Are you prepared to use designated hospitals?:
Hospital Rate of Payment:
Unlimited at 100% Momentum Health Rate
Casualty / Emergency Visits:
Subject to HealthSaver, if available
Specialists:
Full cover for Associated specialists. Other specialists at 100% of MHR
Other healthcare professionals eg. Physio, Occupational, Dietician:
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy):
Subject to pre-authorisation. Co-pay of R1 570 per authorisation out-of-hospital. An additional co-payment of R3 150 applies if performed in-hospital. Anaesthetists are covered up to R480
MRI and CT scans:
Unlimited at 100% of MHR. Subject to pre-authorisation and co-pay of R2 620 per scan, in or out of hospital
Organ Transplants:
Recipient: Unlimited at 100% of MHR. Donor; only if a member of Momentum Health: R19 500 for cadaver or R39 600 for live donor
Oncology / Cancer:
R300 000 per beneficiary per annum, thereafter a 20% co-pay applies. As you chose Associated as your chronic provider, you need to obtain your oncology medication from Medipost
Neck and Back Operations:
Unlimited at 100% of MHR. Standard co-pay of R1 570 per authorisation and an additional co-pay of R3 150 applies. Subject to prosthesis limit
Joint Replacements:
Unlimited at 100% of MHR. Standard co-pay of R1 570 per authorisation and an additional co-pay of R3 150 applies. Subject to prosthesis limit
Medical and Surgical Appliances:
In-hospital; R6 310 per family
In Hospital Dentistry:
Limited to maxillo-facial surgery, impacted wisdom teeth & general anaesthesia for children < 7. Cover for hospital and anaesthetist accounts only. Dental, dental specialist and maxillo-facial surgeon paid from HealthSaver, if available
Rehabilitation, Hospice and Step-down facilities:
Treatment for Mental Health:
R35 600 per beneficiary and subject to treatment at a preferred provider. Includes psychiatry and psychology, drug and alcohol rehabilitation. 21-day sub-limit applies to drug and alcohol rehabilitation
HIV / AIDS:
At an Associated provider. Anti-retroviral treatment unlimited. HIV related admissions limited to R67 200 per family
Ambulance Service:
Netcare 911 in an emergency
International Travel Benefit:
R7.66m emergency cover, per beneficiary per 90-day journey. Includes R15 500 each for emergency optometry and dentistry and R765 000 terrorism cover. A co-pay of R1 710 applies per out-patient claim
