Hospital Rate of Payment:
Hospital accounts are paid in full at the rate agreed upon with the hospital group. No overall annual limit applies.
Upfront Payments to hospitals:
Casualty / Emergency Visits:
Subject to Day-to-day Benefit
Specialists:
Associated specialists covered in full. Other specialists covered up to 300% of Momentum Health Rate
Other healthcare professionals eg. Physio, Occupational, Dietician:
Covered up to 300% of Momentum Health Rate
Radiology and pathology:
Subject to overall annual day-to-day limit of R25 900 per beneficiary
Medical and Surgical Appliances:
In Hospital Dentistry:
Hospital and anaesthetist accounts paid from Major Medical Benefit. Dental, dental specialist and maxillofacial surgeon accounts paid from Day-to-day Benefit and accumulate towards overall day-to-day limit ofR25 900 per beneficiary
Rehabilitation, Hospice and Step-down facilities:
Treatment for Mental Health:
Includes psychiatry and psychology, drug and alcohol rehabilitation. R37 900 per beneficiary. 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment atpreferred provider.
HIV / AIDS:
Immune deficiency related to HIV - At any provider. Anti-retroviral treatment - No annual limit applies. HIV related admissions - R72 700 per family
International Travel Benefit:
R9.01 million emergency cover, per beneficiary per 90-dayjourney. Includes R15 500 each foremergency optometry andemergency dentistry andR765 000 terrorism cover. A co-payment of R1 710 applies perout-patient claim.
