Custom Option

Provider
Any or Associated hospitals

Consultations and visits
Associated specialists covered in full
Other specialists covered up to 100% of the Momentum Medical Scheme Rate

Oncology
R300 000 per beneficiary per year, thereafter a 20% copayment applies. Momentum Medical Scheme reference pricing may apply to chemotherapy and adjuvant medication

Organ transplants (recipient)

No annual limit applies

MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans (in- and out-of-hospital)
No annual limit applies, subject to R3 050 co-payment per scan

Medical rehabilitation, private nursing, Hospice and step-down facilities
R61 000 per family

Mental health
– including psychiatry and psychology
– drug and alcohol rehabilitation

R43 000 per beneficiary

Take-home medication
7 days’ supply

Certain specialised procedures/treatment covered, when clinically appropriate, in- or out-of-hospital

(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.

Any, Associated or State

26 conditions, according to the Chronic Disease List in the 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.

You can add HealthSaver+ to supplement your day-to-day benefits.

Preventative care includes:
Baby immunisations, Flu vaccines, Tetanus diphtheria injection, Pneumococcal vaccine
Early detection tests include:
Dental consultation (including sterile tray and gloves)

Pap smear consultation (nurse, GP or gynaecologist)

Pap smear (pathologist)
– Standard or LBC (Liquid based cytology) or – HPV PCR screening test
(If result indicates high risk, then a follow-up LBC is also covered)

Mammogram DEXA bone density scan (radiologist, GP* or specialist)

General physical examination (GP* consultation)

Prostate specific antigen (pathologist)

Health assessment available at Dis-Chem, Clicks or MediRite pharmacy clinics: blood
pressure test, cholesterol and blood sugar (finger prick tests), height, weight and waist
circumference measurements

Cholesterol test (pathologist)**

Blood sugar test (pathologist)***

Glaucoma test HIV test (pathologist)

* If you chose Associated as your chronic provider, a 30% co-payment will apply if you do not use an Associated GP for GP consultations covered under the Health Platform Benefit

** Only covered if health assessment results indicate a total cholesterol of 6 mmol/l and above

*** Only covered if health assessment results indicate blood sugar levels are 11 mmol/l and above

Maternity programme

Doula benefit (your gynaecologist must be an Associated Specialist)

Antenatal visits (Midwives, GP* or gynaecologist)

Nurse home visits

Pathology tests: Blood group, full blood count, Rhesus factor, creatinine, glucose strip, haemoglobin estimation, Urinalysis, Urine tests (microscopic exams, antibiotic susceptibility and culture)

Urine tests (dipstick) Scans Paediatrician visits

Health line
24-hour emergency health advice.

Emergency evacuation
Emergency evacuation in South Africa by Netcare 911.

International emergency medical transport by preferred provider
R7 660 000 per beneficiary per 90-day journey. This benefit includes R15 500 for emergency optometry, R15 500 for emergency dentistry and R765 000 terrorism cover A R2 070 co-payment applies per emergency out-patient claim