Momentum Ingwe A (any provider) medical aid plan: 2020

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Ingwe A
2020 Costs:
Total Cost pm:

Main member:

R439

Adult:

R439

Child:

R439
Savings (per year):
  • No savings option on this plan
Income band:



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IN HOSPITAL PROCEDURES:
Ingwe A
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • The Blue Plan gap cover will increase this to 500% scheme rate
network Specialists:
  • n/a
  • The Blue Plan gap cover will increase this to 500% scheme rate
non-Network GPs:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
network GPs:
  • n/a
  • The Blue Plan gap cover will increase this to 500% scheme rate
Hospital Choice:
  • Choose any hospital
Penalty for using other hospital:
  • n/a
Specialised Radiology:
  • PMBs only and only in State facilities
Supplementary Services: (Physio, etc)
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • PMBs only and only in State facilities
Co-payments:
  • N/A
Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R13,130 per family
  • Private nursing and hospice: no benefit
Casualty:
  • 1 consult per person and 2 per family with R100 co-payment. This benefit is shared with out-of-network GP consults and after-hours consults
    • Both the Blue Plan and Red Plan gap cover will pay up to R20,000 per person for unpaid casualty costs in event of emergency
    Other:
    • High and Intensive Care: 10 days
      Excluded:
    • Cardiovascular: 24-hour halter ECG, Blood transfusions, carotid angiograms, coronary angiogram, coronary angioplasty, plasmapheresis
    • ENT: arthroscopies, direct laryngoscopy, nasal scans and surgery, functional nasal and sinus surgery
    • General surgery: removal of minor skin lesions, laparoscopy, nail surgery, treatment of headache
    • Gastro-intestinal: colonoscopy, ERCP, gastroscopies, oesophagoscopy, sigmoidoscopy
    • Gynaecology: cervical laser ablation, hysteroscopy
    • Neurology: 48-hour halter EEG, electro-convulsive therapy, hyperbaric oxygen treatment for decompression sickness, myelogram
    • Obstetrics: amniocentesis
    • Oncology: hyperbaric oxygen for radiation necrosis
    • Opthalmology: cataract removal, pterygium removal, trabeculectomy, treatment of disease of conjunctiva
    • Orthopaedic: arthroscopy, back and neck surgery, conservative neck and back treatment, joint replacements, bunionectomy
    • Respiratory: bronchography, bronchoscopy, treatment of adult influenza, treatment of adult respiratory tract infections
    • Urology: cystoscopy
    Note:
    • Gap cover is an add-on to your medical aid, not a stand alone product
    • Gap cover has a maximum benefit payout of R157,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R157,000 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):
    Ingwe A
    Scheme Benefits Notes and Links:
    Main Member: Adult: Child:
    Savings /yr: No savings option on this plan
    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:
    • Primary Care Network: Unlimited
    • Non-network: 1 consult per person and 2 per family with R100 co-payment. This benefit is shared with ER and after-hours consults
    Childcare:
    Specialists consultations:
    • From Ingwe Active Primary Care Network: 2 consults per family limited to R1,050 per consult and R2,100 per family
    • Psychologists and psychiatrists: PMB only, at State facilities
    Pathology:
    • Some specific pathology covered by scheme
    General radiology:
    • Some specific x-rays covered by scheme
    Specialised radiology:
    • PMBs only and only in State facilities
    • No benefit, unless PMB
    Supplementary Services: (Physio, etc)
    • PMBs only and only in State facilities



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    MATERNITY BENEFITS:
    Ingwe A
    Scheme Benefits Notes and Links:
    Hospital stay:
    • Elective C-sections: no benefit
    • The Blue Plan gap cover will increase this to 500% scheme rate
    Consultations:
    • 4 consults, paid by scheme
    • 1 consult from nurse home visit, day after return from hospital
    Scans:
    • 2 growth scans



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    CANCER (ONCOLOGY):
    Ingwe A
    Scheme Benefits Notes and Links:
    Overall coverage (in and out of hospital):
    • PMBs only and only in State facilities



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    DENTISTRY:
    Ingwe A
    Scheme Benefits Notes and Links:
    Standard Dentistry:
    • Standard dentistry: paid by scheme. Includes:
      • 1 consult per person
      • Fillings
      • Extractions
      • X-rays
    Specialised Dentistry:
    • Specialised dentistry: no benefit
    In-Hospital Dentistry:
    • PMBs only and only in State facilities
    Orthodontics:
    • No benefit
    Maxillo Facial Surgery:
    • PMBs only and only in State facilities



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    MEDICATION:
    Ingwe A
    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
    • Must be obtained from Primary Care Network
    Acute (presrcibed) medication:
    • Some prescribed medication covered by scheme
    Over-the-counter:
    • No benefit
    Birth Control:
    • No benefit
    On Discharge:
    • 7 days supply
    Biological:
    • No benefit, unless PMB level of care



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    OPTOMETRY:
    Ingwe A
    Scheme Benefits: Notes and Links:
    Optometry:
    Limit:Paid by scheme, every 2 years
    Consult:1 per person
    Frames:1 pair per person
    Single lenses1 set as needed
    Bifocals:1 set as needed
    Multifocals
    Contacts
    Refractive Surgery:No benefit
    Notes:



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    MENTAL HEALTH:
    Ingwe A
    Scheme Benefits Notes and Links:
    In-hospital:
    • PMBs only and only in State facilities
    Out-of-hospital:
    • PMBs only and only in State facilities
    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:
    Ingwe A
    Scheme Benefits Notes and Links:
    General Appliances:
    • In-hospital: R5,400 per family
    • Out-of-hospital: no benefit
    1.1. Hearing Aids:
    • No benefit
    1.2. Wheelchairs:
    • No benefit
    Dialysis:
    • PMBs only and only in State facilities
    International Insurance:
    • No benefit
    Other:



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    WELLNESS/PREVENTATIVE BENEFITS:
    Ingwe A
    Scheme Benefits: Notes and Links:
    Flu vaccination:
    • Covered
    Pneumonia vaccines:
    • No benefit
    Biometric Screening:
    • Covered
    Child Immunisation:
    • Covered
    Pap Smear:
    • Covered for 15yrs+
    Mammogram:
    • No benefit
    PAS Test:
    • Covered for 40yrs+, every 1-5 years depending on age
    HIV Test:
    • Covered for 15yrs+, every 5 years
    Other:



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    PROSTHETICS:
    Ingwe A
    Scheme Benefits: Notes and Links:
    Overal Limit:
    • PMBs only and only in State facilities
    Sub-limits:



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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