Major Medical Benefit
To ensure that you’re covered for more than just an occasional visit to your local GP, the Major Medical Benefit gives you plan-specific benefits that cover you in full in the event that you’re hospitalised or required to go through surgery.
What does it cover?
With this cover, your hospital accounts and costs related to your stay in a hospital, as well as certain procedures performed both in- or out-of-hospital, are paid for at the agreed rate, subject to pre-authorisation.
The following is an overview of the cover provided across our six medical aid options.
Ingwe Option
Cover
Hospital accounts are covered in full at the rate agreed with the hospital group.
Specialists are covered up to 100% of the Momentum Health Rate.
No annual limit applies.
Hospital Provider
Any hospital,
Ingwe Network or
State hospitals.
Evolve Option
Cover
Hospital accounts are covered in full at the rate agreed with the hospital group.
Specialists are covered up to 100% of the Momentum Health Rate. A R1 570 co-payment per authorisation applies, except for car accidents, maternity confinements, and emergency treatment.
No annual limit applies.
Hospital Provider
Custom Option
Cover
Hospital accounts are covered in full at the rate agreed with the hospital group.
Specialists are covered up to 100% of the Momentum Health Rate. A R1 570 co-payment per authorisation applies, except for car accidents, maternity confinements, and emergency treatment.
No annual limit applies.
Hospital Provider
Any or Associated hospitals.
Incentive Option
Cover
Hospital accounts are covered in full at the rate agreed with the hospital group.
Specialists are covered up to 200% of the Momentum Health Rate. Co-payments may apply for certain specialised procedures or treatment.
No annual limit applies.
Hospital Provider
Any or Associated hospitals.
Extender Option
Cover
Hospital accounts are covered in full at the rate agreed with the hospital group.
Specialists are covered up to 200% of the Momentum Health Rate. Co-payments may apply for certain specialised procedures or treatment.
No annual limit applies.
Hospital Provider
Any or Associated hospitals.
Summit Option
Cover
Hospital accounts are covered in full at the rate agreed with the hospital group.
Specialists are covered up to 300% of the Momentum Health Rate.
No annual limit applies.
Hospital Provider
Any hospital
For more information about hospitalisation and specialised procedures covered under the Major Medical Benefit, have a look at the focus page or your chosen medical aid option to see what you’re covered for.
How to get pre-authorisation
You get pre-authorisation once benefits have been verified and Scheme Rules and protocols have been applied. If the hospital or doctor obtains the authorisation on your behalf, you need to verify whether or not you will need to pay any co-payments or shortfalls as a result of not using a Designated Service Provider, or resulting from benefit limits or protocols.
Follow these steps to get pre-authorisation:
Step 1
Phone our member call centre on 0860 117 859
Step 2
Make a note of the authorisation number
Step 3
Give the authorisation number to your provider
When you phone the pre-authorisation call centre, make sure you have the following information available: