Our Benefits Marketing Brochure 2020

Our benefits Marketing Brochure 2020

Index

2 Make the right choice 4 Individual contributions

Options: 6 Ingwe Option 8 Evolve Option 10 Custom Option 12 Incentive Option 14 Extender Option 16 Summit Option

18 Health Platform Benefit 20 Specialised Procedures/Treatment 22 Chronic Benefit 24 List of hospitals 26 Exclusions Financial adviser call centre 0800 43 25 84 27 Glossary of terms Member call centre 0860 11 78 59 Emergency evacuation 082 911 Fraud hotline 0800 00 04 38 [email protected] General disclaimers This brochure is a marketing aid. Members [email protected] On joining the Scheme, all Momentum Health members receive a detailed Claims [email protected] member brochure. Note that Momentum Health may specify certain Financial advisers [email protected] principles relating to the use of your benefits. Scheme Rules will always take precedence and are available on request. [email protected] In terms of the Medical Schemes Act, medical schemes may apply waiting periods and/or late joiner penalties to new members joining the Website momentumhealth.co.za Scheme. If we do apply a waiting period and/or a late joiner penalty to your Postal address PO Box 2338 Durban 4000 membership, we will let you know before we activate your cover. 2 Make the right choice important to match yourimportant family’s healthcare needs.Usethefollowing guideto findtheoptionthatbestmatches your needs. Momentum Healthstrives to offer you good value for money by combining flexibility withcomprehensive cover, becauseitis Make therightchoice available from your chosenPrimary Care Network provider. On theIngwe Option,HealthPlatform Benefitsare only Rand amountperbenefit,provided you notifyusbefore usingthebenefit. Health Platform Benefitsare paidby theSchemeupto amaximum Health Platform HealthSaver+. You have thechoice ofaddingmore day-to-day cover through the prescribed medication,etc. This benefitprovides for day-to-day medicalexpenses, suchasGPvisits, Day-to-day approval. Minimum Benefits(PMBs). Chronic benefitsare subjectto registration and Chronic DiseaseList(CDL) conditions, whichform ofthePrescribed part need ongoing treatment. The Chronic Benefitincludescover for the26 The Chronic Benefitcovers certain life-threatening conditions that Chronic appropriate andhasbeenpre-authorised. registered day clinicorout-patient facility, provided treatment isclinically out-of-hospital procedures thatcansafely beperformed inadoctor’s room, The MajorMedicalBenefitprovides cover for hospitalisationandcertain Major Medical products that Momentumoffers. and isaseparate entity to MomentumHealth.You canbeamemberofMomentum Healthwithouttakingany ofthecomplementary innovative HealthReturns solution.These complementary products are notmedicalscheme benefits.Momentumisnotamedicalscheme, enhance your medicalaid.These voluntary complementary products range from aworld-class lifestyle programme, Multiply, to the You canchooseto make use ofadditionalproducts available from ofMomentumMetropolitan Momentum, apart Life Limited, to seamlessly Complementary MomentumProducts The BenefitStructure Benefit Benefit Benefit Benefit

26 No overall annuallimitapplies at negotiated rate Hospital accounts covered infull 100% Specialists covered upto Secondary care prescribed medicine,etc.) Primary care Network Chronic Benefitformulary: health educationandadvice andemergency cover. a leadingmaternity programme, management ofcertain diseases, of life andgives peace ofmindthrough preventative care, earlydetection, The HealthPlatform encourages healthawareness, enhances quality

conditions -noannuallimitapplies ofMomentumHealthRate Network providers** Ingwe Active Primary Care Care Network providers** tests, x-rays, etc. including doctor, pharmacy, blood For medicalmanagement or Network hospitals* Any hospital,Ingwe Primary Care Network providers** providers** Ingwe Primary Care Network entrylevel formulary State hospitals (such asGPvisits, (Specialist visits) Option Ingwe

or Ingwe Active

Ingwe Primary

26 26 Other specialistscovered upto Associated specialistscovered infull. You may addthe R1 570 No overall annuallimitapplies at negotiated rate Hospital accounts covered infull Momentum HealthRate cover for your day-to-day healthcare needs State Chronic Benefitformulary: conditions -noannuallimitapplies formulary co-payment applies State blood tests, x-rays, etc. including doctor, pharmacy, For medicalmanagement Network hospitals* Evolve Any facilities

HealthSaver+ Option Evolve

to provide 100%

Option Evolve

cover for your day-to-day healthcare needs You may addthe State: Associated: Any: Chronic Benefitformulary: 26 R1 570 No overall annuallimitapplies at negotiated rate Hospital accounts covered infull Momentum HealthRate Other specialistscovered upto Associated specialistscovered infull.

conditions -noannuallimitapplies Core formulary + State formulary co-payment applies

HealthSaver is acomplementary product offered by Momentum Any Medical management incl.doctor, hospitals* Any medication), or pharmacy for chronic GPsCourier andMedipost Associated** Any pharmacy, bloodtests, x-rays, etc. healthcare expenses. You needto The optionthatyou choosewilldetermine how muchyou willpay, andhow muchcover you willhave for thedifferent types of of chronic medication(like pillsto lower highbloodpressure), day-to-day expenses (like visitingyour GP), oremergency care. Healthcare expenses involve more thanjustthecost ofyour stay inhospital,itcould bethecost

Entry level formulary (Any GPandany pharmacy), or Associated an additional amount by choosingto contribute for medical expenses Add more cover HealthSaver and pocket that suitsyour needs HealthSaver+ Option Custom

(Selected preferred State

facilities to provide 100%

Savings R10 300 Additional 26 No overall annuallimitapplies at negotiated rate Hospital accounts covered infull Momentum HealthRate Other specialistscovered upto Associated specialistscovered infull. State: Associated: Any: Chronic Benefitformulary:

conditions -noannuallimitapplies

Standard formulary

State formulary 10% Savings ifavailable Any medication), or pharmacy for chronic GPsCourier andMedipost Associated** Any pharmacy, bloodtests, x-rays, etc. Medical management incl.doctor, hospitals* Any perfamily

6 conditions limited to , subjectto oftotal contribution

(Any GPandany pharmacy), or Entry level formulary Associated Option Incentive

(Selected preferred State

facilities * View alistofthesehospitals onpage 24 200%

Extended Cover Savings State: Associated: Any: Chronic Benefitformulary: R10 300 Additional 26 No overall annuallimitapplies at negotiated rate Hospital accounts covered infull Momentum HealthRate Other specialistscovered upto Associated specialistscovered infull.

conditions -noannuallimitapplies

Extended formulary

State formulary 25% medication), or pharmacy for chronic GPsCourier andMedipost Associated** Any pharmacy, bloodtests, x-rays, etc. Medical management incl.doctor, hospitals* Any consultations) an Associated GPfor GP their chronic provider mustuse who have chosenAssociated as Any perfamily 36

Entry level formulary or (Any GPandany pharmacy), or of total contribution plus conditions limited to

Associated Associated Option Extender

(Selected preferred State

(Members ** facilities View alistoftheseproviders onmomentumhealth.co.za 200%

See separate MomentumComplementary

Product brochure for more information of

No overall annuallimitapplies at negotiated rate Hospital accounts covered infull Momentum HealthRate Other specialistscovered upto Associated specialistscovered infull. 26 36 both day-to-day cover andcover for the This isacombined limitincorporating day-to-day limitof Paid from riskbenefit,subjectto overall Comprehensive Chronic Benefitformulary: per beneficiary to theoverall day-to-day limitof Additional additionalchronic conditions.

conditions -noannuallimitapplies Freedom-of-choice Freedom-of-choice blood tests, x-rays, etc. including doctor, pharmacy, For medicalmanagement Any hospital 36 conditions accumulate formulary Option Summit

R25 900

perbeneficiary 300%

R25 900

3 Make the right choice 4 Individual contributions Custom Evolve Ingwe Incentive

Monthly income Individual

Option Option

Option

Option R9 451 -R13500 R7 151 -R9450 R726 -R7150 R13 501+ <= R725 contributions Evolve Network Ingwe Network Ingwe Network Ingwe Network Ingwe Network Ingwe Network Associated Associated Hospital Hospital Hospital Hospital State State State State State Any Any Any Any Any Any Any Ingwe Active Primary Care Network Ingwe Active Primary Care Network Ingwe Active Primary Care Network Ingwe Active Primary Care Network Ingwe Active Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Associated Associated Associated Associated Chronic Chronic Chronic Chronic Chronic Chronic State State State State State Any Any Any Any

Annual Savings Savings 10% Risk contribution Total contribution Annual Savings Savings 10% Risk contribution Total contribution Annual Savings Savings 10% Risk contribution Total contribution Annual Savings Savings 10% Risk contribution Total contribution Annual Savings Savings 10% Risk contribution Total contribution Annual Savings Savings 10% Risk contribution Total contribution Ingwe Active Primary Care Network Ingwe Active Primary Care Network Ingwe Active Primary Care Network Ingwe Active Primary Care Network Ingwe Active Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Ingwe Primary Care Network Day-to-day R2689 R2 090 R3 900 R3 960 R2 496 R2 988 R2 658 R1 294 R4 476 R2 269 R3 732 R2 568 R3 588 R2 238 R2 926 R2 872 R3 359 R2 392 R1 644 R2 767 R2 106 R1 602 R1 642 R3 301 R1175 R2 319 R3 251 R3 192 R2 971 R1 927 R2 141 R1 661 P R1 151 P P R905 P R439 R439 R439 R824 R266 R299 R330 R325 R373 R961 R719 R214 R2 094 R2 609 R3 032 R2 508 R1 294 R2 390 R2 028 R2 348 R2 656 R2 269 R2139 R2 856 R3 636 R2 238 R2 872 R2 729 R1 644 R1 690 R2 377 R1 830 R1 950 R1 602 R1 885 R1175 R1 633 R1 242 R2 221 R3 192 R1 577 R3 132 R1 661 A R1 521 R439 R1 151 A A A R905 R209 R439 R439 R824 R303 R266 R238 R961 R719 R169 R261 R1 294 R1 454 R1 309 R1021 R1 260 R1 278 R1 740 R1 536 R1 356 R1 233 R1 476 R1 051 R1 134 R1 150 C R439 R1 110 R833 C C R430 R466 C R499 R988 R668 R984 R946 R907 R388 R396 R497 R582 R744 R766 R739 R397 R378 R523 R414 R821 R818 R416 R105 R471 R145 R128 R123 R113 R82 Individual contributions Summit Extender On theIngwe Option,allchildren are charged for. OntheEvolve, Custom, Incentive, Extender andSummitOptions, amaximumof3 children are charged for P =Principal Option

Option

A =Adult

C = Child

Child rates apply to dependantsyounger than21 Associated Hospital Hospital Any Any

