Our benefits Benefit Option Overview 2019 - Del Financial Services

 
Our benefits Benefit Option Overview 2019 - Del Financial Services
Our benefits

Benefit Option Overview 2019
Our benefits Benefit Option Overview 2019 - Del Financial Services
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Postal address                       PO Box 2338 Durban 4000

This Benefit Option Overview provides a summary of the Momentum Health 2019 benefits. If you
need more information, please speak to your Financial Adviser, contact our call centre on
0860 11 78 59 or visit our website at momentumhealth.co.za.

Scheme Rules will always take precedence and are available by submitting a request on our website
at momentumhealth.co.za.

Momentum Health is registered in terms of the Medical Schemes Act No 131 of 1998.
Our benefits Benefit Option Overview 2019 - Del Financial Services
Index
 2     Make the right choice

Options:

 6     Ingwe Option

 7     Impact Option

8      Custom Option

 9     Incentive Option

10     Extender Option

11     Summit Option

 12        Health Platform Benefit

14         List of hospitals

16         Exclusions
Our benefits Benefit Option Overview 2019 - Del Financial Services
Make the right choice
    Momentum Health strives to offer you good         The Benefit Structure
    value for money by combining flexibility with
    comprehensive cover, because it is important
    to match your family’s healthcare needs.
    Use the following guide to find the option        Major Medical Benefit
    that best matches your needs. Healthcare
    expenses involve more than just the cost of       The Major Medical Benefit provides cover for
    your stay in hospital, it could be the cost of    hospitalisation and certain out-of-hospital procedures
    chronic medication (like pills to lower high      that can safely be performed in a doctor’s room,
    blood pressure), day-to-day expenses (like        registered day clinic or out-patient facility, provided
    visiting your GP), and/or emergency care.         treatment is clinically appropriate and has been pre-
    The option that you choose will determine         authorised.
    how much you will pay, and how much
    cover you will have for the different types of
    healthcare expenses. You need to choose the
    option that best fits both your wallet and your
    healthcare needs.
                                                      Chronic Benefit

                                                      The Chronic Benefit covers certain life-threatening
                                                      conditions that need ongoing treatment. The Chronic
                                                      Benefit includes cover for the 26 Chronic Disease List
                                                      (CDL) conditions, which form part of the Prescribed
                                                      Minimum Benefits (PMBs). Chronic benefits are
     Health Platform Benefit                          subject to registration and approval.

     Health Platform Benefits are paid by the
     Scheme up to a maximum Rand amount
     per benefit, provided you notify us before
     using the benefit. On the Ingwe and Impact
     Options, Health Platform Benefits are only       Day-to-day Benefit
     available from your chosen Primary Care
     Network provider.
                                                      This benefit provides for day-to-day medical expenses,
                                                      such as GP visits, prescribed medication, etc.
     The Health Platform encourages health            You have the choice of adding more day-to-day cover
     awareness, enhances quality of life and
                                                      through the HealthSaver+.
     gives peace of mind through preventative
     care, early detection, a leading maternity
     programme, management of certain
     diseases, health education and advice and
     emergency cover.

2
Our benefits Benefit Option Overview 2019 - Del Financial Services
Ingwe Option                                          Impact Option                                       Custom Option

  Specialists covered         Hospital choice          Specialists covered          Hospital              Associated             Hospital choice
  up to 100% of                                        up to 100% of                                      specialists covered
                              Any hospital,                                         Impact Network        in full                Any or Associated
  Momentum Health                                      Momentum Health
                              Ingwe Network                                         hospitals*            --------------------   hospitals*
  Rate                                                 Rate
                              hospitals* or                                                               Other specialists
  --------------------                                 --------------------                               covered up to 100%
                              State hospitals
  Hospital accounts                                    Hospital accounts                                  of Momentum
  covered in full at                                   covered in full at                                 Health Rate
  negotiated rate                                      negotiated rate                                    --------------------
  --------------------                                 --------------------                               Hospital accounts
                                                                                                          covered in full at
  No overall annual                                    No overall annual                                  negotiated rate
  limit applies                                        limit applies                                      --------------------
                                                                                                          No overall annual
                                                                                                          limit applies
                                                                                                          --------------------
                                                                                                          R1 500 co- payment
                                                                                                          applies

  26 conditions - no          Provider choice          26 conditions - no           Provider              26 conditions -        Provider choice
  annual limit applies                                 annual limit applies                               no annual limit
                              For medical                                           For medical           applies                For medical
                              management                                            management                                   management
  Chronic Benefit             including doctor,        Chronic Benefit              including doctor,                            including doctor,
                                                                                                          Chronic Benefit
  Formulary                   pharmacy, blood          Formulary                    pharmacy, blood                              pharmacy, blood
                                                                                                          Formulary
  Network entry-level         tests, x-rays, etc.      Network entry-level          tests, x-rays, etc.                          tests, x-rays, etc.
                              Ingwe Primary                                         Impact Primary        Any: Core              Any (Any GP and
  formulary                                            formulary                                          formulary
                              Care Network                                          Care Network                                 any pharmacy),
                              providers** or                                        providers**           Associated: Entry-     Associated**
                                                                                                          level formulary
                              Ingwe Active                                                                State: State           (Selected preferred
                              Primary Care                                                                formulary              GPs and Medipost
                              Network                                                                                            Courier pharmacy
                              providers**                                                                                        for chronic
                                                                                                                                 medication), or
                                                                                                                                 State facilities

