Focus on International Emergency Travel Cover

Below is information about focus on International Emergency Travel Cover

This document serves as a comprehensive overview of the International Emergency Travel benefit provided by the Momentum Medical Scheme. It outlines the coverage details, eligibility criteria, and important procedures that members must follow to ensure they are adequately protected while traveling internationally.

Who is covered?

Beneficiaries enrolled in the Evolve, Custom, Incentive, Extender, and Summit Options are entitled to coverage for a leisure journey lasting up to 90 days. The coverage limits for each option are as follows:

• Ingwe Option: Not covered
• Evolve Option: R5 million per beneficiary
• Custom Option: R7.66 million per beneficiary
• Incentive Option: R8 million per beneficiary
• Extender Option: R8.22 million per beneficiary
• Summit Option: R9.01 million per beneficiary

The total coverage limit includes R15,500 for emergency optometry, R15,500 for emergency dental services, and R765,000 specifically for terrorism-related incidents. Please note that a co-payment of R2,180 is applicable for each out-patient claim.

Definitions

Medical expenses encompass all reasonable and customary charges that are necessarily incurred due to an emergency, which may arise from an illness or injury during an international trip. This includes situations that lead to hospitalization, surgical interventions, or other diagnostic and remedial treatments prescribed by a registered and legally qualified medical practitioner.

Optical expenses are defined as emergency optical treatments up to R15,500, which must be provided by a registered and legally qualified optometrist or ophthalmic surgeon. If optical treatment is required due to an illness or injury while traveling internationally, these costs will be deducted from the total emergency travel cover limit.

Dental expenses refer to emergency dental treatments up to R15,500 aimed at restoring dental function or alleviating pain, provided by a registered and legally qualified dentist. Similar to optical expenses, if dental treatment is necessary due to an illness or injury while on an international journey, these costs will also be covered under the overall emergency travel cover limit.

An emergency condition is characterized by the sudden and unexpected onset of an accidental injury or illness during an insured journey, necessitating immediate medical or surgical treatment. Failure to provide such treatment could lead to serious impairment of bodily functions or could jeopardize the beneficiary’s life.

What is the period of cover?

The coverage begins the moment you leave South Africa and remains effective for a maximum duration of 90 consecutive days or until your return to South Africa, whichever occurs first.

Do I need to pre-notify?

It is essential for all members to pre-notify Momentum Medical Scheme of their intention to travel to any international destination to gain access to the international emergency cover benefit. In addition to pre-notification, you must have your treating doctor in South Africa complete a fit-to-travel questionnaire. This questionnaire confirms that the doctor is comfortable with your travel plans, taking into account any health risks, including that related to the coronavirus. This is particularly important if you meet any of the following criteria:

• You have been hospitalized in the two months leading up to your travel.
• You are registered in any health management programs, including those for chronic diseases, oncology, or organ transplant management.
• You are 60 years of age or older.
• You are pregnant.
• You have an underlying condition such as diabetes, hypertension, or cardiovascular issues.
• You have an immune-suppressive condition.
• You have any chronic respiratory diseases or conditions.

As part of Momentum Medical Scheme’s commitment to managed care, it is deemed inappropriate for beneficiaries undergoing active oncology treatment, those dependent on home oxygen, or those on chronic renal dialysis to travel. Consequently, these individuals will not be authorized for any international emergency cover benefits related to these conditions, even if the treatment is considered an emergency and a fit-to-travel confirmation has been obtained. The same restrictions apply to maternity benefits or treatment, including childbirth. A comprehensive list of exclusions related to this benefit can be found in the Travel Policy Wording that is provided upon pre-notification.

The fit-to-travel confirmation is valid for 30 days. If you submit the questionnaire more than 30 days before your departure, you will need to provide an updated fit-to-travel confirmation within 30 days of your departure date.

If you are unsure whether you or your dependents need to obtain a fit-to-travel confirmation, or if you require further information, please contact us through the Momentum App, via the web chat facility on momentummedicalscheme.co.za, email us at [e-mail], send us a WhatsApp message, or call us at 0860 11 78 59.

How do I pre-notify Momentum Medical Scheme of my intention to travel abroad?

You can pre-notify us of your travel plans before you embark on your journey through several convenient methods:

• Using the Momentum App;
• Accessing the web chat facility on momentummedicalscheme.co.za;
• By emailing us at [e-mail];
• Or by sending us a WhatsApp message or calling us at 0860 11 78 59.

When pre-notifying, please provide the following information:

• Your Momentum Medical Scheme membership number;
• The ID and passport numbers of all beneficiaries traveling;
• The departure and return dates of your journey;
• Details of all countries you will visit during the trip, including the purpose of travel.

