Momentum Ingwe E (State providers) 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:
Ingwe State E
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R1,393 R1,393 R419
Cost 2017: (R1,291) (R1,291) (R389)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: R1,260,000 per family
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
Income band: This plan is only available to households with income in R11,701+pm band.
View other income bands
  • 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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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Ingwe State E
2017 v 2018 benefits Gap benefits Notes
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.

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Hospital Choice:
  • State facilities. If you choose another provider, you will need to pay the difference in cost.
  • No benefit
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: 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
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OUT OF HOSPITAL BENEFITS:
Ingwe State E
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Ingwe Primary Care Network: Unlimited
  • Non-network: 1 consult per person and 2 per family with R100 co-payment
  • No benefit


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Childcare:
  • No benefit
Specialists consultations:
  • From Ingwe 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 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 State E
2017 v 2018 benefits Gap benefits Notes
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

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Consultations:
  • 4 consults, paid by scheme
  • No benefit
Scans:
  • Unchanged
  • No benefit
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CANCER (ONCOLOGY):
Ingwe State E
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • PMBs only, at state facilities
  • 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:
Ingwe State E
2017 v 2018 benefits Gap benefits Notes
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

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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

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
Ingwe State E
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • PMB chronic: paid by scheme
  • Chronic benefits from Ingwe Primary Care Network
  • No benefit

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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 State E
2017 v 2018 benefits 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:
Ingwe State E
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit

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Out-of-hospital:
  • No benefit unless PMB. Then at State facilities only.
  • No benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
Ingwe State E
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • In-hospital: R4,900 per family
  • Out-of-hospital: no benefit
  • No benefit

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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:
  • No benefit
  • 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 State E
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered for under 18yrs and 60yrs+
  • No benefit

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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

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
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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