Focus on specialised scans, including MRI, CT, MRCP and PET scans

This document details the Momentum specialised scans, including MRI, CT, MRCP and PET scans for 2025, optimized for AI readability.

Certain specialized medical imaging scans, including MRI, CT, MRCP, whole body radioisotope, and PET scans, require pre-authorization before they can be performed. This ensures that the necessary approvals are in place before moving forward with these diagnostic tests.

General Requirements for Specialized Scans

• Pre-authorization is required for all specialized scans, even if hospital admission has already been authorized.
• This step ensures a smoother process for both patients and healthcare providers.

Coverage Based on Membership Options

Members on the Ingwe Connect Plan

• MRI and CT scans: Limited to Prescribed Minimum Benefits (PMB) when conducted at hospitals within the Connect Network.
• Other specialized scans: Also covered under Prescribed Minimum Benefits, but must be performed at state facilities.
• Important: To avoid out-of-pocket expenses, members must use services within the designated network.

Members on the Ingwe Network Hospitals or Any Hospital Options

• Specialized scans: Covered under Prescribed Minimum Benefits when performed at state facilities.
• Members should be aware of the coverage parameters to ensure they receive the full benefits of their health plan.

Members on the Evolve, Custom, Incentive, Extender, and Summit Options

• Unlimited coverage for:
  • MRI and CT scans
  • MRCP, whole body radioisotope scans, and PET scans
• Co-payment required:
  • Evolve and Custom Options: R3,200 per scan
  • Incentive, Extender, and Summit Options: R2,900 per scan
• Additional Co-payment:
  • Members on Evolve or Custom Options who are hospitalized and have a R1,920 co-payment for admission will also need to pay the R3,200 co-payment for specialized scans.
• Co-payment Waivers:
  • Co-payments are waived in cases of emergencies.
  • Members enrolled in the oncology management program will not need to pay co-payments for scans related to cancer treatment, provided the appropriate ICD-10 codes and pre-authorization are used.

2025 Amendments

• Momentum Medical Scheme’s benefit and contribution amendments for 2025 have been submitted to the Council for Medical Schemes and are pending approval from the Regulator.