  Primary care                Provider choice          Primary care                 Provider              You may add the        Provider
  (such as GP visits,                                  (such as GP visits,                                HealthSaver+ to
                              Ingwe Primary                                         Impact Primary                               Any
  prescribed medicine,                                 prescribed medicine,                               provide cover for
                              Care Network                                          Care Network
  etc.)                                                etc.)                                              your day-to-day
                              providers** or                                        providers**
  ------------------                                   ------------------                                 healthcare needs
                              Ingwe Active
  Secondary care                                       Secondary care
                              Primary Care
  (Specialist visits)                                  (Specialist visits)
                              Network
                              providers**

+ HealthSaver is a complementary product offered by Momentum
* View a list of these hospitals on page 14 ** View a list of these providers on momentumhealth.co.za

                                                                                                                                                       3
Our benefits Benefit Option Overview 2019 - Del Financial Services
Make the right choice                                                                                                     (continued)

    Incentive Option                                Extender Option                                Summit Option

    Associated              Hospital choice          Associated             Hospital choice        Associated                Hospital
    specialists covered                              specialists covered                           specialists covered
                            Any or Associated                               Any or Associated                                Any hospital
    in full                                          in full                                       in full
                            hospitals*                                      hospitals*
    --------------------                             --------------------                          --------------------
    Other specialists                                Other specialists                             Other specialists
    covered up to 200%                               covered up to 200%                            covered up to 300%
    of Momentum                                      of Momentum                                   of Momentum
    Health Rate                                      Health Rate                                   Health Rate
    --------------------                             --------------------                          --------------------
    Hospital accounts                                Hospital accounts                             Hospital accounts
    covered in full at                               covered in full at                            covered in full at
    negotiated rate                                  negotiated rate                               negotiated rate
    --------------------                             --------------------                          --------------------
    No overall annual                                No overall annual                             No overall annual limit
    limit applies                                    limit applies                                 applies

    26 conditions - no      Provider choice          26 conditions - no     Provider choice        26 conditions - no        Provider
    annual limit applies                             annual limit applies                          annual limit applies
    --------------------    For medical              --------------------   For medical                                      For medical
                                                                                                   --------------------
    Additional 6            management               Additional 36          management                                       management
                                                                                                   Additional
    conditions limited      including doctor,        conditions limited     including doctor,                                including doctor,
                                                                                                   36 conditions
    to R9 800               pharmacy, blood          to R9 800              pharmacy, blood                                  pharmacy, blood
                                                                                                   accumulate to the
    per family              tests, x-rays, etc.      per family             tests, x-rays, etc.                              tests, x-rays, etc.
                                                                                                   overall day-to-day
                            Any (Any GP and                                 Any (Any GP and                                  Freedom-of-choice
                                                                                                   limit of
                            any pharmacy),                                  any pharmacy),
    Chronic Benefit                                  Chronic Benefit                               R24 700 per
                            Associated**                                    Associated**
    Formulary                                        Formulary                                     beneficiary
                            (Selected preferred                             (Selected preferred
    Any: Standard           GPs and Medipost         Any: Extended          GPs and Medipost
    formulary               Courier pharmacy for     formulary              Courier pharmacy for   Chronic Benefit
    Associated: Entry-      chronic medication),     Associated: Entry-     chronic medication),   Formulary
    level formulary         or State facilities      level formulary        or State facilities    Comprehensive
    State: State                                     State: State                                  formulary
    formulary                                        formulary

    Savings 10% of          Provider                 Savings 25% of         Provider choice        Paid from risk            Provider
    total contribution                               total contribution                            benefit, subject to
                            Any, subject to                                 Any or Associated                                Freedom-of-choice
                                                     plus Extended                                 overall day-to-day
                            Savings if available                            (Members who
                                                     Cover                                         limit of
                                                                            have chosen
                                                                                                   R24 700 per
                                                                            Associated as their
                                                                                                   beneficiary.
                                                                            chronic provider
                                                                                                   --------------------
                                                                            must use an
                                                                                                   This is a combined
                                                                            Associated GP for
                                                                                                   limit incorporating
                                                                            GP consultations)
                                                                                                   both day-to-day
                                                                                                   cover and cover for
                                                                                                   the 36 additional
                                                                                                   chronic conditions.

       +    HealthSaver is a complementary product offered by Momentum
       *    View a list of these hospitals on page 14
       **   View a list of these providers on momentumhealth.co.za

4
Designed to complement
Complementary Momentum Products
You can choose to make use of additional products available from Momentum Group, a division of
MMI Group Limited (Momentum), to seamlessly enhance your medical aid.
These voluntary complementary products range from a world-class wellness and rewards
programme, Multiply, to the innovative HealthReturns solution.
These complementary products are not medical scheme benefits. Momentum is not a medical
scheme, and is a separate entity to Momentum Health. You can be a member of Momentum Health
without taking any of the complementary products that Momentum offers.

                                                     See separate Momentum Complementary
                                                                brochure for more information.

    HealthSaver
    Add more cover for
    medical expenses by
    choosing to contribute
    an additional amount
    that suits your needs
     and pocket

                                                                                                 5
Ingwe Option Overview
        Major Medical Benefit          Specialists covered up to 100% of Momentum Health Rate
                                       Hospital accounts covered in full at negotiated rate
                                       No overall annual limit applies
        Choice of hospital provider Any hospital, Ingwe Network hospitals or State hospitals
        Specialised Procedures /       Certain procedures/treatments covered - e.g. hernia repairs, laser tonsillectomy
        Treatments                     or grommets
        Chronic Benefit                26 conditions covered
        Day-to-day Benefit             Primary care benefits such as medicine, GP visits, basic dentistry, basic radiology
                                       and basic pathology
        Chronic and Day-to-day         Ingwe Primary Care Network or Ingwe Active Primary Care Network
        provider
        Health Platform                Covers benefits such as Health Assessments, dental examinations, routine GP
                                       check-ups, pap smears, etc.
                                       Maternity benefit: 4 antenatal visits and 2 growth scans

