Momentum Extender Associate (any provider for chronic) medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Extender Network hospital (and Network provider for chronic)
Quick Overview
Main: Adult: Child:
Total Cost pm: R4,715 R3,761 R1,415

(Pay only for first 3)

Savings: R14,148 R11,280 R4,248
Self Payment:
(per year, if you use up all your savings)
R4,552 R4,920 R1,352
Above Threshold:
  • Once your savings are depleted, and you have paid the self payment gap, scheme will cover most out of hospital expenses at scheme rate, with sublimits for some benefits.
Gap (optional):
  • Varies. See below for specific recommendation for this plan.
In brief: See full benefits below

IN HOSPITAL PROCEDURES:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits: Gap Benefits:
Specialists:
  • 200% scheme rate
  • Network specialists covered in full
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice:
  • Network hospitals
  • No benefit
Specialised Radiology:
  • You or your gap pay R2,150 co-payment
  • In and out of hospital
  • Gap cover pays co-payments for procedures approved by medical aid
Supplementary Services: (Physio, etc) TBC
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals, for non-PMB treatment
  • No benefit for out-of-hospital services
Transplants:
  • Recipient: Unlimited
  • Donor R18,600 cadaver costs and R37,700 for live donor costs. Only covered if recipient is a member of the scheme
  • Sublimit increased as necessary, subject to medical aid approval for procedure
Co-payments:
  • Gastroscopies, nail surgery, cystoscopies, colonoscopies, sigmoidoscopies, removing of extensive skin lesions: R550 co-payment if done in day-clinic
  • Otherwise, R1,300 co-payment for most admissions other than for maternity, motor accident and emergency treatment
  • Specialised radiology: R2,150 co-payment
  • Gap cover pays co-payments for procedures approved by medical aid
Alternatives to hospitals:
  • Medical rehabilitation, private nursing, hospice and step-down facilities: R47,900 per family. Paid by scheme.
  • No benefit
Casualty:
  • Paid from day-to-day benefit
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other:
  • Gastroscopies and colonoscopies: Anaesthetists covered up to R900
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Sublimits increased as necessary
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

No phone calls!
Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: R14,148 R11,280 R4,248
Self Payment:
(per year, if you use up all your savings)
R4,552 R4,920 R1,352
Above Threshold: Once your savings are depleted, and you have paid the self payment gap, scheme will cover most out of hospital expenses at scheme rate, with sublimits for some benefits.
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • Network GPs: 100% scheme rate
  • Non-network GPs: 75% scheme rate
  • No benefit
Childcare:
  • 2 consults with paediatrician for children under 1yr
  • No extra benefit available
Specialists consultations:
  • Paid from day-to-day benefit
  • No benefit
Pathology:
  • Paid from day-to-day benefit
  • No benefit
General radiology:
  • Paid from day-to-day benefit
  • No benefit
Specialised radiology:
  • Paid by scheme, with R2,150 co-payment, unless PMB
  • Co-payment paid, for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
Hospital stay:
  • Network specialists covered in full, otherwise 200% scheme rate
  • Pays up to 500% scheme rate for specialists, GPs and other medical professionals, in-hospital only
Consultations:
  • 12 consults, paid by scheme
  • No benefit
Scans:
  • 2 x 2D scans, paid by scheme
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R500,000 per person, with a 20% co-payment thereafter

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
Dentistry:
  • Standard dentistry: paid from day-to-day benefit
  • Specialised dentistry: paid from day-to-day benefit, R12,200 per person and R31,900 per family In-hospital: maxillo-facial surgery, impacted wisdom teeth and general anaesthesia for children under 7yrs: R1,650 co-payment and surgeon accounts accumulate to threshold and specialised dentistry sub-limit
  • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
Orthodontics:
  • See above
  • No extra benefit available
Maxillo Facial Surgery:
  • See above
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme, from Network provider
  • non-PMBs chronic: additional 36 conditions covered, R8,800 per family
  • No benefit
Acute (presrcibed) medication:
    Paid from day-to-day benefit, R15,900 per person and R30,000 per family
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefit
  • , but does not accumulate to threshold
  • No benefit
Birth Control:
  • Paid from day-to-day benefit
  • No benefit
On Discharge:
  • 7 days supply
  • No benefit
Biological:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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OPTOMETRY:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
Optometry:
    Paid from day-to-day benefit. R3,750 per person and R2,050 per frame
  • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
In-hospital:
  • R34,400 per person
  • Sublimits increased by R40,000 per event or medical condition
Out-of-hospital:
    Paid from day-to-day benefit, R18,000 per family
  • No benefit
Trauma:
  • Covers certain day-to-day claims for recovery from specific traumatic events (near drowning, poisoning, allergic reactions, etc)
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
General Appliances:
  • In-hospital: R6,300 per family, paid by scheme
  • Out-of-hospital: R22,200 per family
  • No benefit
1.1. Hearing Aids:
  • R6,700, subject to "General Appliances" limit
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • Unlimited, at Network chronic provider
HIV:
  • HIV related admissions: R65,900 per family
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport: Netcare 911
  • No benefit
International Insurance:
  • R8.2 million international emergency cover. Includes R15,500 for emergency optometry, R15,500 for emergency dentistry and R765,000 terrorism cover.
  • R1,550 co-payment applies for each outpatient claim
  • No benefit
Other:
    Cochlear implants: R166,000 per person
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
Flu vaccination:
  • Covered for under 18yrs and 60yrs+
  • No benefit
Pneumonia vaccines:
  • Covered for 60yrs+
  • No benefit
Back Rehabilitation Programme: TBC
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered for 15yrs+
  • No benefit
Mammogram:
  • Covered for 38yrs+, every 2 years
  • No benefit
PAS Test:
  • Covered for 40yrs+, every 1-5 years depending on age
  • No benefit
HIV Test:
  • Covered for 15yrs+, every 5 years
  • No benefit
Other:
  • Bone density scan: 50yrs+, every 3 years
  • Glaucoma test: 40yrs+, every 1-2 yrs, depending on age
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
Extender Network hospital (and Network provider for chronic)
Scheme Benefits Gap benefits
Overal Limit:
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
Sub-limits:
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid

No phone calls!
Our quote will include the right gap cover for this plan


    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised