Ingwe Option

Providers
Any private hospital, Ingwe Network of hospitals, or State hospitals (public facilities).

Benefit
Hospital accounts are covered in full at the rate agreed upon with the hospital group.
Accounts for specialists are covered up to 100% of the Momentum Medical Scheme Rate.
Maternity confinements
No annual limit applies.
Caesarean section
Emergency caesareans are covered.
Neonatal intensive care
No annual limit applies.
Organ transplant
Limited to Prescribed Minimum Benefits* at State facilities.
MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans.
Limited to Prescribed Minimum Benefits* at State facilities.
Medical rehabilitation and step-down facilities
R15 900 per beneficiary (combined limit), subject to case management
Take-home medication
7 days’ supply.

(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.

Benefits are only available from the Ingwe Primary Care Network or Ingwe Active Network provider, depending on the network you chose, and are subject to a list of medicines referred to as the Fixed formulary. You need to get your chronic medication from Medipost.

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.

Benefits are only available from the Ingwe Primary Care Network or Ingwe Active Network provider, depending on the network you chose, and are subject to the rules and provisions set by the network, commonly referred to as protocols. This benefit is also subject to the network’s list of applicable tariff codes.

General practitioners
There is no limit to the number of times you may visit your network GP. However, please note all visits (whether virtual or in person) from the 11th visit onwards must be pre-authorised. You also get 3 virtual doctor consultations per beneficiary per year from the GP Virtual Consultation Network, which includes Hello Doctor. Consultations include scripting of schedule 1 to 4 medication where required
Optical and optometry
1 eye test and 1 pair of clear standard or bi-focal lenses with a standard frame as per formulary per beneficiary every 2 years. Spectacles will only be funded if your refraction measurement is more than 0.5
Dentistry
Examinations, fillings and x-rays as per the list of tariff codes. One dental consultation is covered per year per beneficiary. You need to call us for pre-authorisation if you need more than 4 fillings or 4 extractions
Prescribed Medicine
Subject to a list of medicines, referred to as a prescribed formulary
Mental health
Limited to Prescribed Minimum Benefits* at State facilities.
Specialist visits
2 visits per family per year, limited to R1 290 per visit and up to a maximum of R2 580 per family per year. Covered at 100% of Momentum Medical Scheme Rate. Subject to referral by your Ingwe Primary Care Network or Ingwe Active Network provider and pre-authorisation. Psychologists and psychiatrists are limited to Prescribed Minimum Benefits at State facilities

+ If you would like cover for additional day-to-day expenses, you can make use of the Momentum HealthSaver+ 

(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.

Health Platform Benefits are only available from your chosen Primary Care Network provider, except for health assessments, maternity programme benefits and baby immunisations, up to R2 800 in baby’s first year, which are available at any healthcare provider.

Preventative care includes:

Baby immunisations: covered in private facilities for baby’s first year,
limited to R2 800. After baby’s first year, or once the limit has been
reached, immunisations are available at the Department of Health
baby clinics
Flu vaccines Tetanus diphtheria injection

Maternity programme
Antenatal visits (Midwives, GP or gynaecologist) Urine tests (dipstick) Nurse home visit

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

Scans

Paediatrician visits

Early detection tests

Dental consultation (including sterile tray and gloves)

Pap smear consultation (nurse or GP) 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)
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)**

HIV test (pathologist)

*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

Health line
24-hour emergency health advice.

Emergency evacuation
Emergency evacuation in South Africa by Netcare 911.