Freedom-of-choice Associated Associated Chronic Chronic Chronic State State Any Any Threshold Annual Savings Savings 25% Risk contribution Total contribution Threshold Annual Savings Savings 25% Risk contribution Total contribution Threshold Annual Savings Savings 25% Risk contribution Total contribution Risk contribution Total contribution Threshold Annual Savings Savings 25% Risk contribution Total contribution Threshold Annual Savings Savings 25% Risk contribution Total contribution Threshold Annual Savings Savings 25% Freedom-of-choice Day-to-day R22 900 R22 900 R22 900 R22 900 R22 900 R22 900 R18732 R15 096 R19 068 R21 300 R17 184 R5 033 R6 244 R4 683 R17 136 R5 729 R4 297 R4 285 R4 768 R6 357 R3 775 R10 187 R5 326 R1 432 R1 258 R1 428 R1 589 R5 713 R1 775 R7 101 R1 561 P P R20000 R20000 R20000 R20000 R20000 R20000 R15084 R13 836 R15 360 R14 076 R11 448 R17 160 R5 029 R3 840 R3 459 R2 863 R4 289 R4 612 R3 772 R3 817 R5 120 R4 691 R8 147 R1 430 R1 280 R5 719 R1 257 R3 518 R1 153 R1 173 A R954 A R6600 R6600 R6600 R6600 R6600 R6600 R2 340 R5304 R5 040 R5 484 R4 440 R4 944 R2 037 R1 480 R1 829 R1 648 R6 108 R1 679 R1 528 R1 259 R1 372 R1 236 R1 325 R1 767 R1 110 C R420 R509 C R457 R442 R370 R412 5 Individual contributions 6 Options All children are charged for income monthly Choose your R13 501+ <= R725 R13 500 R9 451 - R7 151 - R9 450 R7 150 R726 -

Choose your Ingwe Network Ingwe Network Ingwe Network Ingwe Network Ingwe Network Hospital State State State State State Any Any Any Any Any providers Ingwe Active Primary Ingwe Active Primary Ingwe Active Primary Ingwe Active Primary Ingwe Active Primary Ingwe Primary Care Ingwe Primary Care Ingwe Primary Care Ingwe Primary Care Ingwe Primary Care Care Network Care Network Care Network Care Network Care Network Network Network Network Network Network Chronic Chronic Ingwe Active Primary Ingwe Active Primary Ingwe Active Primary Ingwe Active Primary Ingwe Active Primary Ingwe Primary Care Ingwe Primary Care Ingwe Primary Care Ingwe Primary Care Ingwe Primary Care Momentum thatletsyou save for medicalexpenses. HealthSaver If you needmore day-to-day cover, you canchooseto make useofthe benefits available from your chosennetwork provider. The chronic andday-to-day benefits. may onlyuseGPs ontheIngwe Active Primary Care Network for your Care Network providers. Ifyou chooseAny hospital,pleasenote thatyou consult Ingwe Primary Care Network providers orIngwe Active Primary prescribed medicine,dependingonyour provider choice, you needto For lower monthlycontribution. private hospitals(see page 24 for thislist),orState hospitalsfor aneven cover, you canchooseto useeitherAny hospital,theIngwe Network of There isnooverall annuallimitfor The Ingwe Optionprovides affordable access to entrylevel cover. Overview Care Network Care Network Care Network Care Network Care Network Day-to-day chronic treatment Network Network Network Network Network Health Platform +. HealthSaver+ isacomplementary product offered by Choose your R2 269 R2 238 R2 872 R1 644 R1 602 R1175 R1 661 benefitprovides cover for arange ofpreventative care R905 R439 R439 R439 R1 151 R719 R824 R961 and day-to-day benefits family composition R2350 R1438 R3 204 R4 538 R4 476 R3 288 R2 302 R5 744 R3 322 R1810 R1 648 R1 922 R878 R878 R878 hospitalisation R3 705 R2 073 R2 937 R1641 R2 160 R1107 R1319 R1 377 R2 761 R1 581 R2 141 R1 221 R835 R878 R817 , suchasGPvisitsor R2224 R4 999 . For your hospitalisation R2 045 R2816 R5 206 R1826 R1256 R2 338 R3 785 R6 577 R1274 R2 732 R3 675 R1317 R3 821 R2638 R3282 R1634 R4 320 R2 442 R2214 R1670 R4 282 R1756 R2 754 R5 874 R5 522 R4 146 R7 410 R3 162 R2066 R2602 R3052 R3748 R6 045 R2012 R6 542 R4 779 R2195 R2 839 R8 243 R3 592 R4 819 R4 617 R3 170 + — — — — —

Over-the-counter medication Prescribed medication whole bodyradioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), Radiology –basic(such asX-rays) Pathology –basic(such asbloodsugar orcholesterol tests) Optical andoptometry (excl. contact lensesandrefractive eye surgery) Physiotherapy Specialists Out-of-network GP, casualty orafter-hours visits General practitioners External medicalandsurgical appliances (incl.hearingaids,wheelchairs etc.) Dentistry –specialised(such asbridges orcrowns) Dentistry –basic(such asextractions orfillings) Mental health(incl.psychiatry andpsychology) Osteopathy, Audiometry, Chiropody andPodiatry and Speechtherapy, Chiropractors, Dieticians,Biokinetics,Orthoptists, Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational General ruleapplicableto Day-to-day Benefits Savings Provider Day-to-day Benefit General ruleapplicableto Chronic Benefits Cover Provider Chronic Benefit HIV related admissions Anti-retroviral treatment Immune deficiencyrelated to HIV Private nursing andHospice Medical rehabilitation andstep-down facilities Take-home medicine - drugandalcohol rehabilitation - incl.psychiatry andpsychology Mental health whole bodyradioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), Prosthesis –external (such armsorlegsetc.) asartificial etc.) Prosthesis –internal (incl.kneeandhipreplacements, permanentpacemakers and backbraces etc.) Medical andsurgical appliances in-hospital(such stockings, knee assupport Neonatal intensive care Caesarean sections:Onlyemergency caesareans are covered Maternity confinements In-hospital dentalandoral benefits Organ transplants Renal dialysis andOncology High andintensive care General ruleapplicableto MajorMedicalBenefits Provider Benefit Major MedicalBenefit — — — — — HealthSaver isacomplementary product offered by Momentum The sub-limitsspecifiedapplyperyear. Shouldyou notjoinin January, your sub-limits willbeadjusted pro-rata (thismeansitwillbeadjusted in linewiththenumberofmonthsleftinyear) facility charges andtheamountcharged by theprovider you use If you chooseState hospitals asyour preferred provider for theMajorMedical Benefitanddonot usethisprovider, aco-payment willapply. This co-payment willbethedifference inthecost between State will beresponsible for 70% ofthenegotiated tariff If you chooseIngwe Network hospitals asyour preferred provider for MajorMedical Benefitsanddonotusethisprovider, you willhave aco-payment of30% onthehospital account andMomentumHealth Chronic andDay-to-day Benefitsare onlyavailable from the Ingwe PrimaryCare Network ortheIngwe Active PrimaryCare Network This table represents asummaryofthebenefitsfor 2020 Limited to Prescribed MinimumBenefitsatState facilities 10 days peradmission condition line withtheSchemeRulesandclinicalprotocols thattheSchemehasestablishedfor thetreatment ofeach cancer you willneedto register onaDiseaseManagement Programme. MomentumHealthwillpay benefitsin You needto phonefor authorisationbefore makinguseofyour MajorMedicalBenefits.For someconditions like Any hospital,Ingwe Network hospitalsorState hospitals No overall annuallimitapplies Hospital accounts are covered infullattherate agreed uponwiththehospitalgroup Specialists covered upto 100%ofMomentumHealthRate 2 visitsperfamily peryear, limited to R1050pervisitandupto amaximumofR2100 perfamily peryear. Covered Maximum of2visitsperfamily per year, R100co-payment pervisitapplies otherwise a30%co-payment willapplyandMomentumHealthberesponsible for 70% ofthenegotiated tariff) 1 visitperbeneficiaryyear, subjectto authorisation(you needto authorisewithin72 hours oftheconsultation, the 11thvisitonwards mustbepre-authorised There isnolimitto thenumberoftimesyou visityour Primary Care Network GP. However, pleasenote allvisitsfrom Not covered Not covered beneficiary. You needto callusfor pre-authorisation ifyou have more than4fillingsorextractions Examinations, fillingsandx-rays asperthelistoftariffcodes. Onedentalconsultation iscovered peryear per Limited to Prescribed MinimumBenefitsatState facilities Limited to Prescribed MinimumBenefitsatState facilities subject to thenetwork’s listofapplicabletariffcodes subject to therulesandprovisions setby thenetwork, commonly referred to asprotocols. This benefitisalso Benefits are onlyavailable from theIngwe Primary Care Network orIngwe Active Primary Care Network, andare Not applicable.You canchooseto addtheHealthSaver Ingwe Primary Care Network orIngwe Active Primary Care Network subject to alistofmedicine,referred to asaNetwork entrylevel formulary Benefits are onlyavailable from theIngwe Primary Care Network orIngwe Active Primary Care Network, andare 26 conditions, according to Chronic DiseaseListinPrescribed MinimumBenefits Ingwe Primary Care Network orIngwe Active Primary Care Network R34 000perfamily R31 900perfamily At your chosennetwork provider Not covered R13 130perbeneficiary 7 days’ supply Limited to Prescribed MinimumBenefitsatState facilities, 21-day sub-limitappliesto drugandalcohol rehabilitation Limited to Prescribed MinimumBenefitsatState facilities Limited to Prescribed MinimumBenefitsatState facilities Limited to Prescribed MinimumBenefitsatState facilities R5 400perfamily No annuallimitapplies No annuallimitapplies Not covered. Maxillo-facial trauma covered atState facilities, limited to Prescribed MinimumBenefits Limited to Prescribed MinimumBenefitsatState facilities Not covered Subject to alistofmedicine,referred to asaprescribed formulary Limited to Prescribed MinimumBenefitsatState facilities Specific listofblackandwhite x-rays covered Specific listofpathologytests covered years. Spectacleswillonlybegranted ifyour refraction measurement ismore than0.5 1 eye test and1pairofclearstandard orbi-focal lenseswithstandard frame asperformulary perbeneficiaryevery 2 Included inthespecialistlimit Minimum BenefitsatState facilities provider andpre-authorisation. PsychologistsNetwork andpsychiatristsCare are limited to Prescribed Primary at 100%ofMomentumHealthRate. Subject to referral by your Ingwe Primary Care Network orIngwe Active + 7 Options 8 Options Maximum of3children charged for Your Evolve Network providers Hospital Chronic Chronic State

