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

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

Pricing:

Extender Network hospital (and State provider for chronic)
Main member: Adult member: Child member:
Total Cost pm: R5,231 R3,967 R1,537
(Pay only for first 3)
Savings: R15,693 R11,901 R4,611
Self Payment Gap:
R8,207 R8,999 R2,289
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 State 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 State 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 State provider for chronic)
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R15,693 R11,901 R4,611
Self Payment Gap:
R8,207 R8,999 R2,289
Above Threshold: Unlimited
PMBs out of hospital:
  • 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.
General info:
GP consultations:
  • 1 GP consult per person, paid by scheme, every 1-5 years (frequency depends on age)
  • Otherwise, from day-to-day benefit, unless PMB
Childcare:
  • 2 consults with paediatrician for children under 1yr
Specialists consultations:
  • From day-to-day benefit, unless PMB
Pathology:
    From day-to-day benefit , unless PMB.
General radiology:
    From day-to-day benefit , unless PMB.
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)
  • From day-to-day benefit, unless PMB
General Appliances:
  • In-hospital: R7,230 per family, paid by scheme
  • Out-of-hospital: R25,500 per family
1.1. Hearing Aids:
  • R7,690, subject to "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
Note:
  • 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
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.



Medication cover:

Extender Network hospital (and State provider for chronic)
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings /yr: R15,693 R11,901 R4,611
Self Payment Gap:
R8,207 R8,999 R2,289
Above Threshold: Unlimited
Chronic:
Acute (presrcibed) medication:
    Paid from day-to-day benefit, R18,200 per person and R34,400 per family
Over-the-counter:
  • From day-to-day benefit
  • , but does not accumulate to threshold
Birth Control:
  • From day-to-day benefit
On Discharge:
  • 7 days supply
Biological:
  • Specialised oncology benefits are available for certain biologicals and immunologicals, subject to criteria
  • Oncologist must be authorised by scheme
Note:
  • 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
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.

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


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