Momentum Incentive Associate (associate for chronic) 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:
Incentive Network hospital (and Network provider for chronic)
2018 costs Gap
In brief: On Incentive Network hospital (and Network provider for chronic) 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?
  • 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: R2,514 R2,000 R956
Cost 2017: (R2,323) (R1,848) (R949)
Overal Limit: Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: R3,012 R2,400 R1,152
Children: Pay for maximum 3 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:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 200% scheme rate
  • Network specialists covered in full
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Network hospitals
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology:
  • Unlimited with a R2,150 co-payment
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Supplementary Services: (Physio, etc) TBC
  • Up to 500% of scheme rate for service providers
Transplants:
  • Recipient: Unlimited
  • Donor R18,600 cadaver costs and R37,700 for live donor costs. Only covered if recipient is a member of the scheme
  • Sublimit increased by R40,000 per event or medical condition, unlimited for the year
Co-payments:
    Gastroscopies, nail surgery, cystoscopies, colonoscopies, sigmoidoscopies, removing of extensive skin lesions: no co-payment if done in day-clinic, otherwise R1,300 co-payment applies Specialised radiology: R2,150 co-payment
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
    Medical rehabilitation, private nursing, hospice and step-down facilities: R46,400 per family. Paid by scheme.
  • No benefit
Casualty:
  • Paid from day-to-day benefit
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit
  • No benefit
Childcare:
  • 2 consults with paediatrician for children under 1yr
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit
  • No benefit
Pathology:
  • Paid from day-to-day benefit
  • No benefit
General radiology:
  • Paid from day-to-day benefit
  • No benefit
Specialised radiology:
  • Unlimited with a R2,150 co-payment, paid by scheme
  • No benefit
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • No benefit
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MATERNITY BENEFITS:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • Network specialists covered in full, otherwise 200% scheme rate
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Consultations:
  • 12 consults, paid by scheme
  • No benefit
Scans:
  • 2 x 2D scans, paid by scheme
  • No benefit
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CANCER (ONCOLOGY):
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • R400,000 per person, with a 20% co-payment thereafter
  • Up to additional 500% of scheme rate to cover shortfall for specialists
  • Full cover for the 20% co-payment
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:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • Standard dentistry: One dental consult per year. Otherwise, from day-to-day benefit
  • In-hospital: maxillo-facial surgery, impacted wisdom teeth and general anaesthesia for children under 7yrs: R1,650 co-payment and surgeon accounts paid from day-to-day benefits
  • Full cover for in-hospital deductibles/co-payments
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics:
  • Paid from day-to-day benefit
  • No benefit
Maxillo Facial Surgery:
  • See above
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
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MEDICATION:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • PMB chronic: paid by scheme, from Network provider
  • non-PMBs chronic: additional 6 conditions covered, R8,800 per family
  • No benefit
Acute (presrcibed) medication:
  • Paid from day-to-day benefit
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefit
  • No benefit
Birth Control:
  • Paid from day-to-day benefit
  • No benefit
On Discharge:
  • 7 days supply
  • No benefit
Biological:
  • No benefit
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OPTOMETRY:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • Paid from day-to-day benefit
  • No benefit
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MENTAL HEALTH:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital:
  • R34,400 per person
  • Sublimits increased by R40,000 per event or medical condition
Out-of-hospital:
  • Paid from day-to-day benefit, unless PMB
  • No benefit
Trauma:
  • Covers certain day-to-day claims for recovery from specific traumatic events (near drowning, poisoning, allergic reactions, etc)
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OTHER BENEFITS:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • In-hospital: R5,950 per family
  • Out-of-hospital: No benefit
  • No benefit
1.1. Hearing Aids:
  • Paid from day-to-day benefit
  • No benefit
1.2. Wheelchairs:
  • Paid from day-to-day benefit
  • No benefit
Dialysis:
  • Unlimited, at Network chronic provider
HIV:
  • HIV related admissions: R65,900 per family
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • R8 million international emergency cover. Includes R15,500 for emergency optometry, R15,500 for emergency dentistry and R765,000 terrorism cover.
  • R1,550 co-payment applies for each outpatient claim
  • No benefit
Other:
    Cochlear implants: R152,400 per person
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: Medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policy holder was not at fault: Gap will provide all legal assistance, fully covered.
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WELLNESS/PREVENTATIVE BENEFITS:
Incentive Network hospital (and Network provider for chronic)
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered for under 18yrs and 60yrs+
  • No benefit
Pneumonia vaccines:
  • Covered for 60yrs+
  • 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:
  • Covered for 38yrs+, every 2 years
  • 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:
  • Bone density scan: 50yrs+, every 3 years
  • Glaucoma test: 40yrs+, every 1-2 yrs, depending on age
  • 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