Momentum Ingwe C (associate provider) medical aid plan: 2019

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Ingwe Network C
2019 Costs:
Total Cost pm:

Main member:

R1,062

Adult:

R1,062

Child: (Pay for all)

R397
Savings (per year):
  • No savings option on this plan
Income band:
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In brief (2018): See full benefits below

IN HOSPITAL PROCEDURES:
Ingwe Network C
Scheme Benefits: Notes and Links:
Specialists:
  • Up to 100% scheme rate
  • You or gap cover pay the balance, if any
Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Choose anIngwe Network hospital, or pay a 30% co-payment if you voluntarily choose another hospital
Specialised Radiology:
  • No benefit unless PMB. Then at State facilities only.
Supplementary Services: (Physio, etc) TBC
Transplants:
  • PMBs only, at State facilities
Co-payments:
  • N/A
Alternatives to hospitals:
  • Medical rehabilitation and step-down facilities: R12,500 per family
  • Private nursing and hospice: no benefit
Casualty: 2019 Benefits coming November 9, 2018
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: removal of minor skin lesions, laparoscopy, nail surgery, treatment of headache
  • 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
  • Opthalmology: catarct removal, pterygium removal, trabeculectomy, treatment of disease of conjunctiva
  • Orthopaedic: arthroscopy, back and neck surgery, conservative neck and back treatment, joint replacements, bunionectomy
  • Respiratory: bronchography, bronchoscopy, treatment of adult influenza, treatment of adult respiratory tract infections
  • Urology: cystoscopy
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)
What next?
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Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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 Network C
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info: 2019 Benefits coming November 9, 2018
GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with R100 co-payment
Childcare: 2019 Benefits coming November 9, 2018
Specialists consultations:
  • From Ingwe Primary Care Network: 2 consults per family limited to R1,000 per consult and R2,000 per family
Pathology:
  • Some specific pathology covered by scheme, from Ingwe Active Primary Care network
General radiology:
  • Some specific x-rays covered by scheme, from Ingwe Primary Care network
Specialised radiology:
  • No benefit unless PMB. Then at State facilities only.
Supplementary Services: (Physio, etc)
  • No benefit unless PMB. Then at State facilities only.
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MATERNITY BENEFITS:
Ingwe Network C
Scheme Benefits Notes and Links:
Hospital stay:
  • Complicated: R41,900
  • Uncomplicated: R28,600
  • Neonatal intensive care: R60,100, unless PMB
  • Elective C-sections: no benefit
Consultations:
  • 4 consults, paid by scheme
Scans:
  • 2 growth scans
What next?
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CANCER (ONCOLOGY):
Ingwe Network C
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, at State facilities
What next?
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DENTISTRY:
Ingwe Network C
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard dentistry: paid by scheme. Includes:
    • 1 consult per person
    • Fillings
    • Extractions
    • X-rays
Specialised Dentistry:
  • Specialised dentistry: no benefit
In-Hospital Dentistry:
  • Maxilo-facial surgery: no benefit, unless PMB. Then at State facilities.
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • No benefit unless PMB. Then at State facilities only.
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MEDICATION:
Ingwe Network C
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • All benefits from Ingwe Primary Care Network
Acute (presrcibed) medication:
  • Some prescribed medication covered by scheme
Over-the-counter:
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • 7 days supply
Biological:
  • No benefit, unless PMB level of care
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OPTOMETRY:
Ingwe Network C
Scheme Benefits: Notes and Links:
Optometry:
Limit:Paid by scheme, every 2 years
Consult:1 per person
Frames:1 pair per person
Single lenses1 set as needed
Bifocals:1 set as needed
Multifocals
Contacts
Refractive Surgery:No benefit
Notes:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MENTAL HEALTH:
Ingwe Network C
Scheme Benefits Notes and Links:
In-hospital: 2019 Benefits coming November 9, 2018
Out-of-hospital:
  • No benefit unless PMB. Then at State facilities only.
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Trauma:
  • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OTHER BENEFITS:
Ingwe Network C
Scheme Benefits Notes and Links:
General Appliances:
  • In-hospital: R5,150 per family
  • Out-of-hospital: no benefit
  • No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Dialysis:
  • PMBs only
  • , at State Facilities
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
Emergency Transport: Netcare 911
International Insurance:
  • No benefit, unless PMB
Other: TBC
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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WELLNESS/PREVENTATIVE BENEFITS:
Ingwe Network C
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered for under 18yrs and 60yrs+
Pneumonia vaccines:
  • No benefit
Back Rehabilitation Programme: TBC
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered for 15yrs+
Mammogram:
  • No benefit
PAS Test:
  • Covered for 40yrs+, every 1-5 years depending on age
HIV Test:
  • Covered for 15yrs+, every 5 years
Other: 2019 Benefits coming November 9, 2018
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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PROSTHETICS:
Ingwe Network C
Scheme Benefits: Notes and Links:
Overal Limit:
  • PMBs only, at State Facilities
Sub-limits: 2019 Benefits coming November 9, 2018
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    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