Focus on the Africa Benefit

Below is information about focus on the Africa Benefit 

Momentum Medical Scheme offers coverage for its members enrolled in the Custom, Incentive, Extender, and Summit Options who are employed in sub-Saharan Africa. This coverage encompasses a range of benefits, which are governed by the Scheme Rules and clinical protocols. The Africa Benefit is designed to assist members with various medical needs while they are working in these regions.

The benefits provided under this scheme include coverage for both emergency and elective hospital admissions, as well as day procedures and medical admissions. An elective procedure is defined as a medical intervention that is typically arranged in advance and does not necessitate immediate or urgent care. A common example of this would be a knee replacement surgery. For members who qualify for the Africa Benefit, pre-notification is not a requirement; however, in the event of an emergency, authorization must be obtained from the Scheme’s provider while in sub-Saharan African countries. Additionally, there is a separate Emergency Travel Benefit, which requires pre-notification before traveling from South Africa. For further details regarding this benefit, please refer to the International Emergency Travel focus page.

The Africa Benefit covers the following in respect of emergency treatment once authorized by theScheme’s provider:

• Emergency medical evacuation to the nearest suitable medical facility.
• Coverage for the costs associated with necessary medical, surgical, hospital, emergency transport, and other treatments administered to the beneficiary immediately prior to medical evacuation.

Options

The Africa Benefit is accessible to members who are part of the Custom, Incentive, Extender, and Summit Options. It is highly recommended that members enrolled in the Custom, Incentive, and Extender Options choose the Any Hospital provider option. This is important because those who select the Associated Hospital provider option will incur a 30% co-payment for each event. An "event" is defined as a hospital admission or procedure, which includes all related claims from service providers, such as radiology, pathology, and specialist accounts.

Claims

For elective treatments, members are required to pay the providers directly and then submit their claims for reimbursement to the Scheme via email at [e-mail]. It is important to note that claim refunds will only be deposited into a member’s South African bank account. Elective procedures are reimbursed up to a global event fee, which is based on the average cost the Scheme would have paid for that specific event in South Africa. Once the maximum global event fee, as determined by the Scheme, has been reimbursed to the member, no further benefits will be provided for that same event.

Members must ensure that all hospital claims and related service provider claims for the event are submitted together to the Scheme within four months from the date of service. Claims submitted after this four-month period will be classified as stale according to the Scheme Rules and will not be reimbursed by the Scheme. In cases of medical emergencies, members are not required to pay the claims upfront. They should contact the Scheme’s provider at [phone] (reverse call charges are accepted) for authorization and submit the authorized claims to [e-mail].

Countries covered

The Africa Benefit extends its coverage to beneficiaries residing in any of the following African countries and islands:

• Angola
• Benin
• Botswana
• Burundi
• Cameroon
• Comoros
• DRC
• Djibouti
• Equatorial Guinea
• Eritrea
• Ethiopia
• Gabon
• Ghana
• Guinea
• Kenya
• Lesotho
• Liberia
• Madagascar
• Malawi
• Mauritius
• Mozambique
• Nigeria
• Namibia
• Réunion
• Rwanda
• Seychelles
• Sierra Leone
• Swaziland
• Tanzania
• Togo
• Uganda
• Zambia
• Zimbabwe

Contact details from outside South Africa

For assistance from outside South Africa, members can reach the member call center at [phone] or [phone]. For non-emergency claim submissions, members can send their claims to [e-mail]. In case of a medical emergency, they should contact [phone] (reverse call charges are accepted). For emergency claim submissions, claims should be sent to [e-mail]. For more information, members can visit the website at momentummedicalscheme.co.za.