Momentum Incentive (associate provider for chronic) medical aid plan: 2020

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

Incentive Network hospital (and Network provider for chronic)
Total Cost pm:

Main member:

R2,988

Adult:

R2,377

Child:

R1,134
Savings: R3,588 R2,856 R1,356

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IN HOSPITAL PROCEDURES:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • 200% scheme rate
network Specialists:
  • Covered in full
non-Network GPs:
  • 100% scheme rate
network GPs:
  • Covered in full
Hospital Choice:
  • Network hospital
Penalty for using other hospital:
  • 30% of hospital account
  • n/a
Specialised Radiology:
  • R2,370 co-payment
Supplementary Services: (Physio, etc)
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • Recipient: Unlimited
  • Donor: R21,500 cadaver costs and R43,600 for live donor costs. Only covered if recipient is a member of the scheme
Co-payments:
  • Arthroscopies
  • Back and neck surgery
  • Carpal Tunnel release
  • Functional nasal and sinus procedures
  • Joint replacements
  • Laparoscopies
  • R3,150 co-payment
  • Gastroscopies,
  • Nail surgery,
  • Cystoscopies, colonoscopies, sigmoidoscopies,
  • Removing of extensive skin lesions
  • No co-payment if done in day-clinic or R3,150 co-payment if done in 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, there is no co-payment and paid out of available day-to-day benefits
  • In-hospital: R3,150 co-payment
  • Otherwise, R1,500 co-payment for most admissions other than for maternity, motor accident and emergency treatment
  • Specialised radiology: R2,370 co-payment
Alternatives to hospitals:
    Medical rehabilitation, private nursing, hospice and step-down facilities: R53,000 per family. Paid by scheme.
Casualty:
  • From day-to-day benefit, unless PMB
  • Both the Blue Plan and Red Plan gap cover will pay up to R10,000 per person for unpaid casualty costs in event of emergency
Other:
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R165,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R165,000 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)

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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):
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
General info:
  • Consider getting Primary Health Care (PHC) (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
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
  • See Primary Health Care benefit above
Childcare:
  • 2 consults with paediatrician for children under 1yr
Specialists consultations:
  • From day-to-day benefit, unless PMB
  • See Primary Health Care benefit above
Pathology:
    From day-to-day benefit , unless PMB.
  • See Primary Health Care benefit above
General radiology:
    From day-to-day benefit , unless PMB.
  • See Primary Health Care benefit above
Specialised radiology:
  • R2,370 co-payment
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB

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MATERNITY BENEFITS:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits Notes and Links:
Hospital stay:
  • Contracted Specialists: covered in full, otherwise 200% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
  • 12 consults, paid by scheme
  • 1 consult from nurse home visit, day after return from hospital
  • 1 consult from nurse home visit, 2 weeks after above visit
  • 1 consult from nurse home visit, 6 weeks after above visit
Scans:
  • 2 x 2D scans, paid by scheme

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CANCER (ONCOLOGY):
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R400,000 per person, with a 20% co-payment thereafter

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DENTISTRY:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard dentistry: One dental consult per year. Otherwise, from day-to-day benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Specialised Dentistry:
  • From day-to-day benefit
In-Hospital Dentistry:
  • In-hospital: maxillo-facial surgery, impacted wisdom teeth and general anaesthesia for children under 7yrs: Hospital and anaesthetist accounts paid by scheme, withR1,500 co-payment and surgeon accounts paid from day-to-day benefit
Orthodontics:
  • From day-to-day benefit
Maxillo Facial Surgery:
  • See above

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MEDICATION:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
Chronic:
  • 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 6 non-CDL conditions are covered on this plan, up to a R10,300 per family
  • Must use Network provider
Acute (presrcibed) medication:
  • From day-to-day benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Over-the-counter:
  • From day-to-day benefit
Birth Control:
  • From day-to-day benefit
On Discharge:
  • 7 days supply
Biological:
  • No benefit, unless PMB level of care

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OPTOMETRY:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
Optometry:
Limit:Day-to-day benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here

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MENTAL HEALTH:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits Notes and Links:
In-hospital:
  • R37,900 per person, at preferred provider
Out-of-hospital:
  • From day-to-day benefit, unless PMB
Trauma:
  • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts

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OTHER BENEFITS:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits Notes and Links:
General Appliances:
  • In-hospital: R6,560 per family
  • Out-of-hospital: day-to-day benefit
1.1. Hearing Aids:
  • From day-to-day benefit, unless PMB
1.2. Wheelchairs:
  • From day-to-day benefit, unless PMB
Dialysis:
  • Unlimited, at any chronic provider
International Insurance:
  • R8 million international emergency cover. Includes R15,500 for emergency optometry, R15,500 for emergency dentistry and R765,000 terrorism cover.
  • R1,710 co-payment applies for each outpatient claim
Other:
    Cochlear implants: R168,000 per person

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WELLNESS/PREVENTATIVE BENEFITS:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered for under 18yrs and 60yrs+
Pneumonia vaccines:
  • Covered for 60yrs+
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered for 15yrs+
Mammogram:
  • Covered for 38yrs+, every 2 years
PAS Test:
  • Covered for 40yrs+, every 1-5 years depending on age
HIV Test:
  • Covered for 15yrs+, every 5 years
Other:
  • Bone density scan: 50yrs+, every 3 years
  • Glaucoma test: 40yrs+, every 1-2 yrs, depending on age

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PROSTHETICS:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R51,100 per person per event, maximum 2 events per year
  • Intraocular lens: R6,700 per person, max 2 events per year
  • External, in-hospital: R23,000 per family
Sub-limits:
  • Intraocular lenses: R6,700 per person per event, maximum 2 events per year

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    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