Momentum Ingwe E (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 E
Quick Overview
Main: Adult: Child:
Total Cost pm: R2,409 R2,409 R699

(Pay for all)

Savings (per year):
  • No savings option on this plan
Gap (optional):
  • Varies. See below for specific recommendation for this plan.
Income band:
In brief: See full benefits below

IN HOSPITAL PROCEDURES:
Ingwe E
Scheme Benefits: Gap Benefits:
Specialists:
  • 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice:
  • Choose any hospital
  • No benefit
Specialised Radiology:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Supplementary Services: (Physio, etc) TBC
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals, for non-PMB treatment
  • No benefit for out-of-hospital services
Transplants:
  • No benefit unless PMB. Then at State facilities only.
  • No extra benefit available (PMB benefits are paid in full by medical aid)
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
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other:
    Excluded:
  • Cardiovascular: 24-hour halter ECG, Blood transfusions, carotid angiograms, coronary angiogram, coronary angioplasty, plasmapheresis
  • ENT: arthroscopies, 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, hyperbaric oxygen treatment for decompression sickness, myelogram
  • Obstetrics: amniocentesis
  • Oncology: hyperbaric oxygen for radiation necrosis
  • Ophthalmology: cataract removal, pterygium removal, trabeculectomy
  • Orthopaedic: arthroscopy, bunionectomy
  • Respiratory: bronchography, bronchoscopy
  • Urology: cystoscopy
  • No benefit for exclusions
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

No phone calls!
Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Ingwe E
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
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 extra benefit available
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

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Ingwe E
Scheme Benefits Gap benefits
Hospital stay:
  • Complicated: R39,900
  • Uncomplicated: R27,200
  • Neonatal intensive care: R57,200
  • C-sections: only emergency
  • Pays up to 500% scheme rate for specialists, GPs and other medical professionals, in-hospital only
  • In-hospital sublimits increased as necessary
Consultations:
  • 4 consults, paid by scheme
  • No benefit
Scans:
  • Unchanged
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Ingwe E
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only, at state facilities
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
Ingwe E
Scheme Benefits Gap benefits
Dentistry:
  • Standard dentistry: paid by scheme. Includes:
    • 1 consult per person
    • Fillings
    • X-rays
  • Specialised dentistry: No benefit
  • Pays shortfalls and co-payments for in-hospital dentistry treatment approved by scheme
Orthodontics:
  • You pay this out of pocket
  • No extra benefit available
Maxillo Facial Surgery:
  • No benefit unless PMB. Then at State facilities only.
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
Ingwe E
Scheme 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

No phone calls!
Our quote will include the right gap cover for this plan

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OPTOMETRY:
Ingwe E
Scheme Benefits Gap benefits
Optometry:
  • 1 eye test per person
  • 1 pair of standard or bi-focal lenses and frame per person, every two years
  • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
Ingwe E
Scheme 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
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
Ingwe E
Scheme 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: Netcare 911
  • No benefit
International Insurance:
  • Unchanged
  • No benefit
Other: TBC
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
Ingwe E
Scheme 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

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
Ingwe E
Scheme Benefits Gap benefits
Overal Limit:
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
Sub-limits:
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid

No phone calls!
Our quote will include the right gap cover for this plan


    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