Choose your R1 294 family composition motor vehicle accidents, maternity confinements andemergency treatment. There isaco-payment for MajorMedicalBenefits,except inthecaseof medical expenses. is acomplementary product offered by Momentumthatletsyou save for medicine, you canchooseto make useofthe If you needcover for otherday-to-day expenses, like GPvisitsorprescribed preventative screening tests, certain check-ups andmore. The scripts, medicationandtreatment. For limit for hospitalisation. of private hospitals(see page 24 for thislist).There isnooverall annual The Evolve Optionprovides cover for Overview R2 588 chronic Health Platform

treatment R2 588 Benefitprovides cover for arange ofbenefits,such as , you needto useState facilities for your chronic R3 882 hospitalisation R5 176 HealthSaver R6 470 attheEvolve Network +. HealthSaver+ + * — — —

Over-the-counter medication Prescribed medication whole bodyradioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), Radiology (such asX-rays) Pathology (such asbloodsugar orcholesterol tests) Optical andoptometry (incl.contact lensesandrefractive eye surgery) Specialists General practitioners pressure monitors, wheelchairs etc.) External medicalandsurgical appliances (incl.hearingaids,glucometers, blood Dentistry –specialised(such asbridges orcrowns) Dentistry –basic(such asextractions orfillings) Mental health(incl.psychiatry andpsychology) Osteopathy, Audiometry, Chiropody, Physiotherapy andPodiatry and Speechtherapy, Chiropractors, Dieticians,Biokinetics,Orthoptists, Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational General ruleapplicableto Day-to-day Benefits Savings Provider Day-to-day Benefit General ruleapplicableto Chronic Benefits Cover Provider Chronic Benefit HIV related admissions Anti-retroviral treatment Immune deficiencyrelated to HIV Medical rehabilitation, private nursing, Hospice andstep-down facilities Trauma benefit Take-home medicine - drugandalcohol rehabilitation - incl.psychiatry andpsychology Mental health whole bodyradioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), Prosthesis –external (such armsorlegsetc.) asartificial Prosthesis –internal (incl.permanentpacemakers, cochlear implants,etc.) and backbraces etc.) Medical andsurgical appliances in-hospital(such stockings, knee assupport Neonatal intensive care Maternity confinements In-hospital dentalandoral benefits Organ transplants Oncology Renal dialysis Casualty orafter-hours visits High andintensive care General ruleapplicableto MajorMedicalBenefits Co-payment Provider Benefit Major MedicalBenefit — — — See glossaryonpage 27 for thedefinitionofemergency treatment HealthSaver isacomplementary product offered by Momentum The sub-limitsspecified applyperyear. Shouldyou notjoininJanuary, your sub-limitswillbeadjusted pro-rata (thismeans itwillbeadjusted inlinewiththenumberofmonthsleftyear) If you donotuseEvolve Network hospitals for MajorMedical Benefits,you willhave aco-payment of30%onthehospital account andMomentumHealthwillberesponsible for 70% ofthenegotiated tariff This table represents asummaryofthebenefitsfor 2020 Benefits are subjectto HealthSaver Not applicable.You canchooseto addtheHealthSaver Any Benefits are subjectto registration ontheChronic Management Programme andapproval by theScheme 26 conditions, according to Chronic DiseaseListinPrescribed MinimumBenefits State facilities R37 900perfamily No annuallimitapplies At your chosennetwork provider R45 900perfamily the event iscovered asperauthorisation drowning, poisoning,severe allergic reaction andexternal andinternal headinjuries.Appropriate treatment related to Covers certain day-to-day claimsthatformoftherecovery part following specifictraumatic events, suchasnear 7 days’ supply Limited to Prescribed MinimumBenefitsatState facilities, 21-day sub-limitappliesto drugandalcohol rehabilitation No annuallimitapplies,subjectto aco-payment ofR2620 perscanandpre-authorisation R21 900perfamily Other internal prostheses: R33200perbeneficiaryevent, maximum2events peryear Intraocular lenses:R4990perbeneficiaryevent, maximum2events peryear R5 950 perfamily No annuallimitapplies No annuallimitapplies Not covered. Maxillo-facial trauma covered atState facilities, limited to Prescribed MinimumBenefits Limited to Prescribed MinimumBenefitsatState facilities Evolve Network ofOncologists apply to chemotherapy andadjuvant medication.You needto get your oncology treatment andmedicationfrom the R200 000perbeneficiaryyear, thereafter a20%co-payment applies.MomentumHealthReference Pricing will Limited to Prescribed MinimumBenefitsatState facilities Subject to HealthSaver No annuallimitapplies condition line withtheSchemeRulesandclinicalprotocols thattheSchemehasestablishedfor thetreatment ofeach cancer, you willneedto register onaDiseaseManagement Programme. MomentumHealthwillpay benefitsin You needto phonefor authorisationbefore makinguseofyour MajorMedicalBenefits.For someconditions, like An additionalco-payment may applyfor specialisedprocedures -seepage 22 R1 570 perauthorisation,except for motor vehicle accidents, maternity confinements andemergency treatment Evolve Network hospitals No overall annuallimitapplies Hospital accounts are covered infullattherate agreed uponwiththehospitalgroup Other specialistscovered upto 100%ofMomentumHealthRate Associated specialistscovered infull Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver (see MomentumComplementary Product brochure for more details onHealthSaver Subject to HealthSaver Subject to HealthSaver Covered from MajorMedical Benefit,subjectto R2620 co-payment perscanandpre-authorisation Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver + + + + + + + + + + + + + ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable + ifavailable + + ) * .

9 Options 10 Options Maximum of3children charged for Choose your Associated Hospital Any providers Associated Associated Chronic State State Any Any Choose your R2 090 R2 496 R2 767 R2 106 R1 642 R2 319 family composition motor vehicle accidents, maternity confinements andemergency treatment. There isaco-payment for MajorMedicalBenefits,except inthecaseof medical expenses. is acomplementary product offered by Momentumthatletsyou save for medicine, you canchooseto make useofthe If you needcover for otherday-to-day expenses, like GPvisitsorprescribed preventative screening tests, certain check-ups andmore. The the maximumcontribution discount. State facilities for your chronic script,medicationandtreatment to obtain pharmacy for your chronic medication.Alternatively, you canchooseto use use alistofAssociated GPs for your chronic scriptandMedipostcourier choose to receive adiscount onyour monthlycontribution by selectingto chronic scriptsandany pharmacyfor your chronic medication.Oryou can For to asAssociated hospitals,seepage 24 for thislist). contribution by selectingto useaspecificlistofprivate hospitals(referred access to any hospitaloryou canchooseto receive adiscount onyour There isnooverall annuallimitfor hospitalisation.You canchooseto have The Custom Optionprovides cover for Overview chronic Health Platform R4 446 R4 988 R2 884 R3 667 R3 739 R4 149

treatment Benefitprovides cover for arange ofbenefits,such as , you canchooseto have access to any GPfor your R2 850 R3 403 R2 856 R2 224 R3 755 R3 137 hospitalisation R4 483 R3 466 R4 433 R4 967 R5 976 R5 353 HealthSaver atprivate hospitals. R4 048 R6 964 R6 260 R5 785 R5 227 R5 199 +. HealthSaver+ R4 630 R6 603 R5 965 R7 952 R5 971 R7 167 + ** * — — —

Osteopathy, Audiometry, Chiropody, Physiotherapy andPodiatry and Speechtherapy, Chiropractors, Dieticians,Biokinetics,Orthoptists, Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational General ruleapplicableto Day-to-day Benefits Savings Provider Day-to-day Benefit General ruleapplicableto Chronic Benefits Cover Provider Chronic Benefit HIV related admissions Anti-retroviral treatment Immune deficiencyrelated to HIV Medical rehabilitation, private nursing, Hospice andstep-down facilities Take-home medicine - drugandalcohol rehabilitation - incl.psychiatry andpsychology Mental health Prosthesis -external (such armsorlegsetc.) asartificial cochlear implants,etc.) Prosthesis –internal (incl.kneeandhipreplacements, permanentpacemakers, back braces etc.) Medical andsurgical appliances in-hospital(such stockings, kneeand assupport whole bodyradioisotope andPETscans(in-out-of-hospital) MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), Neonatal intensive care Maternity confinements Over-the-counter medication Prescribed medication whole bodyradioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), Radiology (such asX-rays) Pathology (such asbloodsugar orcholesterol tests) Optical andoptometry (incl.contact lensesandrefractive eye surgery) Specialists General practitioners pressure monitors, wheelchairs etc.) External medicalandsurgical appliances (incl.hearingaids,glucometers, blood Dentistry –specialised(such asbridges orcrowns) Dentistry –basic(such asextractions orfillings) Mental health(incl.psychiatry andpsychology) and Limited to maxillo-facial surgery (excluding implants), impacted wisdom teeth In-hospital dentalandoral benefits Only covered whenrecipient isamemberoftheScheme Organ transplants (donor) Organ transplants (recipient) Oncology Renal dialysis Casualty orafter-hours visits High andintensive care General ruleapplicableto MajorMedicalBenefits Co-payment Provider Benefit Major MedicalBenefit — — —

general anaesthesiafor children under7 See glossaryonpage 27 for thedefinitionofemergency treatment HealthSaver isacomplementary product offered by Momentum The sub-limitsspecified applyperyear. Shouldyou notjoininJanuary, your sub-limitswillbeadjusted pro-rata (this means itwillbeadjusted inlinewiththenumberofmonthsleftyear) responsible for 70% ofthenegotiated tariff If you chooseAssociated hospitals asyour preferred provider for Major Medical Benefits,anddonotusethisprovider, you willhave aco-payment of30%onthehospital account. MomentumHealthwillbe This table represents asummaryofthebenefitsfor 2020 If you chooseState asyour chronic provider, you needto make useofState facilities for renal dialysis Associated asyour chronic provider, you need to obtain your oncology medication from Medipost ** **

Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver (see MomentumComplementary Product brochure for more details onHealthSaver Benefits are subjectto HealthSaver Not applicable.You canchooseto addtheHealthSaver Any Benefits are subjectto registration ontheChronic Management Programme andapproval by theScheme 26 conditions, according to Chronic DiseaseListinPrescribed MinimumBenefits Any, Associated orState R67 200perfamily No annuallimitapplies At your chosennetwork provider R51 100perfamily 7 days’ supply preferred provider R35 600perbeneficiary, R21 900perfamily Other internal prostheses: R46600perbeneficiary perevent, maximum2events peryear Intraocular lenses:R5500perbeneficiaryevent, maximum2events peryear R6 310perfamily No annuallimitapplies,subjectto R2620 co-payment perscanandpre-authorisation No annuallimitapplies No annuallimitapplies authorisation. Dental,dentalspecialistandmaxillo-facial surgeon accounts paidfrom HealthSaver Hospital andanaesthetistaccounts paidfrom MajorMedicalBenefit,subjectto R1570 co-payment per R39 600live donorcosts (incl.transportation) R19 500cadaver costs No annuallimitapplies apply to chemotherapy andadjuvant medication R300 000perbeneficiaryyear, thereafter a20%co-payment applies.MomentumHealthReference Pricing will No annuallimitapplies Subject to HealthSaver No annuallimitapplies condition line withtheSchemeRulesandclinicalprotocols thattheSchemehasestablishedfor thetreatment ofeach cancer, you willneedto register onaDiseaseManagement Programme. MomentumHealthwillpay benefitsin You needto phonefor authorisationbefore makinguseofyour MajorMedicalBenefits.For someconditions, like additional co-payment may applyfor specialisedprocedures -seepage 22 Subject to HealthSaver Subject to HealthSaver Covered from MajorMedical Benefit,subjectto R2620 co-payment perscanandpre-authorisation Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver Subject to HealthSaver R1 570 perauthorisation,except for motor vehicle accidents, maternity confinements andemergency treatment Any orAssociated hospitals No overall annuallimitapplies Hospital accounts are covered infullattherate agreed uponwiththehospitalgroup Other specialistscovered upto 100%ofMomentumHealthRate Associated specialistscovered infull and obtain your oncology treatment from anoncologist authorised by theScheme.Ifyou chooseState or + + + + + + + + + + + + +

ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable ifavailable 21-day sub-limitappliesto drugandalcohol rehabilitation + ifavailable + , subjectto treatment at + ) + ifavailable * . An . An 11 Options 12 Options Maximum of3children charged for Choose your Associated Hospital Any providers Associated Associated Chronic State State Any Any Choose your R2988 R2658 R3732 R3301 R3251 R2141 family composition Account to cover your other Momentum thatletsyou save for medicalexpenses. HealthSaver If you needmore day-to-day cover, you canchooseto make useofthe 10% ofyour contribution goes to adedicated Personal Medical preventative screening tests, certain check-ups andmore. The obtain themaximumcontribution discount. can chooseto useState facilities for your chronic scriptandmedicationto Medipost courier pharmacyfor your chronic medication.Alternatively, you by selectingto usealistofAssociated GPs for your chronic scriptand can chooseto receive discount afurther onyour monthlycontribution chronic scriptsandany pharmacyfor your chronic medication.Oryou For to asAssociated hospitals,seepage 24 for thislist). contribution by selectingto useaspecificlistofprivate hospitals(referred access to any hospital,oryou canchooseto receive adiscount onyour There isnooverall annuallimitfor The Incentive Optionprovides cover for hospitalisationatprivate hospitals. Overview chronic Health Platform Benefit R5860 R6764 R4752 R5365 R5957 R3831

treatment +. HealthSaver+ isacomplementary product offered by , you canchooseto have access to any GPfor your R4534 R4529 R3709 R2962 R5186 R4122 provides cover for arange ofbenefits,such as day-to-day hospitalisation R6499 R5803 R4652 R7190 R8218 R7138 expenses. . You canchooseto have R6854 R8423 R5473 R9672 R7633 R8416 Savings R9694 R6294 R7905 R9656 R11126 R8767

* — — —

condition line withtheSchemeRulesandclinicalprotocols thattheSchemehasestablishedfor thetreatment ofeach cancer, you willneedto register onaDiseaseManagement Programme. MomentumHealthwillpay benefitsin You needto phonefor authorisationbefore makinguseofyour MajorMedicalBenefits.For someconditions, like for specialisedprocedures -seepageapply 22 may Co-payments Any orAssociated hospitals No overall annuallimitapplies Hospital accounts are covered infullattherate agreed uponwiththehospitalgroup Other specialistscovered upto 200%ofMomentumHealthRate Associated specialistscovered infull Subject to Savings, ifavailable Subject to Savings, ifavailable Subject to Savings, ifavailable Benefits are subjectto available Savings, claimsare paidatcost withnosub-limits Fixed at10%oftotal contribution Any Benefits are subjectto registration ontheChronic Management Programme andapproval by theScheme 6 additionalconditions -limited to R10300perfamily peryear 26 conditions, according to Chronic DiseaseListinPrescribed Minimum Benefits-noannuallimitapplies Cover for 32conditions: Any, Associated orState R72 700 perfamily No annuallimitapplies At your chosennetwork provider R53 000perfamily the event iscovered asperauthorisation drowning, poisoning,severe allergic reaction andexternal andinternal headinjuries.Appropriate treatment related to Covers certain day-to-day claimsthatformoftherecovery part following specifictraumatic events, suchasnear 7 days’ supply preferred provider R37 900perbeneficiary, R23 000perfamily Other internal prostheses: R51 100perbeneficiaryevent, maximum2events peryear Intraocular lenses:R6700 perbeneficiaryevent, maximum2events peryear Cochlear implants:R168000perbeneficiary, maximum 1 event per year R6 560perfamily No annuallimitapplies,subjectto R2370 co-payment perscanandpre-authorisation No annuallimitapplies No annuallimitapplies authorisation. Dental,dentalspecialistandmaxillo-facial surgeon accounts paidfrom Savings, ifavailable Hospital andanaesthetistaccounts paidfrom MajorMedicalBenefit,subjectto R1500co-payment per R43 600live donorcosts (incl.transportation) R21 500cadaver costs No annuallimitapplies apply to chemotherapy andadjuvant medication R400 000perbeneficiaryyear, thereafter a20%co-payment applies.MomentumHealthReference Pricing will No annuallimitapplies Subject to Savings No annuallimitapplies Subject to Savings, ifavailable Subject to Savings, ifavailable Covered from MajorMedical Benefit,subjectto R2370 co-payment perscan andpre-authorisation Subject to Savings, ifavailable Subject to Savings, ifavailable Subject to Savings, ifavailable Subject to Savings, ifavailable Subject to Savings, ifavailable Subject to Savings, ifavailable Subject to Savings, ifavailable and obtain your oncology treatment from anoncologist authorisedby theScheme.Ifyou chooseState or

21-day sub-limitappliesto drugandalcohol rehabilitation , subjectto treatment at 13 Options 14 Options Maximum of3children charged for Choose your Associated Hospital Any providers Associated Associated Chronic State State Any Any Choose your R6244 R5033 R5729 R6357 R5713 R7101 family composition The offered by Momentumthatletsyou save for medicalexpenses. Extended Cover isactivated. HealthSaver+ isacomplementary product day-to-day expenses andto pay for out-of-pocket expenses before your You canchooseto make useofthe (a pre-determined amountthatisbasedonyour family size). benefits once your day-to-day claimshave reached theThreshold the to cover your annualday-to-day expenses, you willalsohave access to Account to cover 25% ofyour contribution isavailable inaPersonal Medical obtain themaximumcontribution discount. can chooseto useState facilities for your chronic scriptandmedicationto Medipost courier pharmacyfor your chronic medication.Alternatively, you by selectingto usealistofAssociated GPs for your chronic scriptand can chooseto receive discount afurther onyour monthlycontribution chronic scriptsandany pharmacyfor your chronic medication.Oryou For to asAssociated hospitals,seepage 24 for thislist). contribution by selectingto useaspecificlistofprivate hospitals(referred access to any hospital,oryou canchooseto receive adiscount onyour There isnooverall annuallimitfor The Extender Optionprovides cover for hospitalisationatprivate hospitals. Overview preventative screening tests, certain check-ups andmore. chronic treatment Extended Cover Health Platform R10404 R12820 R10341 R11477 R8850 R11273 day-to-day benefitwhichprovides cover further for day-to-day Benefitprovides cover for arange ofbenefits,suchas , you canchooseto have access to any GPfor your R7392 R7377 R8186 R9138 R6513 R8011 expenses. Ifthiscomponent isnotenough hospitalisation HealthSaver R13040 R10330 R12083 R13306 R14857 R11989 + for additional . You canchooseto have R16894 R14807 R13637 R13762 R15135 R11810 Savings

R16964 R13290 R15285 R16574 R15441 R18931 * — — —

Per child:R6600(max.3children) Per adultdependant:R20000 Member: R22 900 Annual Threshold levels: Over-the-counter medication(includingprescribed vitaminsandhomeopathicmedicine) Prescribed medication body radioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), whole Radiology (such asX-rays) Pathology (such asbloodsugar orcholesterol tests) Optical andoptometry (incl.contact lensesandrefractive eye surgery) Specialists General practitioners pressure monitors, wheelchairs etc.) External medicalandsurgical appliances (incl.hearingaids,glucometers, blood Dentistry –specialised(such asbridges orcrowns) Dentistry –basic(such asextractions orfillings) Mental health(incl.psychiatry andpsychology) Audiometry, Chiropody, Physiotherapy andPodiatry Speech therapy, Chiropractors, Osteopathy, Dieticians,Biokinetics,Orthoptists, Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and General rule Savings Provider Day-to-day Benefit General ruleapplicableto Chronic Benefits Cover Provider Chronic Benefit HIV related admissions Anti-retroviral treatment Immune deficiencyrelated to HIV Medical rehabilitation, private nursing, Hospice andstep-down facilities Trauma benefit Take-home medicine - drugandalcohol rehabilitation - incl.psychiatry andpsychology Mental health Prosthesis -external (such armsorlegsetc.) asartificial Prosthesis –internal (incl.kneeandhipreplacements, permanentpacemakers etc.) Medical andsurgical appliances in-hospital(such stockings, kneeandbackbraces assupport etc.) body radioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), whole Maternity confinements general anaesthesiafor children under7 Limited to maxillo-facial surgery (excluding implants), impacted wisdom teeth and In-hospital dentalandoral benefits Only covered whenrecipient isamemberoftheScheme Organ transplants (donor) Organ transplants (recipient) Oncology Renal dialysis Casualty orafter-hours visits High andintensive care General ruleapplicableto MajorMedicalBenefits Co-payment Provider Benefit Major MedicalBenefit — — — If you chooseState asyour chronic provider, you needto make useofState facilities for renal dialysis The sub-limitsspecifiedapplyperyear. Shouldyou notjoinin January, your sub-limits willbeadjusted pro-rata (thismeansitwillbeadjusted in linewiththenumberofmonthsleftinyear) responsible for 70% ofthenegotiated tariff If you choose Associated hospitals asyour preferred providerbe for MajorMedical Benefits,anddonotusethisprovider,will Health you willhave aco-payment of30%onthehospital account. Momentum This table represents asummaryofthebenefitsfor 2020 Associated asyour chronic provider, you need to obtain your oncology medication from Medipost * applicable to Day-to-day Benefits * (in-andout-of-hospital)

