Our benefits Marketing brochure 2019 Financial adviser call centre 0800 43 25 84 Member call centre 0860 11 78 59 Emergency evacuation 082 911 Fraud hotline 0800 00 04 38 Members [email protected] Claims [email protected] Financial advisers [email protected] [email protected] Website momentumhealth.co.za Postal address PO Box 2338 Durban 4000 General disclaimers This brochure is a marketing aid. On joining the Scheme, all Momentum Health members receive a detailed member brochure. Note that Momentum Health may specify certain principles relating to the use of your benefits. Scheme Rules will always take precedence and are available on request. In terms of the Medical Schemes Act, medical schemes may apply waiting periods and/or late joiner penalties to new members joining the Scheme. If we do apply a waiting period and/or a late joiner penalty to your membership, we will let you know before we activate your cover. Index 2 Make the right choice 4 Individual contributions Options: 6 Ingwe Option 8 Impact 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 27 Glossary of terms Make the right choice The Benefit Structure Ingwe Option Impact Option Specialists covered Hospital choice Specialists covered Hospital up to 100% of up to 100% of Major Medical Benefit Any hospital, Impact Network Momentum Health Momentum Health Ingwe Network hospitals* Rate Rate hospitals* or -------------------- -------------------- The Major Medical Benefit provides cover for State hospitals Hospital accounts Hospital accounts hospitalisation and certain out-of-hospital procedures that covered in full at covered in full at negotiated rate negotiated rate can safely be performed in a doctor’s room, registered day -------------------- -------------------- clinic or out-patient facility, provided treatment is clinically No overall annual No overall annual limit applies limit applies appropriate and has been pre-authorised. 26 conditions - no Provider choice 26 conditions - no Provider Chronic Benefit annual limit applies annual limit applies For medical For medical management management Chronic Benefit including doctor, Chronic Benefit including doctor, The Chronic Benefit covers certain life-threatening Formulary pharmacy, blood Formulary pharmacy, blood conditions that need ongoing treatment. The Chronic Network entry-level tests, x-rays, etc. Network entry-level tests, x-rays, etc. formulary Ingwe Primary formulary Impact Primary Benefit includes cover for the 26 Chronic Disease List Care Network Care Network providers** or Ingwe providers** (CDL) conditions, which form part of the Prescribed Active Primary Care Minimum Benefits (PMBs). Chronic benefits are subject to Network providers** registration and approval. Primary care Provider choice Primary care Provider (such as GP visits, (such as GP visits, Day-to-day Benefit Ingwe Primary Impact Primary prescribed medicine, prescribed medicine, Care Network Care Network etc.) etc.) providers** or providers** ------------------ ------------------ This benefit provides for day-to-day medical expenses, such as Ingwe Active Secondary care Secondary care Primary Care (Specialist visits) (Specialist visits) GP visits, prescribed medication, etc. Network providers** You have the choice of adding more day-to-day cover through the HealthSaver+. 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. On the Ingwe and Impact Options, Health Platform Benefits are only available from your chosen Primary Care Network provider. + HealthSaver is a complementary product offered by Momentum * View a list of these hospitals on page 24 ** View a list of these providers on momentumhealth.co.za Complementary Momentum Products You can choose to make use of additional products available from Momentum Group, a division of MMI Group Limited (Momentum), to seamlessly enhance your medical aid. These voluntary complementary products range from a world-class wellness and rewards programme, Multiply, to the innovative HealthReturns solution. These complementary products are not medical scheme benefits. Momentum is not a medical scheme, and is a separate entity to Momentum Health. You can be a member of Momentum Health without taking any of the complementary products that Momentum offers. Make the right choice Make 2 Momentum Health strives to offer you good value for money by combining flexibility with comprehensive cover, because it is important to match your family’s healthcare needs. Use the following guide to find the option that best matches your needs. Healthcare expenses involve more than just the cost of your stay in hospital, it could be the cost of chronic medication (like pills to lower high blood pressure), day-to-day expenses (like visiting your GP), and/or emergency care. The option that you choose will determine how much you will pay, and how much cover you will have for the different types of healthcare expenses. You need to choose the option that best fits both your wallet and your healthcare needs. Custom Option Incentive Option Extender Option Summit Option Associated Hospital choice Associated Hospital choice Associated Hospital choice Associated Hospital specialists covered specialists covered specialists covered specialists covered Any or Associated Any or Associated Any or Associated Any hospital in full in full in full in full -------------------- hospitals* hospitals* hospitals* Other specialists -------------------- -------------------- -------------------- covered up to 100% Other specialists Other specialists Other specialists of Momentum covered up to 200% covered up to 200% covered up to 300% Health Rate of Momentum of Momentum of Momentum -------------------- Health Rate Health Rate Health Rate Hospital accounts -------------------- -------------------- -------------------- covered in full at negotiated rate Hospital accounts Hospital accounts Hospital accounts -------------------- covered in full at covered in full at covered in full at No overall annual negotiated rate negotiated rate negotiated rate limit applies -------------------- -------------------- -------------------- -------------------- No overall annual limit No overall annual limit No overall annual limit R1 500 co-payment applies applies applies applies 26 conditions - no Provider choice 26 conditions - no Provider choice 26 conditions - no Provider choice 26 conditions - no Provider annual limit applies annual limit applies. annual limit applies. annual limit applies. For medical For medical For medical For medical -------------------- management -------------------- management -------------------- management management Chronic Benefit including doctor, Additional 6 including doctor, Additional 36 including doctor, Additional including doctor, Formulary pharmacy, blood conditions limited to pharmacy, blood tests, conditions limited to pharmacy, blood 36 conditions pharmacy, blood tests, x-rays, etc. R9 800 x-rays, etc. R9 800 tests, x-rays, etc. accumulate to the tests, x-rays, etc. Any: Core formulary per family overall day-to-day Any (Any GP and any per family Any (Any GP and any Any (Any GP and any Freedom-of-choice Associated: Entry- limit of level formulary pharmacy), pharmacy), pharmacy), Chronic Benefit Chronic Benefit R24 700 per State: State Associated** Associated** Associated** Formulary Formulary beneficiary formulary (Selected preferred (Selected preferred (Selected preferred GPs and Medipost Any: Standard GPs and Medipost Any: Extended GPs and Medipost Chronic Benefit Courier pharmacy for formulary Courier pharmacy for formulary Courier pharmacy for Formulary chronic medication), Associated: Entry- chronic medication), Associated: Entry- chronic medication), or State facilities level formulary or State facilities level formulary or State facilities Comprehensive State: State State: State formulary formulary formulary You may add the Provider choice Savings 10% of total Provider choice Savings 25% of total Provider choice Paid from risk benefit, Provider HealthSaver+ to contribution contribution plus subject to overall Any Any, subject to Any or Freedom-of-choice provide cover for Extended Cover day-to-day limit of Savings if available Associated your day-to-day (Members who have R24 700 per healthcare needs chosen Associated beneficiary. as their chronic -------------------- provider must use an This is a combined Associated GP for limit incorporating GP consultations) both day-to-day cover and cover for the 36 additional chronic conditions. The Health Platform encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection, a leading maternity programme, management of certain diseases, health education and advice and emergency cover. HealthSaver Add more cover for medical expenses by See separate Momentum Complementary Product brochure for more information. choosing to contribute an additional amount that suits your needs and pocket Make the right choice Make 3 Individual Contributions P = Principal A = Adult C = Child Child rates apply to dependants younger than 21 On the Ingwe and Impact Options all children are charged for. On the Custom, Incentive, Extender and Summit Options, a maximum of 3 children are charged for Ingwe Option Hospital Chronic Day-to-day