Focus on GroupSaver+

Here is detailed information regarding Focus on Momentum GroupSaver

GroupSaver serves as a supplementary product designed to assist employer groups in financing specific medical expenses, treatments, and procedures that are not covered by the Momentum Medical Scheme and/or Momentum Health4Me for their employees. This innovative approach allows employers to provide additional financial support for healthcare needs, ensuring that their employees have access to necessary medical services that may otherwise be out of reach.

Who is eligible for GroupSaver?

GroupSaver is accessible to employer groups that have a workforce of more than 100 employees who are enrolled in either the Momentum Medical Scheme or Momentum Health4Me. This threshold ensures that the program is tailored for larger organizations, allowing them to extend this valuable benefit to their employees and enhance their overall health coverage.

How does GroupSaver operate?

GroupSaver functions as a funding mechanism established in the name of the employer, creating a dedicated pool of funds aimed at enhancing benefits for a specific list of treatments and procedures. Employers have the flexibility to determine whether the funds from GroupSaver will be available to all employees covered under the plan or if they will be restricted to members enrolled in particular options. For example, it can be utilized to cover benefits that are not included in a specific option, thereby providing targeted support where it is needed most.

Furthermore, employers may impose limits on the amount of funding available for certain procedures, such as MRI and CT scans, or they may set a cap on the number of claims that can be submitted per employee. It is crucial that the terms regarding which employees can access these funds, as well as the specific benefits and the healthcare providers that will be included, are clearly defined and agreed upon with the employer at the outset of establishing the GroupSaver contract between Momentum Health Solutions and the employer.

The primary goal of GroupSaver is to ensure that sufficient funds are allocated for the claims specified. To facilitate this, there is a minimum contribution requirement of R100 per employee each month. If a broader range of claims is to be included, a higher monthly contribution per member will be necessary. Additionally, a monthly administrative fee is applied for each member, which is determined by the benefits that are covered under the GroupSaver plan.

Claims Process

When a claim is made, an authorization number will be issued once the benefits to be disbursed from the GroupSaver fund have been approved. The adviser or the employer plays a crucial role in facilitating claims to GroupSaver, ensuring that there is control and transparency throughout the process.

To keep all parties informed, monthly claims reports are generated and distributed to both the employer and the adviser. Healthcare providers also receive claims statements following each payment cycle. It is important to note that GroupSaver claims are not reflected on the members’ claims statements, as the contractual relationship exists solely between the employer and the service provider.