    Choose your               Choose your providers                                        Choose your family composition
    monthly income

                              Hospital            Chronic             Day-to-day

                               State                                                          R407         R814        R757   R1 164    R1 514   R1 864
                                                  Ingwe Primary        Ingwe Primary
                               Ingwe              Care Network         Care Network
Impact Option Overview
   Major Medical Benefit         Specialists covered up to 100% of the Momentum Health Rate
                                 Hospital accounts covered in full at the rate agreed upon with the hospital group
                                 No overall annual limit applies
   Hospital provider             Impact Network hospitals
   Specialised Procedures /      Certain procedures/treatments covered - e.g. hernia repairs, laser tonsillectomy
   Treatments                    or grommets
   Chronic Benefit               26 conditions covered
   Day-to-day Benefit            Primary care benefits such as medicine, GP visits, basic dentistry, basic radiology
                                 and basic pathology
   Chronic and Day-to-day        Impact Primary Care Network
   provider
   Health Platform               Covers benefits such as Health Assessments, dental examinations, routine GP
                                 check-ups, pap smears, etc.
                                 Maternity benefit: 4 antenatal visits and 2 growth scans

Your providers                                                       Choose your family composition

Hospital               Chronic                Day-to-day

Impact                 Impact Primary         Impact Primary
Network                Care Network           Care Network               R2 229        R4 458        R2 895            R5 124   R5 790   R6 456

All children are charged for

                                                                                                                                                  7
Custom Option Overview
          Major Medical Benefit        Associated specialists covered in full
                                       Other specialists covered up to 100% of the Momentum Health Rate
                                       Hospital accounts covered in full at the rate agreed upon with the hospital group
                                       No overall annual limit applies
                                       R1 500 co-payment applies, except for motor vehicle accidents, maternity
                                       confinements and emergency treatment
                                       An additional co-payment may apply to certain specialised procedures/
                                       treatments and specialised scans
          Choice of hospital provider Any or Associated hospitals
          Specialised Procedures /     Certain procedures/treatments covered - e.g. hernia repairs, laser tonsillectomy,
          Treatments                   angiograms and hysteroscopies
          Chronic Benefit              26 conditions covered
          Choice of Chronic Provider   Any, Associated or State
          Day-to-day Benefit           You can add HealthSaver+ to provide cover for your day-to-day healthcare
                                       expenses, such as GP visits, prescribed medicine, etc.
          Health Platform              Covers benefits such as Health Assessments, dental examinations, routine GP
                                       check-ups, pap smears
                                       Maternity benefit: 12 antenatal visits, 2 pregnancy scans and
                                       2 paediatrician visits in your child’s first year

    +      HealthSaver is a complementary product offered by Momentum

        Choose your providers                                        Choose your family composition

        Hospital                       Chronic

                                       Any                                R2 113        R3 780         R2 858          R4 525   R5 270   R6 015

        Associated
                                       Associated                        R1 944          R3 451         R2 631         R4 138   R4 825   R5 512

                                       State                              R1 515         R2 661        R2 052          R3 198   R3 735   R4 272

                                       Any                                R2 521        R4 545          R3 421        R5 445    R6 345   R7 245

        Any
                                       Associated                        R2 304         R4 104           R3 141        R4 941   R5 778   R6 615

                                       State                              R1 938        R3 400         R2 648          R4 110   R4 820   R5 530

    Maximum of 3 children charged for

8
Incentive Option Overview
   Major Medical Benefit         Associated specialists covered in full
                                 Other specialists covered up to 200% of the Momentum Health Rate
                                 Hospital accounts covered in full at the rate agreed upon with the hospital group
                                 No overall annual limit applies
                                 A co-payment may apply to certain specialised procedures/treatments and
                                 specialised scans
   Choice of hospital provider Any or Associated hospitals
   Specialised Procedures /      Certain procedures/treatments covered - e.g. hernia repairs, laser tonsillectomy,
   Treatments                    angiograms and hysteroscopies
   Chronic Benefit               26 conditions covered - no annual limit applies
                                 6 additional conditions covered, subject to limit of R9 800 per family per year
   Choice of Chronic Provider    Any, Associated or State
   Day-to-day Benefit            10% of your total contribution is available in a Savings account to cover your
                                 day-to-day expenses, such as GP visits, prescribed medicine, etc.
   Health Platform               Covers benefits such as Health Assessments, dental examinations, routine GP
                                 check-ups, pap smears
                                 Maternity benefit: 12 antenatal visits, 2 pregnancy scans and
                                 2 paediatrician visits in your child’s first year

Choose your providers                                         Choose your family composition

Hospital                        Chronic

                                Any                                 R3 012        R5 435          R4 138          R6 561   R7 687   R8 813

Associated
                                Associated                         R2 770         R4 973          R3 822          R6 025   R7 077   R8 129

                                State                              R2 006         R3 589          R2 775          R4 358   R5 127   R5 896

                                Any                                R3 406          R6 173         R4 733          R7 500   R8 827   R10 154

Any
                                Associated                         R3 014         R5 433          R4 198          R6 617   R7 801   R8 985

                                State                              R2 464         R4 406          R3 438          R5 380   R6 354   R7 328

