Momentum Extender Network (for hospitals) Network (for chronic): in-and-out of hospital benefits (2021)

January 31, 2021

This page shows the In-hospital, Out-of-hospital and Medicine benefits for Momentum Extender Network hospital (and Network provider for chronic).

Pricing:

Extender Network hospital (and Network provider for chronic)
	Main member:	Adult member:	Child member:
Total Cost pm:	R5,969	R4,805	R1,717 (Pay only for first 3)
Savings:	R17,907	R14,415	R5,151
Self Payment Gap:	R5,993	R6,485	R1,749
Above Threshold:	Unlimited
Children Rates:	(Pay only for first 3)
Note:	Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list. All treatments and procedures are subject to authorisation and protocols All benefits are listed as an indication only. Please verify with your broker and scheme
View other benefits: Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: Compare any two plans, side by side \| View all the Momentum plans, with costs and brief summary

In-hospital Procedures:

Extender Network hospital (and Network provider for chronic)
non-Network Specialists:	200% scheme rate
network Specialists:	Covered in full
non-Network GPs:	Covered in full
network GPs:	Covered in full
Hospital Choice:	Associate hospitals, or 30% of the hospital account Full list of the Associate Hospitals
Penalty for using other hospital:	30% of hospital account/strong>
Specialised Radiology:	MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans: R2,480 co-payment, in and out of hospital
Supplementary Services: (Physio, etc)	When will this be updated?
Transplants:	Recipient: Unlimited Donor: R22,400/strong> cadaver costs and R45,300 for live donor costs. Only covered if recipient is a member of the scheme
Dialysis:	Unlimited, at any chronic provider
Day Hospitals:
Co-payments:	Arthroscopies Back and neck surgery Carpal Tunnel release Functional nasal and sinus procedures Joint replacements Laparoscopies R3,290 additional co-payment Gastroscopies, Nail surgery, Cystoscopies, colonoscopies, sigmoidoscopies, Removing of extensive skin lesions R3,290 additional co-payment if done in hospital No co-payment if done out-of- hospital Conservative back and neck treatment Treatment of diseases of conjuctiva Treatment of headaches Removing of minor skin lesions Treatment of adult influenza Treatment of adult respiratory tract infections If out of hospital, from day-to-day benefit, with no co-payment In-hospital: R3,290 additional co-payment Specialised radiology: R2,480 co-payment
Alternatives to hospitals:	Medical rehabilitation, private nursing, hospice and step-down facilities: R57,000 per family. Paid by scheme.
Casualty:	From day-to-day benefit, unless PMB
Other:	HIV related admissions: R75,600 per family, unless PMB
Note:	PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means. DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit. Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones here, but you must consult with your scheme to get the full list.
View other benefits: Inhospital \| Out of hospital \| Medication \| Maternity \| Cancer \| Mental Health \| Dentistry \| Optometry \| Other/Extra Benefits \| Wellness \| Prosthetics You can also: Compare any two plans, side by side \| View all the Momentum plans, with costs and brief summary

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Out-of-hospital Procedures:

Extender Network hospital (and Network provider for chronic)

	Main Member:	Adult:	Child:
Savings /yr:	R17,907	R14,415	R5,151
Self Payment Gap:	R5,993	R6,485	R1,749
Above Threshold:	Unlimited

How do medical aids pay for day-to-day claims?

All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
This can include consults with specialists, blood or other tests, radiology and medicine
The benefit is paid by the scheme, and not out of your savings account
If you have no day-to-day funds, you still have cover for PMBs
Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
See our Guide to PMBs for more information.

1 GP consult per person, paid by scheme, every 1-5 years (frequency depends on age)
Otherwise, from day-to-day benefit, unless PMB

2 consults with paediatrician for children under 1yr

From day-to-day benefit, unless PMB

day-to-day benefit

MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans: R2,480 co-payment, in and out of hospital

From day-to-day benefit, unless PMB

In-hospital: R7,230 per family, paid by scheme
Out-of-hospital: R25,500 per family

R7,690, subject to "General Appliances" limit

See "General Appliances" limit

PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product

Medication cover:

Extender Network hospital (and Network provider for chronic)

	Main Member:	Adult:	Child:
Savings /yr:	R17,907	R14,415	R5,151
Self Payment Gap:	R5,993	R6,485	R1,749
Above Threshold:	Unlimited

How do medical aids pay for day-to-day claims?

All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. Find out more
An additional 36 non-CDL conditions are covered on this plan, up to a R10,700 per family
You must use a network provider for chronic benefits

day-to-day benefit

R18,200 per person

R34,400 per family

From day-to-day benefit

From day-to-day benefit

7 days supply

Specialised oncology benefits are available for certain biologicals and immunologicals, subject to criteria

Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product

Important!

Unless specified, assume that all benefits 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

There’s more help here:

Compare any 2 medical aid plans, side by side
Find your plan and see all its benefits
Find a medical aid by price
Find a doctor or healthcare professional

Table of Contents