Summit Option

This benefit covers hospitalisation as well as some out-of-hospital procedures that can be safely performed in a doctor's room, registered day clinic, or out-patient facility.

Major Medical Benefits are available at Any hospital.

Hospitalisation

• Associated specialists are covered in full, while other specialists are covered up to 300% of the Momentum Health Rate. Hospital accounts are covered in full at the rate agreed upon with the hospital group. No overall annual limit applies.
• No annual limit on high and intensive care.
• No annual limit on maternity confinement and neonatal intensive care.
• No annual limit for renal dialysis and oncology.
• No annual limit for organ transplant recipients.
• No annual limit for MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans (in and out-of-hospital). You need to pay a co-payment of R2 250 per scan and obtain pre-authorisation.
• R52 700 per family for medical rehabilitation, private nursing, hospice and step-down facilities.
• Trauma benefit for day-to-day claims that form part of your recovery following specific traumatic events.
• Seven days’ supply of take home medication.

Specialised procedures/treatment

• Certain specialised procedures/treatments are covered, when clinically appropriate, in and out of hospital.

This benefit takes care of certain life-threatening conditions, such as diabetes and heart disease, that need ongoing treatment.

Chronic Benefits are available at Any provider.

It covers 26 conditions under Prescribed Minimum Benefits* according to the Chronic Disease List with no annual limit. The 36 additional conditions are subject to a limit of R24 700 per family every year (this is a combined limit incorporating both day-to-day cover and cover for the 36 additional conditions).

*Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide members with continuous care to improve their health and well-being and to make healthcare more affordable. Learn moreopen_in_new

This benefit covers your everyday medical expenses, such as doctors' visits and prescribed medication.

Day-to-day Benefits are available at Any provider.

Savings
There are savings built into this option, but you can add HealthSaver. On this option you get R24 700 to cover day-to-day expenses per beneficiary every year.

General practitioners
Subject to an overall annual day-to-day limit of R24 700 per beneficiary.

Eye care
You get R4 310 to use on eye care per beneficiary. The maximum amount you can spend on a frame is R2 210. Subject to an overall annual day-to-day limit of R24 700 per beneficiary.

Dentistry
Basic dentistry is subject to an overall annual day-to-day limit of R24 700 per beneficiary. Specialised dentistry is paid from available day-to-day benefits, limited to R14 900 per beneficiary and R35 600 per family per year. Both in and out-of-hospital specialist accounts accumulate towards the day-to-day limit.

General anaesthesia for children under 7, maxillo-facial surgery (excluding implants) and impacted wisdom teeth are covered in-hospital. The anaesthetist account is covered up to 300% of the Momentum Health Rate. Hospital accounts are paid in full at the negotiated rate, and the dentist, dental specialist and maxillo-facial surgeon accounts are paid from available day-to-day benefits, subject to the day-to-day limits.

In the case of maxillo-facial trauma, the in-hospital dentist, dental specialist or maxillo-facial surgeon will be payable from the Major Medical Benefit.

Dental implants, including the cost of implants, and the anaesthetist and hospital accounts, are payable from available day-to-day benefits, subject to the day-to-day limits.

Medicine
Prescribed medication is covered up to R19 300 per beneficiary and R31 600 per family per year. Subject to an overall annual day-to-day limit of R24 700 per beneficiary. Over-the-counter medication is paid out-of-pocket or from HealthSaver if applicable.

Mental health
We cover up to R21 200 per family every year. Subject to an overall annual day-to-day limit of R24 700 per beneficiary.

Specialist visits
Subject to overall annual day-to-day limit of R24 700 per beneficiary.

A unique benefit that encourages health awareness, enhances quality of life and gives peace of mind through preventative care and early detection tests.

Preventative care
Includes baby immunisations, flu vaccines, as well as tetanus diphtheria injections.

Early detection tests
Includes pap smears, dental consultations, general physical examinations, prostate specific antigens, health assessments, cholesterol tests, blood sugar tests and HIV tests.

Maternity programme
Women registered on our maternity programme get 12 antenatal visits which include a urine test, two pregnancy scans, various pathology tests, as well as online antenatal and postnatal classes, online video consultations with a lactation specialist, and two visits to the paediatrician during the baby's first year.

Health management programme
For the management of diabetes, hypertension, HIV/Aids, oncology, drug and alcohol rehabilitation, chronic renal failure, organ transplants and cholesterol.

Health line
24-hour emergency health advice.

Emergency evacuation
Emergency evacuation in South Africa by Netcare 911.

International emergency cover by ISOS, covered up to R9,01 million per 90-day journey.

Talk to a doctor, anytime, anywhere. This is a free service to all Momentum clients. Learn moreopen_in_new