Maximum of 3 children charged for

                                                                                                                                              9
Extender Option Overview
        Major Medical Benefit          Associated specialists covered in full
                                       Other specialists covered up to 200% of the Momentum Health Rate
                                       Hospital accounts covered in full at the rate agreed upon with the hospital group
                                       No overall annual limit applies
                                       A co-payment may apply to certain specialised procedures/treatments and
                                       specialised scans
        Choice of hospital provider    Any or Associated hospitals
        Specialised Procedures /       Certain procedures/treatments covered - e.g. hernia repairs, laser tonsillectomy,
        Treatments                     angiograms and hysteroscopies
        Chronic Benefit                26 conditions covered - no annual limit applies
                                       36 additional conditions covered, subject to limit of R9 800 per family per year
        Day-to-day Benefit             25% of your total contribution is available in a Savings account to cover
                                       day-to-day expenses, such as GP visits, prescribed medicine etc. You also have
                                       access to the Extended Cover benefit once your day-to-day claims have reached
                                       the Threshold
                                       Threshold levels: Principal member R20 800 Adult: R18 000 Child: R6 200
        Choice of chronic provider Any, Associated or State
        Health Platform                Covers benefits such as Health Assessments, dental examinations, routine GP
                                       check-ups, pap smears
                                       Maternity benefit: 12 antenatal visits, 2 pregnancy scans and
                                       2 paediatrician visits in your child’s first year

     Choose your providers                                           Choose your family composition

     Hospital                         Chronic

                                      Any                                R5 684        R10 263          R7 292            R11 871   R13 479   R15 087

     Associated
                                      Associated                         R5 240         R9 457          R6 747       R10 964        R12 471   R13 978

                                      State                              R4 580         R8 053          R5 927        R9 400        R10 747   R12 094

                                      Any                               R6 464          R11 669         R8 319        R13 524       R15 379   R17 234

     Any
                                      Associated                         R5 813        R10 496         R7 486         R12 169       R13 842   R15 515

                                      State                              R5 249         R9 558         R6 792             R11 101   R12 644   R14 187

     Maximum of 3 children charged for

10
Summit Option Overview
   Major Medical Benefit         Associated specialists covered in full
                                 Other specialists covered up to 300% of the Momentum Health Rate
                                 Hospital accounts covered in full at the rate agreed upon with the hospital
                                 group
                                 No overall annual limit applies
                                 A co-payment may apply to specialised scans
   Hospital provider             Any hospital
   Specialised Procedures /      Certain procedures/treatments covered - e.g. hernia repairs, laser
   Treatments                    tonsillectomy, angiograms and hysteroscopies
   Chronic Benefit               26 conditions covered - no annual limit applies
                                 36 additional conditions covered, subject to overall day-to-day limit
   Day-to-day Benefit            Covered from risk benefit, subject to overall day-to-day limit of R24 700 per
                                 beneficiary and certain sub-limit
   Chronic and Day-to-day        Freedom-of-choice
   provider
   Health Platform               Covers benefits such as Health Assessments, dental examinations, routine GP
                                 check-ups, pap smears
                                 Maternity benefit: 12 antenatal visits, 2 pregnancy scans and
                                 2 paediatrician visits in your child’s first year

Your providers                                                       Choose your family composition

Hospital               Chronic                  Day-to-day

                       Freedom-of-              Freedom-of-
Any                    choice                   choice                  R9 269       R16 682          R11 398    R18 811   R20 940   R23 069

Maximum of 3 children charged for

                                                                                                                                               11
Health Platform Benefit
     Health Platform Benefits are paid by the Scheme up to a maximum Rand amount per
     benefit, provided you notify us before using the benefit.
     You can pre-notify by contacting the member call centre on 0860 11 78 59, logging on to
     momentumhealth.co.za or via the Momentum app. On the Ingwe and Impact Options,
     Health Platform Benefits are only available from your chosen Primary Care Network
     provider.

                                                                                                                                 Extender
                                                                                                                     Incentive

                                                                                                                                            Summit
                                                                                                            Custom
     Benefit                              Who?                      How often?

                                                                                                   Impact
                                                                                           Ingwe
     Early detection tests
     Health Assessment                    All principal members     Once a year
     (pre-notification not required):     and adult beneficiaries
     Blood pressure test, Cholesterol                                                       ◉       ◉        ◉         ◉           ◉         ◉
     and Blood sugar (finger prick
     tests), height, weight and waist
     circumference
     Dental consultation (incl. sterile   All beneficiaries         Once a year             ◉       ◉        ◉         ◉           ◉         ◉
     tray and gloves)
     Pap smear (pathologist)              Women 15 and older        Once a year             ◉       ◉        ◉         ◉           ◉         ◉
     Pap smear consultation (GP)          Women 15 and older        Once a year             ◉       ◉
     Pap smear consultation (GP* or       Women 15 and older        Once a year                              ◉         ◉           ◉         ◉
     gynaecologist)
     Mammogram                            Women 38 and older        Once every 2 years                       ◉         ◉           ◉         ◉
     DEXA bone density scan               Beneficiaries 50 and      Once every 3 years                       ◉         ◉           ◉         ◉
     (radiologist, GP* or specialist)     older
     General physical examination         Beneficiaries 21 to 29    Once every 5 years      ◉       ◉        ◉         ◉           ◉         ◉
     (GP* consultation)
                                          Beneficiaries 30 to 59    Once every 3 years      ◉       ◉        ◉         ◉           ◉         ◉
                                          Beneficiaries 60 to 69    Once every 2 years      ◉       ◉        ◉         ◉           ◉         ◉
                                          Beneficiaries 70 and      Once a year             ◉       ◉        ◉         ◉           ◉         ◉
                                          older
     Prostate specific antigen            Men 40 to 49              Once every 5 years      ◉       ◉        ◉         ◉           ◉         ◉
     (pathologist)
                                          Men 50 to 59              Once every 3 years      ◉       ◉        ◉         ◉           ◉         ◉
                                          Men 60 to 69              Once every 2 years      ◉       ◉        ◉         ◉           ◉         ◉
                                          Men 70 and older          Once a year             ◉       ◉        ◉         ◉           ◉         ◉
     Cholesterol test (pathologist)**     Principal members and     Once a year
                                          adult beneficiaries                               ◉       ◉        ◉         ◉           ◉         ◉
     Blood sugar test (pathologist)***    Principal members and     Once a year
                                          adult beneficiaries                               ◉       ◉        ◉         ◉           ◉         ◉

     Glaucoma test                        Beneficiaries 40 to 49    Once every 2 years                       ◉         ◉           ◉         ◉
                                          Beneficiaries 50 and      Once a year                              ◉         ◉           ◉         ◉
                                          older
     HIV test (pathologist)               Beneficiaries 15 and      Once every 5 years      ◉       ◉        ◉         ◉           ◉         ◉
                                          older
     Preventative care
     Baby immunisations (On Ingwe         Children up to age 6      As required by the
     and Impact, available at nearest                               Department of Health    ◉       ◉        ◉         ◉           ◉         ◉
     State baby clinic)
     Flu vaccines                         Children between 6        Once a year             ◉       ◉        ◉         ◉           ◉         ◉
                                          months and 5 years
                                          High-risk beneficiaries                           ◉       ◉        ◉         ◉           ◉         ◉
                                          under 18
                                          Beneficiaries 65 and                              ◉       ◉        ◉         ◉           ◉         ◉
                                          older
                                          High-risk beneficiaries                           ◉       ◉        ◉         ◉           ◉         ◉
     Tetanus diphtheria injection         All beneficiaries         As needed               ◉       ◉        ◉         ◉           ◉         ◉
     Pneumococcal vaccine                 Beneficiaries 60 and      Once a year                              ◉         ◉           ◉         ◉
                                          older
                                          High-risk beneficiaries                                            ◉         ◉           ◉         ◉

12
Extender
                                                                                                                           Incentive

                                                                                                                                                  Summit
                                                                                                                 Custom
 Benefit                              Who?                       How often?

                                                                                                        Impact
                                                                                              Ingwe
Maternity programme (subject to registration on the Maternity Management
Programme between 8 and 20 weeks of pregnancy)
Antenatal visits (Midwives, GP* Women registered on
or gynaecologist)               the programme          4 visits                                ◉         ◉
                                      Women registered on
                                      the programme              12 visits                                        ◉          ◉           ◉         ◉
Online antenatal and postnatal        Women registered on        18-month
classes                               the programme              subscription                                                ◉           ◉         ◉

Online video consultation with        Women registered on        Initial consultation                                        ◉
lactation specialist                  the programme
                                                                 Initial consultation                                                    ◉         ◉
                                                                 plus follow up
Urine tests (dipstick)                Women registered on        Included in antenatal
                                      the programme              visits                        ◉         ◉        ◉          ◉           ◉         ◉
Pathology tests                       Women registered on
                                      the programme
Full blood count, blood group,
rhesus, platelet count, rubella
antibody, creatinine, glucose strip                              1 test                                                      ◉           ◉         ◉
test, antiglobin test
Haemaglobin estimation                                           2 tests                                                     ◉           ◉         ◉
Urinalysis                                                       13 tests                                                    ◉           ◉         ◉
Urine tests (microscopic exams,
antibiotic susceptibility and                                    As indicated                                                ◉           ◉         ◉
culture)
Scans                                 Women registered on        2 growth scans                ◉         ◉
                                      the programme
                                      Women registered on                                                         ◉          ◉           ◉         ◉
                                                                 2 pregnancy scans
                                      the programme
                                      Babies up to 12 months     2 visits in baby’s                               ◉          ◉           ◉         ◉
Paediatrician visits                  registered on the          first year
                                      programme
Disease management programmes
Diabetes, Hypertension, HIV/          All beneficiaries     As needed
Aids, Oncology, Drug and              registered on the
alcohol rehabilitation, Chronic       appropriate programme                                    ◉         ◉        ◉          ◉           ◉         ◉
renal failure, Organ transplants,
Cholesterol
Health line
24-hour emergency health advice All beneficiaries                As needed                     ◉         ◉        ◉          ◉           ◉         ◉
Emergency evacuation
Emergency evacuation in South         All beneficiaries          In an emergency
Africa by Netcare 911                                                                          ◉         ◉        ◉          ◉           ◉         ◉

International evacuation by ISOS      All beneficiaries          In an emergency                         ◉        ◉          ◉           ◉         ◉

International emergency cover by ISOS
Ingwe: Not covered                    Per beneficiary per        In an emergency
Impact: R3.38 million                 90-day journey
Custom: R7.66 million
Incentive: R8 million
Extender: R8.22 million
Summit: R9.01m
                                                                                                         ◉        ◉          ◉           ◉         ◉
This benefit includes R15 500 for
emergency optometry,
R15 500 for emergency dentistry
and R765 000 terrorism cover, on
all options, except Ingwe.
A R1 630 co-payment applies per
out-patient claim

Please note
*	On the Custom, Incentive and Extender Options, if you choose Associated as your chronic provider, a 30% co-payment will apply if you do not use
     an Associated GP for the GP consultations
** The cholesterol test is covered if Health Assessment results indicate a total cholesterol of 6 mmol/L and above
*** The blood sugar test is covered if Health Assessment results indicate blood sugar levels are 11 mmol/L and above

                                                                                                                                                           13
List of hospitals

                                                                                                                                                         Associated
                                                                         Associated

                                                                                                                                                Impact
                                                                Impact

                                                                                                                                        Ingwe
                                                        Ingwe
     Eastern Cape                                                                     Gauteng (continued)

