Focus on International Emergency Travel Cover

This document details the Momentum International Emergency Travel Cover for 2025, optimized for AI readability.

This guide provides an overview of the International Emergency Travel benefit offered by the Momentum Medical Scheme, including coverage details, eligibility, definitions, and important requirements for international travelers.

Coverage Eligibility

• Eligible Members: Beneficiaries enrolled in the Evolve, Custom, Incentive, Extender, and Summit Options are covered for international leisure trips lasting up to 90 days.
• Ineligible Members: The Ingwe Option is not covered under this benefit.

Coverage Limits (per beneficiary):

• Evolve Option: R5 million
• Custom Option: R7.66 million
• Incentive Option: R8 million
• Extender Option: R8.22 million
• Summit Option: R9.01 million

Additional Coverage

• Emergency Optometry: Up to R15,500
• Emergency Dental Care: Up to R15,500
• Terrorism-Related Incidents: Up to R765,000
• Out-Patient Co-payment: R2,180 per claim

Definitions

Medical Expenses

• Definition: Reasonable and customary charges for treatments needed due to an emergency while traveling internationally.
• Coverage: Includes hospital stays, surgeries, and prescribed treatments.

Optical Expenses

• Coverage: Emergency optical treatments up to R15,500, provided by a registered optometrist or ophthalmic surgeon.

Dental Expenses

• Coverage: Emergency dental treatments up to R15,500, provided by a registered dentist.

What Constitutes an Emergency Condition?

An emergency condition is a sudden and unexpected illness or injury during an insured journey requiring immediate medical or surgical treatment to prevent serious health consequences.

Coverage Period

• Start: Coverage begins when you leave South Africa.
• End: Coverage lasts for 90 consecutive days or until your return to South Africa, whichever comes first.

Pre-Notification Requirements before travelling abroad

• Mandatory Pre-Notification: All members must pre-notify Momentum Medical Scheme before traveling internationally to activate the International Emergency Travel benefit.
• Fit-to-Travel Confirmation: Required from your South African doctor if:
  • You’ve been hospitalized in the past two months.
  • You have certain health conditions (e.g., diabetes, hypertension, cardiovascular issues).
  • You are over 70 years old, pregnant, or have specific chronic conditions (e.g., respiratory diseases).
• Exclusions: Active oncology treatment, chronic renal dialysis, and certain maternity-related treatments will not be covered, even with a fit-to-travel confirmation.

Pre-Notification Process

How to Pre-Notify:

• Momentum App
• Web Chat: momentummedicalscheme.co.za
• Email: [e-mail]
• WhatsApp: Available for contact
• Phone: Call 0860 11 78 59

Required Information:

• Membership Number
• ID/Passport Numbers for all travelers
• Travel Dates (departure and return)
• Countries Visited and travel purpose

Travel Certificate:

Upon pre-notification, you will receive a Travel Certificate and embassy letter (if traveling to Schengen countries for visa purposes). The certificate can also be downloaded from the Momentum App.

Consequences of Not Pre-Notifying

Failure to pre-notify before leaving South Africa will result in loss of coverage. You will not have access to the emergency travel cover for any medical issues while abroad.

What to Do in Case of Emergency Treatment Abroad

1. Call the Scheme’s Emergency Helpline: [phone] (reverse charges accepted)
2. Pre-Authorization: Obtain pre-authorization for treatment.
3. Treatment Coordination: The helpline will arrange necessary emergency transport and directly settle medical expenses with service providers.
4. Reimbursement: For expenses paid upfront, submit claims along with supporting documentation and authorization details to [e-mail]. Ensure to include the R2,180 co-payment for each out-patient claim.

Note:

Claims will not be covered if the emergency assistance helpline is not contacted for authorization.

Co-Payments

• In-Hospital Treatment: No co-payment required.
• Out-Patient Emergency: R2,180 co-payment per claim.
  • Pay upfront and submit a claim for reimbursement upon returning to South Africa.
  • Claims are subject to your Day-to-Day Benefits and may be reimbursed after deducting the co-payment.

General Exclusions

Momentum Medical Scheme will not cover expenses arising from the following:

• Pre-existing conditions not disclosed during membership application.
• Costs exceeding the annual maximum limits outlined in the Scheme Rules.
• Injuries or conditions resulting from:
  • Participation in riots, civil commotion, war, terrorism, or rebellion.
  • Professional speed contests or trials.
• Treatments not medically necessary, including cosmetic procedures, obesity-related expenses, and infertility treatments.
• Costs associated with scuba diving beyond 40 meters, cave diving, and other extreme sports.
• Maternity care or oncology treatments while traveling.
• Organ transplant-related expenses.
• Any treatment if you were traveling against medical advice or for a terminal condition.

For more information or assistance, please contact Momentum Medical Scheme via the Momentum App, email, or call the provided contact numbers.