Our benefits Benefit Option Overview 2019 - Del Financial Services
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Our benefits Benefit Option Overview 2019
Member call centre 0860 11 78 59
Emergency evacuation 082 911
Fraud hotline 0800 00 04 38
momentummedicalscheme@tip-offs.com
Queries member@momentumhealth.co.za
Claims claims@momentumhealth.co.za
Website momentumhealth.co.za
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.
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
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
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
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
4Designed 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
5Ingwe 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 NetworkImpact 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
7Custom 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
8Incentive 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
9Extender 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
10Summit 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
11Health 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 ◉ ◉ ◉ ◉
12Extender
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
13List 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 ◉ ◉
14Members 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 ◉ ◉
15Exclusions
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;
1611. 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;
17Momentum 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
Download the Momentum App from the Play Store for Android phones
or App Store for iPhones
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