                                     Beacon Bay -                                     Kloof Hospital                   Erasmuskloof                        ◉
     Life Beacon Bay Hospital
                                     East London
                                                         ◉       ◉         ◉
                                                                                      Faerie Glen Hospital             Faerie Glen      ◉                  ◉
     Isivivana Private Hospital      Humansdorp                            ◉          Flora Clinic                     Florida          ◉                  ◉
                                                                                      Fourways Hospital                Fourways                            ◉
     East London Private Hospital East London            ◉                 ◉
                                                                                      Groenkloof Hospital              Groenkloof       ◉                  ◉
     Settlers Private Hospital    Grahamstown                    ◉
                                                                                      Suikerbosrand Clinic             Heidelberg       ◉        ◉         ◉
     Greenacres Hospital          Greenacres -                   ◉
                                  Port Elizabeth                                      Medgate Day Clinic               Helderkruin                         ◉
                                  Korsten - Port                                      Bagleyston Day Clinic            Highlands                 ◉
     New Mercantile Hospital                             ◉                 ◉
                                  Elizabeth                                           Park Lane Clinic                 Houghton                  ◉
     Port Alfred Hospital         Port Alfred                    ◉                    Akasia Clinic                    Karen Park                ◉
     Hunterscraig Psychiatric     Port Elizabeth                           ◉          Arwyp Medical Centre             Kempton Park     ◉        ◉
     Hospital                                                                         New Kensington Clinic            Kensington       ◉                  ◉
     St Georges Hospital          Port Elizabeth         ◉                 ◉          Bellstreet Hospital              Krugersdorp               ◉
     Queenstown Private Hospital Queenstown              ◉                 ◉          Krugersdorp Private Hospital     Krugersdorp               ◉
                                  Southernwood -         ◉       ◉         ◉          Pinehaven Private Hospital       Krugersdorp               ◉
     St. Dominic’s Hospital       East London
                                                                                      Protea Clinic                    Krugersdorp               ◉
     St James Operating Theatres Southernwood -          ◉                 ◉          Lenmed Clinic Limited            Lenasia          ◉
                                  East London
                                  Southernwood -                                      Eugene Marais Hospital           Les Marais       ◉                  ◉
     St Marks Clinic
                                  East London
                                                         ◉                 ◉          Linksfield Park Clinic           Linksfield                ◉
     Cuyler Hospital              Uitenhage                      ◉         ◉          Legae Private Clinic             Mabopane         ◉                  ◉
     St Mary’s Private Hospital   Umtata                 ◉                 ◉          Garden City Clinic               Mayfair                   ◉
                                                                                      Carstenhof Clinic                Midrand          ◉                  ◉
     Free State                                                                       Waterfall City Hospital          Midrand                   ◉
     Hoogland Mediclinic             Bethlehem           ◉       ◉         ◉          Montana Private Hospital         Montana Park              ◉
     Bloemfontein Eye Hospital       Bloemfontein                          ◉          Pretoria East Private Hospital   Moreleta Park             ◉
     Pasteur Hospital                Bloemfontein        ◉                 ◉          Morningside Mediclinic           Morningside                         ◉
     Pelonomi Private Hospital       Bloemfontein                ◉                    Jakaranda Hospital               Muckleneuck               ◉
                                     Fichardtpark -                                   Mulbarton Hospital               Mulbarton                 ◉
     Rosepark Hospital               Bloemfontein
                                                         ◉                 ◉          Riverfield Lodge                 Nietgedacht      ◉                  ◉
     Welkom Mediclinic               Welkom              ◉       ◉         ◉          Rosewood Clinic                  Orange Grove              ◉
     Bloemfontein Mediclinic         Bloemfontein                          ◉          The Donald Gordon                Parktown                            ◉
     Universitas Private Hospital    Bloemfontein                ◉                    Brenthurst Clinic                Parktown         ◉                  ◉
     Kroon Hospital                  Kroonstad                   ◉                    Milpark Hospital                 Parktown                  ◉
     Vaalpark Medical Centre         Sasolburg                   ◉                    Pretoria North Surgical                                              ◉
                                                                                      Centre                           Pretoria North
     Gauteng                                                                          Roseacres Clinic                 Primrose         ◉        ◉         ◉
                                                                                      Olivedale Clinic                 Randburg                  ◉
     Clinton Hospital                Alberton                    ◉
                                                                                      Robinson Hospital                Randfontein      ◉        ◉         ◉
     Union Hospital                  Alberton                    ◉
                                                                                      Moot General Hospital            Rietfontein               ◉
     Femina Clinic                   Arcadia                     ◉
                                                                                      Constantia Clinic                Roodepoort                ◉
     Muelmed Hospital                Arcadia                               ◉
                                                                                      Wilgeheuwel Hospital             Roodepoort       ◉                  ◉
     Pretoria Heart Hospital         Arcadia                               ◉
                                                                                      Rosebank Clinic                  Rosebank                  ◉
     Netcare Rehabilitation                                      ◉
     Hospital                        Auckland Park                                    Genesis Clinic                   Saxonwold                           ◉
     Bedford Gardens Private                                                          Clinix Tshepo                    Soweto           ◉        ◉
     Hospital
                                     Bedfordview         ◉                 ◉          Springs Parkland Clinic          Springs          ◉                  ◉
     Glynnview Hospital              Benoni                                ◉          N17 Private Hospital             Springs                   ◉
     The Glynnwood                   Benoni              ◉                 ◉          St Mary’s Womens Clinic          Springs          ◉                  ◉
     Linmed Hospital                 Benoni                      ◉                    Sunninghill Hospital             Sunninghill               ◉
     Rand Clinic                     Berea                       ◉                    Medforum Hospital                Sunnyside                           ◉
     Birchmed Day Clinic             Birchleigh                            ◉          Pretoria Gynaecology                                                 ◉
                                                                                      Hospital                         Sunnyside
     Sunward Park Hospital           Boksburg                    ◉
     Dalview Clinic                  Brakpan             ◉                 ◉          Emfuleni Mediclinic              Vanderbijlpark   ◉                  ◉
     Brooklyn Surgical Centre        Brooklyn            ◉                 ◉          Vereeniging Mediclinic           Vereeniging               ◉         ◉
     Sandton Mediclinic              Bryanston                             ◉          Clinix Naledi                    Vereeniging      ◉
     Unitas Hospital                 Centurion                   ◉
     Mayo Clinic                     Constantia Kloof                      ◉
     Bougainville Private Hospital   Daspoort                    ◉
     Wilgers Hospital                Die Wilgers         ◉                 ◉

