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Specialised procedure and treatment This document provides a guideline of the procedures and treatment covered on the various benefit options and paid from the Major Medical Benefit, irrespective of whether the procedure and treatment is perf...
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Optometry Benefit for Ingwe Option members On the Ingwe Option, you have the following benefits for optometry: One eye examination (eye test) per beneficiary every two years. One pair of spectacles (frame plus lenses) per beneficiary eve...
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Anorectal - Treatment of haemorrhoids, fissure, fistula Covered for complicated cases that cannot be treated as an out-patient or where the out-patient treatment options failed and treatment is required in a medical facility Biops...
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The Major Medical Benefit includes cover for hospitalisation, as well as certain specialised procedures/ treatment and specialised scans. Overview of the cover provided in hospital across the six options Option
Cover
Lim...
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Third party injuries are incidents where a third party was responsible for the injury and therefore maybe liable for medical expenses, such as a motor vehicle accident (MVA). Any amount recovered from a third party or from the Road Accident Fund...
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Evolve Option members who sustain a sports injury and require treatment are covered for two physiotherapy or biokineticist treatment sessions, up to a limit of R1 060 per year. Members do not need a referral from a GP or doctor before using th...
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You need to obtain pre-authorisation from Momentum Medical Scheme for: Hospitalisation Day hospital admissions Specialised procedures/treatment MRI, CT, Magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET...
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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 require...
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What is a doula? A doula provides non-clinical support and care to a woman (and her partner) during childbirth and the postpartum (after delivery) period. What are the criteria for using the benefit? There are three criteria that need to be...
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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...