acute hospitals
A hospital that provides inpatient medical care and other related services for surgery, acute medical conditions, or injuries, and which is permitted to provide treatment that includes part of an overnight stay at the facility.
AE
Account executive.
Allied professionals
Allied health professionals are healthcare workers who provide services distinct from nursing, medicine, and pharmacy. They work in various settings, offering direct patient care, diagnostics, treatment, and rehabilitation. Examples include physical therapists, occupational therapists, speech-language pathologists, radiologic technologists, medical laboratory technologists, dietitians, respiratory therapists, and clinical social workers. They undergo specialised training and work collaboratively with other healthcare providers to deliver comprehensive patient care.
Associated providers such as hospitals and GPs
These are providers that Momentum Medical Scheme has negotiated agreements with. By choosing to use the Associated hospitals and GPs, members can pay a lower contribution. However, if members then do not use these providers a co-payment will apply.
baby bump benefit
One of the assist benefit on Momentum GapCover. If you fall pregnant while covered on the policy, we will pay you an upfront amount of R2 500 to assist you with any unexpected costs.
CHF
Clinical History Form
CLD
A list of 26 chronic conditions for which all medical schemes in South Africa have to provide cover in terms of the Medical Schemes Act 131 of 1998.
clinical protocol
Momentum Medical Scheme uses appropriate treatment principles, called clinical protocols, to determine and manage benefits for specific conditions. The Scheme’s network providers also apply their own clinical protocols to the benefits they offer our members.
clinically appropriate
Treatment that is in line with the clinical protocols for your condition.
co-payment
This is an amount payable towards medical procedures and treatments. The amount payable may vary depending on the type of procedure or treatment, and where the procedure or treatment is performed. If the co-payment amount is higher than the amount charged by the healthcare provider, the member will have to pay for the cost of the procedure or treatment. A co-payment will not apply in the event of an emergency medical condition.
COPD
Chronic obstructive pulmonary disease
day hospital
A healthcare facility which focuses on the provision of short-stay surgical and diagnostic procedures, performed in an operating theatre on a same-day basis. The patient is admitted in the morning and discharged on the same day.
designated service providers
Momentum Medical Scheme uses a network of designated service providers, such as Associated GPs and Specialists, as well as State facilities, depending on the circumstances, to diagnose and treat our members for the Prescribed Minimum Benefits.
EAP
Employee Assistance Programme provides members with access to professional counselling and wellness services. These services will help members to manage personal concerns that impact their wellbeing, productivity and performance at work, enabling employer groups to create a healthier and more resilient workforce.
emergency medical condition
Emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the person’s life in serious jeopardy.
Evolve network hospitals
Members on the Evolve Option must make use of the Evolve Network hospitals. These are private acute and day hospitals which Momentum Medical Scheme has agreements in place with.
EVP
Employee Value Proposition.
extended cover
On the Extender Option, your day-to-day claims are paid by the Scheme from Extended Cover once you have reached the Threshold level.
FDL
Final decision letter.
FIMS
The Functional Independent Measure Scale.
formulary
A list of medicines that are covered on the different options, from which a doctor can prescribe appropriate medicine for the member's chronic condition.
freedom-of-choice
Members on the Summit Option can get their day-to-day and chronic treatment from any provider and can use any hospital.
Ingwe network hospitals
Members on the Ingwe Option can choose to use Ingwe Network hospitals. These are private hospitals which Momentum Medical Scheme has agreements in place with.
ISC
Internal service consultant.
MH
Momentum Health