14
Members on the Ingwe Option can choose between Any hospital, Ingwe Network hospitals or State hospitals
Members on the Impact Option need to use Impact Network hospitals
Members on the Custom, Incentive and Extender Options can choose between Any or Associated hospitals

                                                                       Associated

                                                                                                                                                              Associated
                                                              Impact

                                                                                                                                                     Impact
                                                      Ingwe

                                                                                                                                             Ingwe
Kwazulu-Natal                                                                       Northern Cape
Kingsway Hospital             Amanzimtoti                     ◉                     Kathu Private Hospital         Kathu                      ◉                   ◉
Alberlito Hospital            Ballito                         ◉                     Kimberley Mediclinic           Kimberley                  ◉       ◉           ◉
Entabeni Hospital             Berea                   ◉                   ◉         Upington Mediclinic            Upington                           ◉           ◉
Chatsmed Garden Hospital      Chatsworth              ◉                   ◉
City Hospital                 Durban                  ◉                   ◉         Western Cape
Durdoc Clinic                 Durban                  ◉                             Bellville Medical Centre       Bellville                  ◉       ◉           ◉
St Augustines Hospital        Durban                          ◉                     Louis Leipoldt Mediclinic      Bellville                                      ◉
Empangeni Garden Clinic       Empangeni               ◉       ◉           ◉         Netcare Blaauwberg Hospital    Blaauwberg                         ◉
Hillcrest Private Hospital    Hillcrest                                   ◉         Cape Gate Mediclinic           Brackenfell                                    ◉
Hilton Private Hospital       Hilton                                      ◉         Christiaan Barnard Memorial
Howick Private Hospital       Howick                                      ◉                                        Cape Town                          ◉
                                                                                    Hospital
Isipingo Hospital             Isipingo                ◉                   ◉         Peninsula Eye Hospital         Claremont                 ◉                    ◉
La Verna Hospital             Ladysmith               ◉                             Kingsbury Hospital             Claremont                 ◉                    ◉
Margate Private Hospital      Margate                 ◉       ◉           ◉         Durbanville Mediclinic         Durbanville                                    ◉
Newcastle Private Hospital    Newcastle               ◉       ◉           ◉         Gatesville Medical Centre      Gatesville                 ◉       ◉           ◉
Ethekwini Hospital            Newlands East –Durban                       ◉         Geneva Clinic                  George                     ◉       ◉           ◉
Parklands Hospital            Overport                        ◉                     George Mediclinic              George                     ◉       ◉           ◉
Mount Edgecombe Hospital      Phoenix                 ◉                   ◉         N1 City Hospital               Goodwood                           ◉
Midlands Medical Centre       Pietermaritzburg        ◉                   ◉         Hermanus Mediclinic            Hermanus                           ◉           ◉
Pietermaritzburg Mediclinic   Pietermaritzburg                            ◉         Knysna Private Hospital        Knysna                     ◉       ◉           ◉
St Annes Hospital             Pietermaritzburg                ◉                     Kuils River Private Hospital   Kuils River                        ◉
The Crompton Hospital         Pinetown                ◉       ◉           ◉         UCT Private Academic
                                                                                                                   Mowbray                            ◉
Hibiscus Hospital             Port Shepstone          ◉                   ◉         Hospital
The Bay Hospital              Richards Bay                    ◉           ◉         Milnerton Mediclinic           Milnerton                                      ◉
Victoria Hospital             Tongaat                                     ◉         Mitchells Plain Medical                                   ◉       ◉           ◉
                                                                                    Centre                         Mitchells Plain
Umhlanga Hospital             Umhlanga                        ◉           ◉
Westville Hospital            Westville               ◉                   ◉         Bayview Hospital               Mossel Bay                 ◉       ◉           ◉
                                                                                    Cape Town Mediclinic           Oranjezicht                                    ◉
Limpopo                                                                             Klein Karoo Mediclinic         Oudtshoorn                         ◉           ◉
                                                                                    Paarl Mediclinic               Paarl                              ◉           ◉
Lephalale Mediclinic          Lephalale                                   ◉
                                                                                    Panorama Mediclinic            Panorama                                       ◉
Limpopo Mediclinic            Polokwane               ◉       ◉           ◉
                                                                                    Vincent Pallotti Hospital      Pinelands                  ◉                   ◉
Pholoso Private Hospital      Polokwane                       ◉
                                                                                    Plettenberg Bay Mediclinic     Plettenberg Bay                                ◉
Tzaneen Private Hospital      Tzaneen                 ◉       ◉           ◉
                                                                                    Constantiaberg Mediclinic      Plumstead                          ◉           ◉
Thabazimbi Mediclinic         Thabazimbi              ◉       ◉
                                                                                    Sport Science Orthopaedic                                                     ◉
                                                                                                                   Rondebosch
                                                                                    Surgical Day Centre
Mpumalanga
                                                                                    Vergelegen Mediclinic          Somerset West                      ◉           ◉
Bronkhorstspruit Hospital     Bronkhorstspruit        ◉       ◉                     Stellenbosch Mediclinic        Stellenbosch               ◉                   ◉
Cosmos Hospital               Emalahleni              ◉       ◉           ◉         Strand Mediclinic              Strand                                         ◉
Ermelo Mediclinic             Ermelo                  ◉       ◉           ◉         West Coast Private Hospital    Vredenburg                 ◉       ◉           ◉
Kiaat Private Hospital        Mbombela                ◉                             Worcester Mediclinic           Worcester                          ◉           ◉
Lowveld Hospital              Mbombela                        ◉           ◉
Nelspruit Mediclinic          Mbombela                ◉                   ◉         These hospital lists are subject to change.
Midmed Hospital               Middelburg              ◉       ◉           ◉         Visit momentumhealth.co.za for the latest information.
Piet Retief Hospital          Piet Retief                                 ◉
Secunda Mediclinic            Secunda                 ◉       ◉           ◉
Highveld Mediclinic           Trichardt               ◉       ◉           ◉

