What does the Major Medical Benefit 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 covered, 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 Medical Scheme 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 Medical Scheme Rate. A R1 640 co-payment per authorisation applies, except for car accidents, maternity confinements, and emergency treatment. An additional co-payment may apply for specialised procedures.
No annual limit applies.
Hospital Provider
Evolve Network hospitals. Certain procedures are only covered in day hospitals.
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 Medical Scheme Rate. A R1 640 co-payment per authorisation applies, except for car accidents, maternity confinements, and emergency treatment. An additional co-payment may apply for specialised procedures.
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 Medical Scheme 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 Medical Scheme 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 Medical Scheme 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 your doctor obtains the authorisation on your behalf, you will need to verify with us if there are any co-payments or shortfalls as a result of not using a Designated Service Provider, or resulting from benefit limits or protocols.
Use one of the following methods to get pre-authorisation:
After you get pre-authorisation
Once you get pre-authorisation, make sure to: