MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans are subject to pre-authorisation. Even if you have authorisation for an in-hospital admission, a separate pre-authorisation will be required for these scans.
Ingwe Connect
MRI and CT scans are limited to Prescribed Minimum Benefits at Connect Network hospitals and other specialised scans are subject to Prescribed Minimum Benefits at State facilities.
Ingwe Network hospitals or Any hospital
All scans are limited to Prescribed Minimum Benefits at State facilities.
Evolve, Custom, Incentive, Extender and Summit Options
Members on the Evolve, Custom, Incentive, Extender and Summit Options have unlimited cover for MRI and CT scans, MRCP, whole body radioisotope and PET scans.
On the Evolve and Custom Options, a co-payment of R3 200 per scan applies. On the Incentive, Extender and Summit Options, a co-payment of R2 900 per scan applies. A member on the Evolve or Custom Option who has been admitted to hospital and is liable for the R1 920 hospital admission co-payment, will be liable for the additional co-payment of R3 200 for MRI scans, CT scans, MRCP, whole body radioisotope and PET scans.
These co-payments will not apply in the case of confirmed emergencies. The co-payment will also not be applicable to members who are registered on the oncology management programme and are having these scans done as part of their oncology treatment, provided the healthcare provider uses the correct ICD-10 codes for the oncology management authorised and pre-authorisation for the scans is obtained.
Momentum Medical Scheme’s 2025 benefit and contribution amendments have been submitted to the Council for Medical Schemes and are subject to approval by the Regulator.