabilitation sub-limited to 21 days
HIV / AIDS: 
Ingwe Network provider. Anti-retroviral treatment R33 200. HIV related admissions limited to R34 000 per family
Ambulance Service: 
Netcare 911 in an emergency
International Travel Benefit: 
No benefit
Day-to-day benefits
GP consultations: 

There is no limit to the number of times you visit your Primary Care Network GP. Pre-authorisation is required from the 11th visit onwards

Specialist consultations: 

2 visits per family per year, limited to R1 100 per visit and up to a maximum of R2 200 per family per annum. Covered at 100% of MHR. Subject to referral by your Ingwe Primary Care Network GP and pre-authorisation

Acute medicine: 

Subject to a list of medicine, referred to as a prescribed formulary

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
1 eye test and 1 pair of clear standard or bi-focal lenses with standard frame as per formulary per beneficiary per 2 year cycle. Spectacles will only be granted if your refraction measurement is more than 0.5
Basic dentistry: 
1 dental consultation per beneficiary per annum. Examinations, fillings and x-rays as per the list of tariff codes. Pre-authorisation required for more than 4 fillings or 4 extractions
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
Limited to PMBs at State facilities
Radiology and Pathology: 
Specific list of tests covered
Pregnancy benefits: 
Subject to registration on the Maternity Management programme between 8-20 weeks:4 antenatal consults with midwife, GP or gynaecologist. 2x growth scans and 1 home nurse visit after return from hospital
Physiotherapy and Occupational Therapy day to day: 
Limited to PMBs at State facilities
Chronic Conditions
Provider: 
Ingwe Primary Care Network
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the PMB Chronic Disease List, issued by the Council for Medical Schemes. Subject to registration on the Chronic Management Programme, Scheme approval and to the Ingwe Primary Care Network entry level formulary

Additional Chronic Conditions: 
None
Preventative Care Benefits
Preventative Benefits: 

From Health Platform Benefit, payable up to a maximum Rand amount per benefit. Health assessment screening(without pre-notification). The following benefits require pre-notification: dental consult, and age and frequency specific tests for pap smear, general physical exam, prostate specific antigen, HIV test, flu vaccines, tetanus diphtheria injection and paediatric immunisations as required by the Department of Health

Total Contributions
Total Contribution Main Member: 
1196.00
Total Contribution Adult: 
1196.00
Total Contribution Child*: 
447.00
Network hospital - Primary Care Network: R7 451 - R9 850
Medical Aid Plan Name Term: 
Ingwe Network