Focus on the Evolve Option Sports Injury Benefit – Momentum

Below is information about focus on the Evolve Option Sports Injury Benefit

Members enrolled in the Evolve Option who experience a sports-related injury and require medical treatment are entitled to receive coverage for two physiotherapy or biokineticist sessions. This benefit is capped at a maximum limit of R1,060 per year. A significant advantage of this benefit is that members are not required to obtain a referral from a general practitioner (GP) or any other doctor prior to utilizing the service. Furthermore, all claims made under this benefit are covered up to the Momentum Medical Scheme Rate, ensuring that members receive the appropriate financial support for their treatment needs.

To take advantage of this benefit, members must go through a pre-authorisation process. This can be easily done by sending a WhatsApp message or calling the dedicated helpline at 0860 11 78 59. When requesting pre-authorisation, it is essential for members to provide specific information to facilitate the process. The details required include:

Information regarding how the injury occurred, which is necessary to verify that it qualifies as a sports injury.
The practice number of the physiotherapist or biokineticist who will be providing the treatment.
The relevant ICD-10 code that corresponds to the injury.
The appropriate tariff codes that apply to the treatment.
The date when the treatment is scheduled to take place.

In situations where members may not have all of the required details at the time of contacting us, we have procedures in place to assist them. Initially, we will issue a reference number to confirm that they have coverage once it is established that the injury is indeed a sports-related one. Subsequently, we will advise members to gather the necessary information from their treating physiotherapist or biokineticist during their visit to the healthcare provider. After the member has provided us with the outstanding details, we will confirm the authorisation number, which will facilitate the payment of their claims. This streamlined process is designed to ensure that members can receive the care they need without unnecessary delays or complications.