treatment related to theevent iscovered asperauthorisation as neardrowning, poisoning,severe allergic reaction andexternal andinternal headinjuries.Appropriate Covers certain day-to-day claimsthatformoftherecovery part following specifictraumatic events, such 7 days’ supply preferred provider R37 900perbeneficiary, 21-day sub-limitappliesto drugandalcohol rehabilitation, subjectto treatment at R24 000perfamily Other internalR69 prostheses: 200perbeneficiaryevent, maximum2events peryear Intraocular lenses:R7170 perbeneficiaryevent, maximum2events peryear Cochlear implants:R183000perbeneficiary, maximum 1 event per year R6 950 perfamily No annuallimitapplies,subjectto R2370 co-payment perscan No annuallimitapplies and accumulate towards limit authorisation. Dental,dentalspecialistandmaxillo-facial surgeon accounts paidfrom Day-to-day Benefit Hospital andanaesthetistaccounts paidfrom MajorMedicalBenefit,subjectto R1500co-payment per R43 600live donorcosts (incl.transportation) R21 500cadaver costs No annuallimitapplies Pricing willapplyto chemotherapy andadjuvant medication R500 000perbeneficiaryyear, thereafter a20%co-payment applies.MomentumHealthReference No annuallimitapplies Subject to Day-to-day Benefit No annuallimitapplies for thetreatment ofeachcondition will pay benefitsinlinewiththeSchemeRulesandclinicalprotocols thattheSchemehasestablished conditions, like cancer, you willneedto register onaDiseaseManagement Programme. MomentumHealth You needto phonefor authorisationbefore makinguseofyour MajorMedicalBenefits.For some Co-payments may applyfor specialist referral procedures -seepage Any orAssociated hospitals No overall annuallimitapplies Hospital accounts are covered infullattherate agreed uponwiththehospitalgroup Other specialistscovered upto 200%ofMomentumHealthRate Associated specialistscovered infull Subject to Savings (does notaccumulate to Threshold) R17 500perbeneficiary, R33100perfamily Covered from MajorMedicalBenefit,subjectto R2370 co-payment perscan andpre-authorisation Unlimited withinthe provisions oftheGeneral Rulementionedabove Unlimited withinthe provisions oftheGeneral Rulementionedabove Overall limitofR4140perbeneficiary. Frame sub-limitofR2260 100% ofMomentumHealthRate 70% ofMomentumHealthRate for non-Associated GPs Associated providers: 100%ofMomentumHealthRate for Associated GPs and Any or State provider:Rate Health Momentum of 100% Depending onthechronic provider selected Subject to pre-authorisation R24 500perfamily, R7390sub-limitperfamily for hearingaids Both in-andout-of-hospital dentalspecialistaccounts accumulate towards thelimit R13 400perbeneficiary, R35200perfamily Unlimited withintheprovisions oftheGeneral Rulementionedabove R19 800perfamily Unlimited withintheprovisions oftheGeneral Rulementionedabove The sub-limitsapplybefore theThreshold andafter isreached and are paidfrom Extended Cover attheMomentumHealthRate subjectto thesub-limitsspecifiedbelow. Threshold, your claimswillbepaidby theSchemefrom Extended Cover. Claims addupto theThreshold out ofyour own pocket, upto theThreshold determined by your family size. Once you have reached this component isnotenoughto cover your annualday-to-day expenses, you willhave aself-funding gap to pay 25% ofyour contribution isavailable to cover day-to-day expenses. This isknown asSavings. Ifthis Fixed at25%oftotal contribution Associated GPfor GPconsultations) Any orAssociated ( Benefits are subjectto registration ontheChronic Management Programme andapproval by theScheme 36 additionalconditions -limited to R10300perfamily peryear no annuallimitapplies Cover for 62 conditions: 26 conditions, according to Chronic DiseaseListinPrescribed MinimumBenefits- Any, Associated orState R72 700 perfamily No annuallimitapplies At your chosennetwork provider R55 000perfamily and obtain your oncology treatment from an oncologist authorisedby the Scheme.Ifyou chooseState or Members whohave chosenAssociated astheirchronic provider mustusean

and pre-authorisation 22 15 Options 16 Options Maximum of3children charged for Your providers Hospital Any Freedom-of-choice Chronic Chronic Freedom-of-choice Day-to-day preventative screening tests, certain check-ups andmore. The offered by Momentumthatletsyou save for medicalexpenses. day-to-day cover even further. HealthSaver+ isacomplementary product Should you wish,you canchooseto usethe and There isnooverall annuallimitfor hospitalisation.Extensive The SummitOptionprovides cover for Overview chronic benefits Health Platform Choose your R10 187 family composition Benefitprovides cover for arange ofbenefits,such as are available from any provider. R18 334 R12 527 hospitalisation HealthSaver R20 674 atany hospital. R23 014 + to increase your day-to-day R25 354

+ — —

Over-the-counter medication(includingprescribed vitaminsandhomeopathicmedicine) Prescribed medication body radioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), whole Radiology (such asX-rays) Pathology (such asbloodsugar orcholesterol tests) Optical andoptometry (incl.contact lensesandrefractive eye surgery) Specialists General practitioners pressure monitors, wheelchairs etc.) External medicalandsurgical appliances (incl.hearingaids,glucometers, blood Dentistry –specialised(such asbridges orcrowns) Dentistry –basic(such asextractions orfillings) Mental health(incl.psychiatry andpsychology) Audiometry, Chiropody, Physiotherapy andPodiatry Speech therapy, Chiropractors, Osteopathy, Dieticians,Biokinetics,Orthoptists, Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and General ruleapplicableto Day-to-day Benefits Savings Provider Day-to-day Benefit General ruleapplicableto Chronic Benefits Cover Provider Chronic Benefit HIV related admissions Anti-retroviral treatment Immune deficiencyrelated to HIV Medical rehabilitation, private nursing, Hospice andstep-down facilities Trauma benefit Take-home medicine - drugandalcohol rehabilitation - incl.psychiatry andpsychology Mental health Prosthesis –external (such armsorlegsetc.) asartificial Prosthesis –internal (incl.kneeandhipreplacements, permanentpacemakers etc.) braces etc.) Medical andsurgical appliances in-hospital( body radioisotope andPETscans MRI andCTscans,magneticresonance cholangiopancreatography (MRCP), whole Neonatal intensive care Maternity confinements general anaesthesiafor children under7 Limited to maxillo-facial surgery (excluding implants), impacted wisdom teeth and In-hospital dentalandoral benefits Only covered whenrecipient isamemberoftheScheme Organ transplants (donor) Organ transplants (recipient) Oncology Renal dialysis Casualty orafter-hours visits High andintensive care General ruleapplicableto MajorMedicalBenefits Provider Benefit Major MedicalBenefit — — HealthSaver isacomplementary product offered by Momentum The sub-limitsspecifiedapplyperyear. Shouldyou notjoininJanuary, your sub-limits willbeadjusted pro-rata (thismeansitwillbeadjusted inlinewiththenumberofmonthsleftyear) This table represents asummaryofthebenefitsfor 2020

(in- andout-of-hospital)

such as, support stockings, knee and back stockings, kneeandback support 7 days’ supply preferred provider R37 900perbeneficiary, R24 000perfamily Other internal prostheses: R69 200perbeneficiaryevent, maximum2events peryear Intraocular lenses:R7170 perbeneficiaryevent, maximum2events peryear Cochlear implants:R183000perbeneficiary, maximum 1 event per year R6 950 perfamily No annuallimitapplies No annuallimitapplies No annuallimitapplies R25 900perbeneficiary facial surgeon accounts paidfrom Day-to-day Benefitandaccumulate towards overall day-to-day limitof Hospital andanaesthetistaccounts paidfrom MajorMedicalBenefit.Dental,dentalspecialistandmaxillo- R43 600live donorcosts (incl.transportation) R21 500cadaver costs No annuallimitapplies medication No annuallimitapplies.MomentumHealthReference Pricing willapplyto chemotherapy andadjuvant No annuallimitapplies Subject to Day-to-day Benefit No annuallimitapplies for thetreatment ofeachcondition will pay benefitsinlinewiththeSchemeRulesandclinicalprotocols thattheSchemehasestablished conditions, like cancer, you willneedto register onaDiseaseManagement Programme. MomentumHealth You needto phonefor authorisationbefore makinguseofyour MajorMedicalBenefits.For some Any hospital No overall annuallimitapplies Hospital accounts are covered infullattherate agreed uponwiththehospitalgroup Other specialistscovered upto 300%ofMomentumHealthRate Associated specialistscovered infull Not covered R25 900perbeneficiary R20 300perbeneficiary, R33200perfamily. Subjectto overall annualday-to-day limitof Covered from MajorMedicalBenefit,subjectto Subject to overall annualday-to-day limitofR25900perbeneficiary Subject to overall annualday-to-day limitofR25900perbeneficiary Subject to overall annualday-to-day limitofR25900perbeneficiary Overall limitofR4530perbeneficiary. Frame sub-limitofR2320 Subject to overall annualday-to-day limitofR25900perbeneficiary Subject to overall annualday-to-day limitofR25900perbeneficiary R25 900perbeneficiary R30 100perfamily. R17500sub-limitfor hearingaids.Subjectto overall annualday-to-day limitof R25 900perbeneficiary. Bothin-andout-of-hospital dentalspecialistaccounts accumulate towards thelimit of limit day-to-day annual R15 600perbeneficiary,overall to R37 400perfamily. Subject Subject to overall annualday-to-day limitofR25900perbeneficiary R22 300perfamily. Subjectto overall annualday-to-day limitofR25900perbeneficiary R7 390perfamily. Subjectto overall annualday-to-day limitofR25900perbeneficiary and anoverall day-to-day limitofR25900perbeneficiary Benefits are paidat100%oftheMomentumHealthRate, subjectto the annualsub-limitsspecifiedbelow Not applicable.You canaddtheHealthSaver You canuseany provider ofyour choice Benefits are subjectto registration ontheChronic Management Programme andapproval by theScheme combined limitincorporating bothday-to-day cover andcover for the36additionalconditions 36 additionalconditions -accumulate to overall day-to-day limitofR25900perbeneficiary. This isa 26 conditions according to Chronic DiseaseListinPrescribed Minimum Benefits-noannuallimitapplies Cover for 62 conditions You canuseany provider ofyour choice R72 700 perfamily No annuallimitapplies At any provider R55 000perfamily treatment related to theevent iscovered asperauthorisation as neardrowning, poisoning,severe allergic reaction andexternal andinternal headinjuries.Appropriate Covers certain day-to-day claimsthatform oftherecovery part following specifictraumatic events, such , subjectto R2370 co-payment perscan

21-day sub-limitappliesto drugandalcohol rehabilitation + R2 370 co-payment perscanandpre-authorisation and pre-authorisation

, subjectto treatment at

17 Options Health Platform Benefit

Health Platform Benefits are paid by the Scheme up to a maximum Rand amount per benefit, provided you notify us before using the benefit. You can pre-notify by contacting the member call centre on 0860 11 78 59, logging on to momentumhealth.co.za or via the Momentum app. On the Ingwe Option, Health Platform Benefits are only available from your chosen Primary Care Network provider.

