Momentum Access medical aid plan: 2017 vs 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Access B
2018 costs Gap
In brief: On Access B in 2018: See full benefits below For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims to 500% scheme rate
  • pays for ER treatment,
  • covers the 20% co-payment for cancer claims and
  • covers other in-hospital co-payments
See more benefits below, or full benefits here.
What’s new in 2018?
  • This is now an income-based plan
  • Otherwise, there are no major changes to this plan in 2018, other than the usual monetary increases in premiums, benefits and co-payments

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Contributions:
Main: Adult: Child:
Cost 2018: R2,025 R2,025 R605
Cost 2017: (R1,842) (R1,842) (R552)
Overal Limit:
  • Unlimited
  • High and intensive care: 12 days per admission
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: No savings option on this plan
Children: Pay for all children
2018 Gap prices are to be confirmed, will be about R300 per family of under 65yrs, and R400 per family with a member who is 65yrs+.
Find out more
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IN HOSPITAL PROCEDURES:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 100% scheme rate
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Access Network hospitals
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Supplementary Services: (Physio, etc) TBC
  • Up to 500% of scheme rate for service providers
Transplants:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Co-payments: .
  • N/A
Alternatives to hospitals:
  • Medical rehabilitation, private nursing, hospice and step-down facilities: R45,900 per family. Paid by scheme.
  • No benefit
Casualty:
  • Shared with specialist benefit, above
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • Access Network GPs: 10 consults per person, otherwise subject to authorisation
  • Non-network: 1 consult per person, 2 per family with R100 co-payment
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • Access Care Network: 3 consults per person and 5 consults per family
  • No benefit
Pathology:
  • Some specific pathology covered by scheme, from Ingwe Active Primary Care network
  • No benefit
General radiology:
  • Some specific x-rays covered by scheme, from Access Care Network
  • No benefit
Specialised radiology:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Supplementary Services: (Physio, etc)
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
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MATERNITY BENEFITS:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • Sublimits increased by R44,000 per event, unlimited for the year
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Consultations:
  • 4 consults, paid by scheme
  • No benefit
Scans:
  • Unchanged
  • No benefit
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CANCER (ONCOLOGY):
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • Standard dentistry: paid by scheme. Includes:
    • 1 consult per person
    • Fillings
    • X-rays
  • Specialised dentistry: No benefit
  • Full cover for in-hospital deductibles
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • No benefit unless PMB. Then at State facilities only.
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
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MEDICATION:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • No benefit
Acute (presrcibed) medication:
  • Some medication covered
  • No benefit
Over-the-counter:
  • No benefit
  • No benefit
Birth Control:
  • No benefit
  • No benefit
On Discharge:
  • 7 days supply
  • No benefit
Biological:
  • No benefit
  • No benefit
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OPTOMETRY:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • 1 eye test per person
  • 1 pair of standard or bi-focal lenses and frame per person, every two years
  • No benefit
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MENTAL HEALTH:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital:
  • R16,150 per person
  • Sublimits increased by R40,000 per event or medical condition
Out-of-hospital:
  • Subject to Specialist limit (3 consults per person, 5 per family)
  • No benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • In-hospital: R5,950 per family
  • No benefit
1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • No benefit
Dialysis:
  • No benefit unless PMB. Then at State facilities only.
HIV:
  • Anti-retroviral treatment: R31,900 per family in hospital
  • HIV related admissions: R34,000 per family
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • R3.38 million international emergency cover. Includes R15,500 for emergency optometry, R15,500 for emergency dentistry and R765,000 terrorism cover.
  • R1,550 co-payment applies for each outpatient claim
  • No benefit
Other: TBC
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: Medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policy holder was not at fault: Gap will provide all legal assistance, fully covered.
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WELLNESS/PREVENTATIVE BENEFITS:
Access B
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered for under 18yrs and 60yrs+
  • No benefit
Pneumonia vaccines:
  • No benefit
  • No benefit
Back Rehabilitation Programme: TBC
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered for 15yrs+
  • No benefit
Mammogram:
  • No benefit
  • No benefit
PAS Test:
  • Covered for 40yrs+, every 1-5 years depending on age
  • No benefit
HIV Test:
  • Covered for 15yrs+, every 5 years
  • No benefit
Other:
  • No benefit
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2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overal Limit:
Sub-limits:

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised