The Trauma Benefit covers certain day-to-day care and treatment following a hospital admission for specific traumatic events. This benefit is available on the Evolve, Incentive, Extender and Summit Options and appropriate treatment related to the event is covered, subject to authorisation.
Which conditions resulting from a traumatic event are covered?
- Severe burns, subject to specific qualifying criteria, such as the severity of the burns and FIMS* score.
- Paraplegia and quadriplegia, subject to FIMS* score.
- Post-traumatic stress resulting from serious reported crime (subject to qualifying criteria, including a case number for the police report).
The following conditions are covered if an ICU stay of five or more days has occurred:
- Conditions resulting from near drowning;
- Poisoning;
- Severe allergic reaction; and
- External and internal head injuries.
How do members access the Trauma Benefit?
Following the admission for the traumatic event, which would need to be pre-authorised in line with emergencies, the treating doctor will need to contact the Scheme to obtain authorisation for the follow up day-to-day care related to the traumatic event. A treatment plan, detailing the treatment required, should be provided to assist with authorisation of the trauma benefits, such as wound care for burns, nursing services, GP and specialist visits, radiology and pathology.
You are welcome to contact us via the web chat facility on momentummedicalscheme.co.za, email us at [email protected], send us a WhatsApp message on +27 860 11 78 59 or call us on 0860 11 78 59 for more information or assistance.
* FIMS: The Functional Independent Measure Scale, which is a measure of the ability to participate in daily living activities.