Benefit Who? How often? Options

Early detection tests Ingwe Evolve Custom Incentive Extender Summit

Health Assessment All principal members and adult Once a year • • • • • • (pre-notification not required): beneficiaries Blood pressure test, Cholesterol and Blood sugar (finger prick tests), height, weight and waist circumference Dental consultation All beneficiaries Once a year • • • • • • (incl. sterile tray and gloves) Pap smear Women 15 and older Once a year • • • • • • (pathologist) Pap smear consultation Women 15 and older Once a year • (GP) Pap smear consultation Women 15 and older Once a year • • • • • (GP* or gynaecologist) Mammogram Women 38 and older Once every 2 years • • • • • DEXA bone density scan Beneficiaries 50 and older Once every 3 years • • • • • (radiologist, GP* or specialist) General physical examination Beneficiaries 21 to 29 Once every 5 years • • • • • • (GP* consultation) Beneficiaries 30 to 59 Once every 3 years • • • • • • Beneficiaries 60 to 69 Once every 2 years • • • • • • Beneficiaries 70 and older Once a year • • • • • • Prostate specific antigen Men 40 to 49 Once every 5 years • • • • • • (pathologist) Men 50 to 59 Once every 3 years • • • • • • Men 60 to 69 Once every 2 years • • • • • • Men 70 and older Once a year • • • • • • Cholesterol test Principal members Once a year • • • • • • (pathologist)** and adult beneficiaries Blood sugar test Principal members Once a year • • • • • • (pathologist)*** and adult beneficiaries Glaucoma test Beneficiaries 40 to 49 Once every 2 years • • • • • Beneficiaries 50 and older Once a year • • • • • HIV test Beneficiaries 15 and older Once every 5 years • • • • • • (pathologist)

Preventative care Ingwe Evolve Custom Incentive Extender Summit Baby immunisations (On Ingwe, Children up to age 6 As required by the • • • • • • available at nearest State baby Department of Health clinic) Flu vaccines Children between 6 months Once a year • • • • • • and 5 years High-risk beneficiaries under 18 Once a year • • • • • • Beneficiaries 65 and older Once a year • • • • • • High-risk beneficiaries Once a year • • • • • • Tetanus diphtheria injection All beneficiaries As needed • • • • • • Pneumococcal vaccine Beneficiaries 60 and older Once a year • • • • • High-risk beneficiaries Once a year • • • • • Health Platform Benefit Health Platform

18 Health Platform Benefit

Benefit Who? How often? Options

Maternity programme (subject to registration on the Maternity Management Ingwe Evolve Custom Incentive Extender Summit Programme between 8 and 20 weeks of pregnancy) Doula benefit Women registered 2 visits per pregnancy • • • • • on the programme Antenatal visits Women registered 4 visits • (Midwives, GP* or gynaecologist) on the programme 12 visits • • • • • Online antenatal and postnatal Women registered 18-month subscription • • • classes on the programme Online video consultation with Women registered Initial consultation • lactation specialist on the programme Initial consultation plus • • follow up Nurse home visit Women registered Day after return from • • • • • • on the programme hospital 2 weeks after initial visit • • • • • 6 weeks after initial visit • • • Urine tests (dipstick) Women registered Included in antenatal visits • • • • • • on the programme Full blood count, blood group, Women registered on the 1 test • • • rhesus, platelet count, rubella programme antibody, creatinine, glucose strip test, antiglobin test Haemaglobin estimation 2 tests • • • Urinalysis 13 tests • • • Pathology tests Pathology Urine tests (microscopic exams, As indicated • • • antibiotic susceptibility and culture) Scans Women registered on the 2 growth scans • programme 2 pregnancy scans • • • • • Paediatrician visits Babies up to 12 months registered 2 visits in baby’s first year • • • • • on the programme

Disease management programmes Ingwe Evolve Custom Incentive Extender Summit Diabetes, Hypertension, HIV/ All beneficiaries registered on the As needed • • • • • • Aids, Oncology, Drug and alcohol appropriate programme rehabilitation, Chronic renal failure, Organ transplants, Cholesterol

Health line Ingwe Evolve Custom Incentive Extender Summit 24-hour emergency health advice All beneficiaries As needed • • • • • • Emergency evacuation Ingwe Evolve Custom Incentive Extender Summit Emergency evacuation in South All beneficiaries In an emergency • • • • • • Africa by Netcare 911 International evacuation by ISOS All beneficiaries In an emergency • • • • • International emergency cover by ISOS Ingwe Evolve Custom Incentive Extender Summit Ingwe: Not covered Per beneficiary per 90-day In an emergency • • • • • Evolve: R5 million journey Custom: R7.66 million Incentive: R8 million Extender: R8.22 million Summit: R9.01 million

This benefit includes R15 500 for emergency optometry, R15 500 for emergency dentistry and R765 000 terrorism cover, on all options, except Ingwe. A R1 710 co-payment applies per out-patient claim Health Platform Benefit Health Platform Please note * On the Custom, Incentive and Extender Options, if you choose Associated as your chronic provider, a 30% co-payment will apply if you do not use an Associated GP for the GP consultations ** The cholesterol test is covered if health assessment results indicate a total cholesterol of 6 mmol/L and above *** The blood sugar test is covered if health assessment results indicate blood sugar levels are 11 mmol/L and above 19 20 Specialised Procedures/Treatment Tubal ligation Marsupialisation ofBartholin’s cyst Incision anddrainage ofBartholin’s cyst Hysteroscopy Dilatation andcurettage Cone biopsy Colposcopy Cervical laserablation Gynaecology Sigmoidoscopy Oesophagoscopy Gastroscopies ERCP Colonoscopy Gastro-intestinal Treatment ofheadache Superficial foreign bodyremoval Open herniarepairs Nail surgery Lymph nodebiopsy Laparoscopy Removal ofminorskin lesions Removal ofextensive skinlesions Drainage ofsubcutaneousabscess Biopsy ofbreast lump General procedures andtreatments Tonsillectomy Functional nasalandsinussurgery Nasal scansandsurgery Nasal cautery Myringotomy Grommets Direct laryngoscopy Antroscopies ENT Plasmapheresis Coronary angioplasty Coronary angiogram Carotid angiograms Blood transfusions 24-hour halter ECG Cardiovascular Specialised Procedures/Treatment The following listisaguidelineoftheprocedures/treatment covered onthevarious benefitoptionsandpaidfrom theMajor covered, pleasecontact pre-authorisation to confirm. complete listofallprocedures/treatment covered by theScheme.Shouldyou needclarity onwhetheraprocedure/treatment is Pre-authorisation isrequired regardless ofwhere theprocedure/treatment isperformed.to note thatthisisnotthe Itisimportant Medical Benefit,irrespective ofwhethertheprocedure/treatment isperformed in-orout-of-hospital. Ingwe Ingwe Ingwe Ingwe Ingwe • • • • • • • • • • • • • • • • Evolve Evolve Evolve Evolve Evolve • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Custom Custom Custom Custom Custom

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Incentive Incentive Incentive Incentive Incentive • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Extender Extender Extender Extender Extender • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Summit Summit Summit Summit Summit • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Specialised Procedures/Treatment — — — Please note Vasectomy Prostate biopsy Cystoscopy Urology Treatment ofadultrespiratory tract infections Treatment ofadultinfluenza Bronchoscopy Bronchography Respiratory facilities) Dialysis (On Ingwe andEvolve Options,limited to Prescribed MinimumBenefitsatState Renal facilities Joint replacements (On Evolve Option, Ganglion surgery Conservative backandnecktreatment (On Evolve Option, covered atState facilities) Carpal tunnelrelease Bunionectomy facilities Back andnecksurgery (On Evolve Option, Arthroscopy Orthopaedic Treatment ofdiseasestheconjunctiva Trabeculectomy Pterygium removal Meibomian cyst excision Cataract removal Ophthalmology Radiotherapy (On Ingwe Option,limited to Prescribed MinimumBenefitsatState facilities) Hyperbaric oxygen for radiation necrosis Chemotherapy (On Ingwe Option,limited to Prescribed MinimumBenefitsatState facilities) Oncology innon-hospital Childbirth Amniocentesis Obstetrics Myelogram Hyperbaric oxygen treatment for decompression sickness Electro-convulsive therapy 48-hour halter EEG Neurology — — — Some oftheSpecialised Procedures/Treatment listed could attract aco-payment on theIncentive andExtender Options,seenext page see next page The SpecialisedProcedures/Treatment listed attract aco-payment ofR1570 perauthorisation ontheEvolve andCustom Options.This co-payment may vary for someoftheprocedures, pre-authorisation). For allotherprocedures, thecost ofanaesthetists, ifany, are covered ifclinically appropriate The costs ofanaesthetists for gastroscopies andcolonoscopies are covered upto R480onEvolve andCustom, upto R1000onIncentive andExtender, andupto R1200on Summit(subject to ) ) limited to Prescribed MinimumBenefitsatState limited to Prescribed MinimumBenefitsatState Ingwe Ingwe Ingwe Ingwe Ingwe Ingwe Ingwe Ingwe • • • • • • • • • Evolve Evolve Evolve Evolve Evolve Evolve Evolve Evolve • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Custom Custom Custom Custom Custom Custom Custom Custom • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Incentive Incentive Incentive Incentive Incentive Incentive Incentive Incentive • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Extender Extender Extender Extender Extender Extender Extender Extender • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Summit Summit Summit Summit Summit Summit Summit Summit • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 21 Specialised Procedures/Treatment 22 Chronic Benefit — chronic prescription andmedication,asfollows: The chronic provider you have chosendetermines how you get your Members onthe Custom, Incentive andExtender Options Reference Price, anda15%co-payment willbeapplied. State formulary, theSchemewillpay upto theMomentumHealth If you voluntarily chooseto get your chronic medicationoutsidethe x-rays etc.). and medicalmanagement (includingdoctor, pharmacy, bloodtests, chronic prescription andmedication,subjectto theState formulary You needto chooseoneofthedesignated State facilities to get your Members onthe Evolve Option pharmacy. for medicine.Chronic medicationisdelivered viaMedipostcourier Network provider andare subjectto aNetwork entrylevel formulary Benefits are onlyavailable from your chosenIngwe Primary Care Members onthe Ingwe Option Incentive andExtender Options + Evolve andCustom Options