North West
Brits Mediclinic              Brits                           ◉           ◉
Anncron Clinic                Klerksdorp              ◉       ◉           ◉
Victoria Private Hospital     Mafikeng                ◉
Potchefstroom Mediclinic      Potchefstroom           ◉       ◉           ◉
Ferncrest Hospital            Rustenburg                      ◉
Peglerae Hospital             Rustenburg              ◉                   ◉
Vryburg Private Hospital      Vryburg                 ◉                   ◉

                                                                                                                                                                           15
Exclusions
     Prescribed Minimum Benefits                             4.    Professional speed contests or professional
                                                                   speed trials (professional defined as where
     Notwithstanding the limitations and exclusions
                                                                   the beneficiary’s main form of income is
     set out below, beneficiaries shall be entitled to the
                                                                   derived from partaking in these contests);
     Prescribed Minimum Benefits.
                                                             5.    Health care provider not registered with the
     Benefits Excluded
                                                                   recognised professional body constituted in
     General exclusions mentioned in this paragraph                terms of an Act of parliament;
     are not affected by any specific exclusions. Unless
                                                             6.    Holidays for recuperative purposes, whether
     otherwise decided by the Scheme (and with
                                                                   deemed medically necessary or not,
     the express exception of medicine or treatment
                                                                   including headache and stress relief clinics;
     approved and authorised in terms of any health
     management programme contracted to the                  7.    All costs for treatment if the efficacy and
     Scheme), expenses incurred in connection with any             safety of such treatment cannot be proved;
     of the following will not be paid by the Scheme, but
                                                             8.    All costs for operations, medicine, treatments
     may be claimed from positive Savings:
                                                                   and procedures for cosmetic purposes or for
     1.    All costs incurred during waiting periods and           personal reasons and not directly caused by
           for conditions which existed at the date of             or related to illness, accident or disease. This
           application for membership of the Scheme                includes the costs of treatment or surgery
           but were not disclosed;                                 related to transsexual procedures;
     2.    All costs that exceed the annual maximum          9.    Obesity;
           allowed for the particular category as set out
                                                             10.   Costs for attempted suicide that exceed the
           in Annexure B of the Scheme Rules, for the
                                                                   Prescribed Minimum Benefits limits;
           benefit to which the beneficiary is entitled in
           terms of the Scheme Rules;
     3.    Injuries or conditions sustained during willful
           participation in a riot, civil commotion, war,
           invasion, terrorist activity or rebellion;

16
11.   Breast reduction and breast augmentation,        18.   Appointments which a beneficiary fails to
      gynaecomastia, otoplasty and                           keep;
      blepharoplasty;
                                                       19.   Circumcision, unless clinically indicated, and
12.   Medication not registered by the Medicine              any contraceptive measures or devices;
      Control Council;
                                                       20.   Reversal of Vasectomies or tubal ligation
13.   Costs for services rendered by any                     (sterilisation);
      institution, nursing home or similar
                                                       21.   Injuries resulting from narcotism or alcohol
      institution not registered in terms of any law
                                                             abuse except for the Prescribed Minimum
      (except a State facility/hospital);
                                                             Benefits;
14.   Gum guards and gold used in dentures;
                                                       22.   Infertility treatment that is included as
15.   Frail care;                                            Prescribed Minimum Benefits will be covered
                                                             in State facilities subject to paragraph 4 of
16.   Travelling expenses, excluding benefits
                                                             Annexure D of the Scheme Rules;
      covered by Emergency rescue and
      International cover;                             23.   The cost of injury and any other related costs
                                                             as a result of scuba diving to depths below
17.   All costs, which in the opinion of the Medical
                                                             40 metres and cave diving.
      Assessor are not medically necessary or
      appropriate to meet the health care needs of
      the patient;

                                                                                                              17
Momentum Health                                                          Council for Medical Schemes

      Member call centre         0860 11 78 59                                   Customer Care Centre   0861 123 267
      Emergency evacuation       082 911
      Fraud hotline              0800 00 04 38
                                 momentummedicalscheme@tip-offs.com              information@medicalschemes.com

                                                                                 medicalschemes.com
      201 uMhlanga Ridge Boulevard Cornubia 4339

      PO Box 2338 Durban 4000 South Africa

      Queries                    member@momentumhealth.co.za
      Claims                     claims@momentumhealth.co.za

      momentumhealth.co.za

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      or App Store for iPhones
                                                                                                                       Version 2019
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