Momentum Ingwe B (any provider) medical aid plan: 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:
Ingwe B
Quick Overview
Main: Adult: Child:
Total Cost pm: R986 R986 R370
Savings (per year): No savings option on this plan
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit:
  • R1,260,000 per family
  • High and intensive care: 10 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
Children: Pay for all children
Income band: This plan is only available to households with income in R676-R6,300pm band.
View other income bands
See full benefits below

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IN HOSPITAL PROCEDURES:
Ingwe B
Benefits Gap benefits
Payout Rate for Specialists: Fusion Gap:
  • Up to 600% scheme rate for specialists and other providers
  • 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
  • R350pm per family. More Info or download application below.
Hospital Choice:
  • Unlimited
  • N/A
Specialised Radiology:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Supplementary Services: (Physio, etc) TBC Fusion Gap:
  • Up to 600% scheme rate for specialists and other providers
Transplants:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Co-payments:
  • N/A
  • N/A
Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R11,900 per family
  • Private nursing and hospice: no benefit
  • 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.
Other:
    Excluded:
  • Cardiovascular: 24-hour halter ECG, Blood transfusions, carotid angiograms, coronary angiogram, coronary angioplasty, plasmapheresis
  • ENT: antroscopies, direct laryngoscopy, nasal scans and surgery, functional nasal and sinus surgery
  • General surgery: laparoscopy, nail surgery
  • Gastro-intestinal: colonoscopy, ERCP, gastroscopies, oesophagoscopy, sigmoidoscopy
  • Gynaecology: cervical laser ablation, hysteroscopy
  • Neurology: 48-hour halter EEG, electro-convulsive therapy, heperbaric oxygen treatment for decompression sickness, myelogram
  • Obstetrics: amniocentesis
  • Oncology: hyperbaric oxygen for radiation necrosis
  • Opthalmology: catarct removal, pterygium removal, trabeculectomy
  • Orthopaedic: arthroscopy, bunionectomy
  • Respiratory: bronchography, bronchoscopy
  • Urology: cystoscopy
  • No benefit for exclusions
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OUT OF HOSPITAL BENEFITS:
Ingwe B
Benefits Gap benefits
GP consultations:
  • Ingwe Active Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with R100 co-payment
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • From Ingwe Active Primary Care Network: 2 consults per family with R100 co-payment
  • 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 Ingwe Active Primary 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:
Ingwe B
Benefits Gap benefits
Hospital stay:
  • Complicated: R39,900
  • Uncomplicated: R27,200
  • Neonatal intensive care: R57,200
  • C-sections: only emergency
  • 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):
Ingwe B
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only, at state facilities
  • No benefit
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DENTISTRY:
Ingwe B
Benefits Gap benefits
Dentistry:
  • Standard dentistry: paid by scheme. Includes:
    • 1 consult per person
    • Fillings
    • X-rays
  • Specialised dentistry: No benefit
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • No benefit unless PMB. Then at State facilities only.
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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MEDICATION:
Ingwe B
Benefits Gap benefits
Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe Active Primary Care Network
  • No benefit
Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
  • 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:
Ingwe B
Benefits Gap benefits
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:
Ingwe B
Benefits Gap benefits
In-hospital:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Out-of-hospital:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
Ingwe B
Benefits Gap benefits
General Appliances:
  • In-hospital: R4,900 per family
  • Out-of-hospital: no benefit
  • No benefit
1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • No benefit
Dialysis:
  • Unchanged
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:
  • Unchanged
  • 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:
Ingwe B
Benefits Gap benefits
Flu vaccination:
  • Unchanged
  • 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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PROSTHETICS:
Ingwe B
Benefits Gap benefits
Overal Limit:
Sub-limits:
  • An additional R40,000 per sublimit, per event

    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