Treatment ofadultinfluenza, Treatment ofadultrespiratory tract infections conjunctiva, Treatment ofheadache,Removing ofminorskinlesions, Conservative backandnecktreatment, Treatment ofdiseasesthe Sigmoidoscopies, Removing ofextensive skinlesions Gastroscopies, Nailsurgery, Cystoscopies, Colonoscopies, nasal andsinusprocedures, Jointreplacements, Laparoscopies Arthroscopies, Backandnecksurgery, Carpaltunnelrelease, Functional Treatment ofadultinfluenza, Treatment ofadultrespiratory tract infections conjunctiva, Treatment ofheadache,Removing ofminorskinlesions, Conservative backandnecktreatment Sigmoidoscopies, Removing ofextensive skinlesions Gastroscopies, Nailsurgery, Cystoscopies, Colonoscopies, nasal andsinusprocedures, Jointreplacements Arthroscopies, Backandnecksurgery Procedure/treatment Procedure/treatment — Specialised Procedure Chronic HealthSaver isacomplementary product offered by Momentum medicines, andwithinthegeneric reference price ifapplicable, you chooseto get your medicationfrom thepreferred listof from any provider, subjectto your optionspecific formulary. If Any: (view the fulllistonmomentumhealth.co.za). Dis-Chem andMedipost Momentum Health.Contracted pharmaciesincludeClicks, may alsobepayable whenusingpharmaciesnotcontracted to items), aco-payment ispayable. Adispensing fee co-payment medication from outsidetheformulary (i.e. non-preferred you willnothave aco-payment. Ifyou chooseto get your

You may get your chronic prescription andmedication benefit

* * , Treatment ofdiseasesthe , Carpaltunnelrelease, Functional * , Laparoscopies * co-payments

On Evolve Option,covered atState facilities (No co-payment applies) Paid from available day-to-day benefits No co-payment applies Paid by Scheme Can onlybeperformed in-hospital

(No co-payment applies) Paid from HealthSaver Co-payment ofR1570 perauthorisation Paid by Scheme Can onlybeperformed in-hospital If performed out-of-hospitalIf performed If performed out-of-hospitalIf performed the fulllist onmomentumhealth.co.za). Contracted pharmaciesincludeClicks, Dis-Chem and Medipost(view payable whenusing pharmaciesnotcontracted to MomentumHealth. formulary price ispayable. Adispensing fee co-payment may alsobe co-payment ofthecost difference between theselected item andthe If you chooseto get your medicationfrom outsidetheformulary, a medication from any provider, subjectto acomprehensive formulary. You have thefreedom ofchoice to get your chronic prescription and Members ontheSummitOption — — — — Option and5%ontheExtender Option. co-payment is15%ontheCustom Option,10%ontheIncentive Health Reference Price, andaco-payment willbeapplied.This the State formulary, theScheme willpay upto theMomentum If you voluntarily chooseto get your chronic medicationoutside pharmacy, bloodtests, x-rays etc.). State formulary and medicalmanagement (includingdoctor, to get your chronic prescription andmedication, subjectto the State If you chooseto: subject to anentrylevel formulary. Associated GPandyour chronic medicationfrom Medipost, Associated: — — — — — — + ifavailable : formulary price for themedicine. Medipost, MomentumHealthwillonlypay 50%ofthe get your chronic medicationfrom apharmacyotherthan Health Rate for theconsultation; GP, theSchemewillonlypay 50%oftheMomentum obtain your chronic prescription from anon-Associated Option, theco-payment willbe15%; Option, theco-payment willbe20% andontheExtender selected item andtheformulary price. OntheIncentive co-payment willbethecost difference between the co-payment willapply. OntheCustom Option,the get your medicationfrom outsidetheformulary, a You needto chooseoneofthedesignated State facilities

You mustget your chronic prescription from an

co-payment ofR3150perauthorisation, If performed in-hospital If performed If performed in-hospital If performed Standard hospitalisationco-payment of R1570, plusspecialisedprocedure

per authorisationapplies R3 150co-payment Paid by Scheme applies

— — — — — — — — — — — — — — — — — — — — — — — — — Ingwe, Evolve, Custom, Incentive, Extender andSummitOptions: The following 26 Chronic DiseaseListconditions are covered onthe Chronic benefitsare subjectto registration andapproval. * — — — — — — subject to alimitofR10300perfamily peryear: On theIncentive Option,anadditional6 conditions are covered, — These are examples ofmedication notcovered — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Chronic conditions Ulcerative colitis Systemic lupuserythematosus Schizophrenia Revellex and Enbrel (excl.Rheumatoid arthritis biologicalssuchas Parkinson’s disease protocols) Multiple sclerosis (excl. biologicalssuchasAvonex Hypothyroidism Hypertension Hyperlipidaemia Haemophilia Glaucoma Epilepsy Diabetes mellitusType 2 Diabetes mellitusType 1 Diabetes insipidus Crohn’s disease(excl. biologicalssuchasRevellex Coronary disease artery Chronic renal disease Chronic obstructive pulmonarydisease Cardiomyopathy Cardiac failure Cardiac dysrhythmias Bronchiectasis Bipolar mooddisorder Asthma Addison’s disease Psoriasis Pemphigus Eczema Allergic rhinitis ADHD (Attention DeficitHyperactivity Disorder) Acne * )

covered

* ) * , subjectto

— — — — — — — — — — — — — — — — overall day-to-day limitofR25900perbeneficiaryyear: Option, theadditional36conditions covered accumulate to the subject to alimit ofR10300perfamily peryear. OntheSummit On theExtender Option,anadditional36conditions are covered, — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Motor neuron disease Menopause Major depression Immunosupression therapy for transplants Hypoparathyroidism Gout Eczema Dermatomyositis Cystic fibrosis Cushing’s disease Benign prostatic hypertrophy Aplastic anaemia Ankylosing spondylitis Allergic rhinitis ADHD (Attention DeficitHyperactivity Disorder) Acne Valvular disease heart Unipolar disorder Thrombocytopenic purpura Thromboangiitis obliterans Systemic sclerosis Stroke Scleroderma Psoriasis Post-traumatic stress syndrome Pituitary microadenomas Pemphigus Paraplegia/Quadriplegia Other seizure disorders Osteoporosis Osteopenia Oncology -ancillarytreatment Obsessive compulsive disorder Narcolepsy Myasthenia gravis Muscular dystrophy andotherinherited myopathies 23 Chronic conditions covered 24 Hospitals Members onthe Members onthe Members onthe Mabopane -Pretoria Les Marais -Pretoria Lenasia Krugersdorp Kensington -Johannesburg Kempton Park Helderkruin -Johannesburg Heidelberg Groenkloof -Pretoria Fourways Florida –Johannesburg Faerie Glen-Pretoria Erasmuskloof -Pretoria Die Wilgers -Pretoria Johannesburg Constantia Kloof – Centurion Bryanston -Johannesburg Brooklyn -Pretoria Brakpan Birchleigh -Johannesburg Benoni Bedfordview -Johannesburg Arcadia -Pretoria Alberton Gauteng Welkom Fichardtpark -Bloemfontein Bloemfontein Bethlehem Free State Umtata Uitenhage Southernwood -EastLondon Queenstown Port Elizabeth Korsten -Port Elizabeth Humansdorp Greenacres -Port Elizabeth East London Beacon Bay -EastLondon Eastern Cape Hospitals Custom, Incentive Evolve Option Ingwe Option Legae Private Clinic Eugene Marais Hospital Lenmed Clinic Limited Pinehaven Private Hospital New Kensington Clinic Arwyp MedicalCentre Medgate Day Clinic Suikerbosrand Clinic Groenkloof Hospital Fourways Hospital Flora Clinic Faerie GlenHospital Kloof Hospital Wilgers Hospital Mayo Clinic Unitas Hospital Sandton Mediclinic Brooklyn Surgical Centre Dalview Clinic Birchmed Day Clinic Linmed Hospital The Glynnwood Glynnview Hospital Hospital Bedford Gardens Private Pretoria Hospital Heart Muelmed Hospital Femina Clinic Clinton Hospital Welkom Mediclinic Rosepark Hospital Pasteur Hospital Bloemfontein Eye Hospital Hoogland Mediclinic St Mary’s Private Hospital Cuyler Hospital St Marks Clinic St JamesOperating Theatres St. Dominic’s Hospital Queenstown Private Hospital St Georges Hospital Hospital Hunterscraig Psychiatric New Mercantile Hospital Isivivana Private Hospital Greenacres Hospital East London Private Hospital Life Beacon Bay Hospital canchoosebetween needto use and Extender Options Evolve Network hospitals Any hospital,Ingwe Network hospitals

Ingwe Ingwe Ingwe canchoosebetween Evolve Evolve Evolve

Associated Associated Associated

Gauteng (continued) Sunnyside -Pretoria Springs Soweto -Johannesburg Saxonwold - Roodepoort Randfontein Randburg -Johannesburg Primrose -Johannesburg Pretoria North Parktown -Johannesburg Nietgedacht -Johannesburg Morningside -Johannesburg Midrand Westville -Durban uMhlanga Tongaat Richards Bay Port Shepstone Pinetown Pietermaritzburg Phoenix -Durban Newlands East–Durban Newcastle Margate Ladysmith Isipingo Howick Hilton -Pietermaritzburg Hillcrest -Durban Empangeni Durban Chatsworth -Durban Berea -Durban Amanzimtoti Kwazulu-Natal Vereeniging Vanderbijlpark Any or Associated hospitals Johannesburg or State hospitals Pretoria Gynaecology Hospital Medforum Hospital St Mary’s Womens Clinic N17 Private Hospital Springs Parkland Clinic Clinix Tshepo Genesis Clinic Wilgeheuwel Hospital Robinson Hospital Olivedale Clinic Roseacres Clinic Pretoria Surgical North Centre Brenthurst Clinic The DonaldGordon Riverfield Lodge Morningside Mediclinic Waterfall City Hospital Carstenhof Clinic Westville Hospital Umhlanga Hospital Gateway Hospital Victoria Hospital The Bay Hospital Melomed Private Hospital Hibiscus Hospital The Crompton Hospital St AnnesHospital Pietermaritzburg Mediclinic Midlands MedicalCentre Mount Edgecombe Hospital Ethekwini Hospital Newcastle Private Hospital Margate Private Hospital La Verna Hospital Isipingo Hospital Howick Private Hospital Hilton Private Hospital Hillcrest Private Hospital Empangeni Garden Clinic St Augustines Hospital City Hospital Durdoc Clinic Chatsmed Garden Hospital Entabeni Hospital Kingsway Hospital Clinix Naledi Vereeniging Mediclinic Midvaal Private Hospital Ocumed Emfuleni Mediclinic

Ingwe Ingwe

Evolve Evolve

Associated Associated Hospitals These hospital listsare subjectto change. Visit Members onthe Members onthe Members onthe Upington Kimberley Kathu Cape Northern Vryburg Rustenburg Potchefstroom Mafikeng Klerksdorp Brits WestNorth Trichardt Secunda Piet Retief Middelburg Mbombela Ermelo Emalahleni Bronkhorstspruit Mpumalanga Thabazimbi Tzaneen Polokwane Lephalale Limpopo Custom, Incentive Evolve Option Ingwe Option Upington Mediclinic Centre Royal HospitalandHeart Kimberley Mediclinic Kathu Private Hospital Vryburg Private Hospital Peglerae Hospital Ferncrest Hospital Potchefstroom Mediclinic Victoria Private Hospital Wilmed Park Private Hospital Anncron Clinic Brits Mediclinic Highveld Mediclinic Secunda Mediclinic Piet Retief Hospital Midmed Hospital Nelspruit Mediclinic Lowveld Hospital Kiaat Private Hospital Ermelo Mediclinic Cosmos Hospital Bronkhorstspruit Hospital Thabazimbi Mediclinic Tzaneen Private Hospital Pholoso Private Hospital Limpopo Mediclinic Lephalale Mediclinic canchoosebetween needto use and Extender Options momentumhealth.co.za Evolve Network hospitals Any hospital,Ingwe Network hospitals Ingwe Ingwe Ingwe Ingwe canchoosebetween Evolve Evolve Evolve Evolve

Associated Associated Associated Associated for the latest information.

