Momentum Incentive Associate (associate for chronic) medical aid plan: 2019

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Incentive Network hospital (and Network provider for chronic)
2019 Costs:
Total Cost pm:

Main member:

R2,770

Adult:

R2,203

Child: (Pay only for first 3)

R1,052
Savings: R3,324 R2,640 R1,260
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IN HOSPITAL PROCEDURES:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
Specialists:
  • Up to 200% scheme rate
  • Contracted Specialists: covered in full
  • You or gap cover pay the balance, if any
Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Choose a Network Hospital, or pay 30% co-payment if you voluntarily choose another hospital
Specialised Radiology:
  • You or your gap pay R2,150 co-payment
  • In and out of hospital
Supplementary Services: (Physio, etc) TBC
Transplants:
  • Recipient: Unlimited
  • Donor: R20,500 cadaver costs and R41,500 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
  • R3,000 co-payment
  • Gastroscopies,
  • Nail surgery,
  • Cystoscopies, colonoscopies, sigmoidoscopies,
  • Removing of extensive skin lesions
  • No co-payment if done in day-clinic or R3,000 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: R3,000 co-payment
  • Otherwise, R1,500 co-payment for most admissions other than for maternity, motor accident and emergency treatment
  • Specialised radiology: R2,500 co-payment
Alternatives to hospitals:
    Medical rehabilitation, private nursing, hospice and step-down facilities: R51,000 per family. Paid by scheme.
Casualty:
  • From day-to-day benefit, unless PMB
Other:
  • Gastroscopies and colonoscopies: Anaesthetists covered up to R950
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)
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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:
Savings /yr: R3,324 R2,640 R1,260
General info: 2019 Benefits coming November 9, 2018
GP consultations:
  • 1 GP consult per person, paid by scheme, every 1-5 years (frequency depends on age)
  • Otherwise, no 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:
  • Paid by scheme, with R2,250 co-payment, unless PMB
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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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
Consultations:
  • 12 consults, paid by scheme
Scans:
  • 2 x 2D scans, paid by scheme
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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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
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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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
Specialised Dentistry:
  • Specialised dentistry: no benefit
In-Hospital Dentistry:
  • In-hospital: maxillo-facial surgery, impacted wisdom teeth and general anaesthesia for children under 7yrs: R1,700 co-payment and surgeon accounts paid from day-to-day benefits
Orthodontics:
  • From day-to-day benefit
Maxillo Facial Surgery:
  • See above
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MEDICATION:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:33 CDL conditions
  • Co-payment for non-formulary:
Acute (presrcibed) medication:
  • From day-to-day benefit
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
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OPTOMETRY:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
Optometry: From
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
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MENTAL HEALTH:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits Notes and Links:
In-hospital: 2019 Benefits coming November 9, 2018
Out-of-hospital:
  • From day-to-day benefit, unless PMB
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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
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OTHER BENEFITS:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits Notes and Links:
General Appliances:
  • In-hospital: R6,250 per family
  • Out-of-hospital: Day-to-day nemefit
  • No 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 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
Emergency Transport: Netcare 911
International Insurance:
  • R8 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
Other:
    Cochlear implants: R152,400 per person
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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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+
Back Rehabilitation Programme: TBC
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
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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PROSTHETICS:
Incentive Network hospital (and Network provider for chronic)
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R48,700 per person per event, maximum 2 events per year
  • External: R22,500 per family
Sub-limits:
  • Intraocular lenses: R6,700 per person per event, maximum 2 events per year
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    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