Custom Option

Any or Associated hospitals

Consultations and visits
Associated specialists covered in full
Other specialists covered up to 100% of Momentum Medical Scheme Rate
Hospital accounts are covered in full at the rate agreed upon with the hospital group
No overall annual limit applies

Oncology
R300 000 per beneficiary per year, thereafter a 20% co-payment applies. Momentum Medical Scheme Reference Pricing will 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 850 co-payment per scan and pre-authorisation

Medical rehabilitation, private nursing, Hospice and step-down facilities
R67 000 per family (combined limit), subject to case management

Mental health
– incl. psychiatry and psychology
– drug and alcohol rehabilitation

R47 300 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: Basic formulary
Associated: Core formulary
State: State formulary

26 conditions – no annual limit applies

(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 have the choice of adding more day-to-day cover through the HealthSaver+

Preventative care includes:

Baby immunisations (On Ingwe Option, baby immunisations are covered in private facilities for baby’s first year, limited to R3 100. Once the limit is reached, immunisations are available at the Department of Health baby clinics

Flu vaccines

Tetanus diphtheria injection

Pneumococcal vaccine

Early detection tests include:

Health assessment: Blood pressure test, Cholesterol and Blood sugar (finger prick tests), height, weight and waist circumference All principal members and adult beneficiaries Once a year

Preventative dental care covered up to R500 per beneficiary at any dental provider

Pap smear consultation (nurse, GP* or gynaecologist)

Pap smear (pathologist)

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

FIT (Faecal immunochemical testing) test

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

General physical examination (GP* consultation)

Prostate specific antigen (pathologist)

Cholesterol test (pathologist)**

Blood sugar test (pathologist)***

Glaucoma test

HIV test (pathologist)

Maternity programme

Doula benefit

Antenatal visits (Midwives, GP* or gynaecologist)

Nurse home visit

Urine tests (dipstick)

Pathology tests – Blood group, full blood count and Rhesus factor, Creatinine, Glucose strip, Haemoglobin estimation, Urinalysis, Urine tests (microscopic exams, antibiotic susceptibility and culture)

Scans

Paediatrician visits

Health line
24-hour emergency health advice