Paarl Oudtshoorn Oranjezicht -CapeTown Mossel Bay Mitchells Plain-CapeTown -CapeTownMilnerton Knysna Hermanus George Gatesville -CapeTown Durbanville -CapeTown Claremont -CapeTown Brackenfell Blaauwberg Bellville -CapeTown Worcester Vredenburg Tokai Strand Stellenbosch Somerset West Rondebosch Plumstead Plettenberg Bay Pinelands -CapeTown Panorama -CapeTown Western Cape Any or Associated hospitals or State hospitals Paarl Mediclinic Klein Karoo Mediclinic Cape Town Mediclinic Bayview Hospital Melomed Private Hospital Mediclinic Milnerton Knysna Private Hospital Hermanus Mediclinic George Mediclinic Geneva Clinic Gatesville MedicalCentre Durbanville Mediclinic Kingsbury Hospital Peninsula Eye Hospital Cape Gate Mediclinic Netcare Blaauwberg Hospital Louis Leipoldt Mediclinic Bellville MedicalCentre Worcester Mediclinic West Coast Private Hospital Melomed Tokai Strand Mediclinic Stellenbosch Mediclinic Vergelegen Mediclinic Paardevlei Private Hospital Surgical Day Centre Science Sport Orthopaedic Constantiaberg Mediclinic Plettenberg Bay Mediclinic Vincent Pallotti Hospital Panorama Mediclinic

Ingwe

Evolve

Associated 25 Hospitals 26 Exclusions 10. 9. 8. 7. 6. 5. 4. 3. 2. 1. Scheme), expenses incurred inconnection withany ofthefollowing willnotbepaidby theScheme,butmay beclaimedfrom positive Savings: the express exception ofmedicineortreatment approved andauthorisedinterms ofany healthmanagement programme contracted to the General exclusions mentionedinthisparagraph are notaffected by any specificexclusions. Unless otherwisedecidedby theScheme(andwith Benefits excluded Notwithstanding thelimitationsandexclusions setoutbelow, beneficiariesshallbeentitledto thePrescribed MinimumBenefits. Prescribed Minimum Benefits

Exclusions Minimum Benefitslimits; Costs for attempted suicidethatexceed thePrescribed Obesity; procedures; includes thecosts oftreatment orsurgery related to transsexual caused by orrelated to illness, accident ordisease.This for cosmetic purposesorfor personal reasons andnotdirectly All costs for operations, medicine,treatments andprocedures treatment cannotbeproved; All costs for treatment iftheefficacyandsafety ofsuch necessary ornot,including headacheandstress relief clinics; Holidays for recuperative purposes,whetherdeemedmedically professional bodyconstituted interms ofanAct ofparliament; Health care provider notregistered withtherecognised income isderived from inthesecontests); partaking (professional definedaswhere thebeneficiary’s mainform of Professional speedcontests orprofessional speedtrials riot, civilcommotion, war, invasion, terrorist activity orrebellion; Injuries orconditions ina sustainedduringwillfulparticipation of theSchemeRules; Rules, for thebenefitto whichthebeneficiaryisentitledinterms categoryparticular assetoutinAnnexure BoftheScheme All costs thatexceed theannualmaximumallowed for the Scheme butwere notdisclosed; which existed atthedate ofapplicationfor membership ofthe All costs incurred duringwaiting periodsandfor conditions 19. 18. 17. 16. 15. 14. 13. 12. 11. 23. 22. 21. 20. Circumcision, unless clinicallyindicated, andany contraceptive Appointments whichabeneficiaryfails to keep; needs ofthepatient; medically necessary orappropriate to meetthehealthcare All costs, whichintheopinionofMedicalAssessor are not rescue andInternational cover; Travelling expenses, excluding benefitscovered by Emergency Frail care; Gum guards andgold usedindentures; State facility/hospital); similar institutionnotregistered interms ofany law (except a Costs for services rendered by any institution,nursing homeor Medication notregistered by theMedicineControl Council; otoplasty andblepharoplasty; Breast reduction andbreast augmentation,gynaecomastia, diving to depthsbelow 40metres andcave diving. The cost ofinjuryandany otherrelated costs asaresult ofscuba of Annexure DoftheSchemeRules; Benefits willbecovered in State facilities subjectto paragraph 4 Infertility treatment thatisincludedasPrescribed Minimum Prescribed MinimumBenefits; Injuries resulting from narcotism oralcohol abuseexcept for the Reversal of Vasectomies ortuballigation (sterilisation); measures ordevices; 5. 4. 3. 2. 1. 7. 6.

Glossary e. d. c. b. a. g. f. Provider definitions: Health Rate (MHR). on anannualbasis.These amountsare calledtheMomentum per treatment. For allotherproviders, theamountwe pay isset radiologists anddentiststo determine theamountwe willpay Health negotiates withhospitals,GPs, specialists,pathologists, Momentum HealthRate (MHR) in terms oftheMedicalSchemesAct No131of1998. which allmedicalschemesinSouthAfrica have to provide cover Chronic DiseaseList(CDL) in terms oftheMedicalSchemesAct No131of1998. which allmedicalschemesinSouthAfrica have to provide cover Prescribed MinimumBenefits(PMBs) organ orwould orpart, place theperson’s life inseriousjeopardy. impairment to bodilyfunctionsorseriousdysfunction ofabodily provide medicalorsurgical treatment would result inserious immediate medical orsurgical treatment, where failure to time, unexpected onsetofahealthcondition thatrequires Emergency medicalcondition our members. also applytheirown clinicalprotocols to thebenefitsthey offer benefits for specificconditions. The Scheme’s network providers principles, calledclinicalprotocols, to determine andmanage Clinical protocol: medication for your chronic condition. option, from whichadoctor canprescribe theappropriate Formulary:

members need to usefor specificbenefits. place withcertain providers ofhealthcare services, which Preferred Providers: provider andcanuseany hospital. can get theirday-to-day andchronic treatment from any Freedom-of-choice: Chronic Benefitprovider. also save onyour contribution by choosingState asyour On theCustom, Incentive andExtender Options,you can Option, you needto useState facilities for Chronic Benefits. hospital provider ontheIngwe Option.OntheEvolve a discount onyour contribution by selectingState asyour State: in place with–seepage 24 for thelistofhospitals. private hospitalswhichMomentumHealthhasagreements must make useofEvolve Network hospitals.These are Evolve Network hospitals: in place with–seepage 24 for thelistofhospitals. private hospitalswhichMomentumHealthhasagreements can chooseto useIngwe Network hospitals.These are Ingwe Network hospitals: co-payment willapply. However, ifyou thendonotusetheseproviders a hospitals andGPs, you canpay alower contribution. agreements with.By choosingto usetheAssociated These are providers thatMomentumHealthhasnegotiated Associated providers, e.g.hospitals,GPs andspecialists: Care Network providers. for chronic andday-to-day benefits,namelyIngwe Primary Ingwe Option,theSchemerelies onanetwork ofproviders place withcertain providers ofhealthcare services. Onthe Network providers:

State hospitalsare publicfacilities. You canreceive A formulary is alistofmedicinescovered on your Momentum Healthusesappropriate treatment

Members ontheSummit Option Momentum Healthhasagreements in Momentum Healthhasagreements in isalistof26 chronic conditions for means thesuddenand,at

Members onthe Members ontheEvolve Option : Every year Momentum isalistofbenefitsfor

Ingwe Option

14. 13. 12. 11. 10. 9. 8. 16. 15.

day-to-day claims.Itisafixed Rand amountsetby theScheme Threshold: your doctor’s rooms orout-patient facility. performed inahospital.For example, they could beperformed in Out-of-hospital procedures: which asub-limitfor frames applies. provide you withanannuallimitonyour opticalbenefit,within overall limitonaspecificbenefit.For example, your optionmight Sub-limit: annual dentistrycheck-up. you are aboutto useaHealthPlatform benefit,suchasyour Pre-notification: option andmembership status. mind thatbenefitswillbepaidinlinewithSchemeRules,your that your treatment willbecovered, itgives you thepeace of provide to thedoctor. Whilepre-authorisation isnotaguarantee You willreceive apre-authorisation numberwhichyou needto treatment, andatwhatrate your optioncovers suchtreatment. Scheme willconfirm whetheryou are covered for theexpected us know thatyou are aboutto receive medicaltreatment. The Pre-authorisation: hospital. procedures canbedonewithoutthepatientbeingadmitted to Out-patient facility: protocols (see definition above) for your condition. Clinically appropriate: the medicineyou choseandthereference price. reference pricing,you willneedto pay thedifference between choose to usechronic medicationthatcosts more thanthe that MomentumHealthwillpay for amedicine. Ifyou voluntarily Momentum HealthReference Price have reached theThreshold level. claims are paidby theSchemefrom Extended Cover, once you Extended Cover: Extended Cover. up to thislevel, your claimswillbepaidby theSchemefrom in linewithyour family size. Once your day-to-day claimsadd

A sub-limitisalimitthatappliesinadditionto the On theExtender Option,there isaThreshold for Pre-notification iswhenyou letusknow that On theExtender Option,your day-to-day Pre-authorisation iswhenyou callusto let Atreatment centre where medical Treatment thatisinline withtheclinical

These are procedures thatare not isthemaximumRandvalue

27 Glossary

Council for MedicalSchemes mome [email protected] Financial advisers Claims Members PO Box 2338Durban4000SouthAfrica 201 uMhlanga Ridge Boulevard Cornubia 4339 [email protected] Fraud hotline Emergency evacuation Member callcentre Financial advisercallcentre medicalschemes.com [email protected] Customer Care Centre ntumhealth.co.za

0861 123267 [email protected] [email protected] [email protected] 0800 000438 082 911 0860 1178 59 0800 432584

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