Upon successful pre-notification, you will receive a Travel Certificate and/or embassy letters where applicable, such as when traveling to Schengen countries that require specific letters for visa applications. Remember that you can also download your travel certificate directly from the Momentum App.

What happens if I do not pre-notify before leaving South Africa?

It is crucial for you to contact us prior to your departure from South Africa, as failure to pre-notify will result in the loss of benefits associated with the international emergency travel cover.

What should I do if I need emergency treatment when traveling abroad?

If you find yourself in need of emergency medical, dental, or optical treatment due to an accidental injury or an emergency illness while traveling abroad, follow these steps:

• Contact the Scheme’s emergency medical assistance helpline at [phone] (reverse call charges are accepted) to obtain pre-authorization.
• The emergency medical assistance helpline will coordinate your emergency transport on behalf of Momentum Medical Scheme, if necessary.
• If authorization is granted, the emergency medical expenses will be settled directly with the service providers.
• For reimbursement of any emergency medical, optical, or dental expenses that you have paid out-of-pocket, email your claims along with any supporting documentation and authorization details to [e-mail]. Please remember that a co-payment of R2,070 applies for each out-patient claim.
• It is important to note that the Scheme will not cover claims for overseas medical treatment if the emergency assistance line was not contacted for authorization. To utilize your available Day-to-day Benefits for these expenses, the claims must be reviewed and approved by the Scheme for reimbursement. Ensure that any claims for review are submitted within one month of your return to South Africa. We can only process claims for accounts issued in English and provided you have available day-to-day benefits.

Do I need to pay any co-payments on claims?

No co-payment is required for in-hospital treatment. However, if you incur out-patient emergency medical expenses, a co-payment of R2,070 will be charged per claim. You will need to pay the out-patient costs upfront and submit a claim for reimbursement when you return to South Africa, subject to the availability of day-to-day benefits. We will cover the incurred costs after deducting the R2,070 co-payment, up to the Momentum Medical Scheme Rate. You may also utilize any available HealthSaver funds to cover any shortfalls.

+Momentum HealthSaver is a voluntary complementary product offered by Momentum Metropolitan Holdings Limited (Momentum). You have the option to utilize additional products from Momentum to enhance your medical aid seamlessly. It is important to note that Momentum is not a medical scheme and operates as a separate entity from Momentum Medical Scheme. The complementary products offered are not classified as medical scheme benefits. You can be a member of Momentum Medical Scheme without enrolling in any of the complementary products provided by Momentum.

General exclusions

Momentum Medical Scheme will not provide benefits for any expenses that result directly or indirectly from the following circumstances:

• All costs incurred during waiting periods and for pre-existing conditions that were not disclosed at the time of application for membership in the Scheme.
• All costs exceeding the annual maximum allowed for the specific category as outlined in Annexure B of the Scheme Rules, according to the benefits entitled to the beneficiary.
• Injuries or conditions sustained while willfully participating in riots, civil commotion, wars, invasions, terrorist activities, or rebellions.
• Professional speed contests or trials, where the beneficiary derives their primary income from participating in such contests.
• Services rendered by healthcare providers not registered with the relevant professional body established under an Act of Parliament.
• Holidays taken for recuperative purposes, regardless of whether they are deemed medically necessary, including visits to headache and stress relief clinics.
• All costs associated with treatments where the efficacy and safety cannot be substantiated.
• All costs related to operations, medicines, treatments, and procedures for cosmetic purposes or personal reasons that are not directly linked to illness, accidents, or diseases. This includes costs associated with treatments or surgeries related to transsexual procedures.
• Costs associated with obesity treatments.
• Expenses for attempted suicide that exceed the costs of three days of hospital-based management or six outpatient consultations.
• Costs related to breast reduction and augmentation, gynecomastia, otoplasty, and blepharoplasty.
• Medications not registered by the Medicine Control Council.
• Costs for services provided by institutions, nursing homes, or similar establishments that are not registered according to the law (except for state facilities or hospitals).
• Costs associated with gum guards and gold used in dentures.
• Expenses for frail care.
• Traveling expenses, except for benefits covered by Emergency rescue and International cover.
• All costs deemed by the Medical Assessor as not medically necessary or appropriate to meet the healthcare needs of the patient.
• Appointments that beneficiaries fail to attend.
• Circumcision unless clinically indicated, as well as any contraceptive measures or devices.
• Reversal of vasectomies or tubal ligations (sterilization).
• Injuries resulting from substance abuse or alcohol misuse.
• Costs associated with infertility treatments.
• Injury costs and related expenses resulting from scuba diving beyond depths of 40 meters or cave diving.
• Care or treatment related to maternity or pregnancy while traveling, including emergencies.
• Oncology care or treatment.
• Care or treatment associated with organ transplants.
• Care or treatment associated with chronic renal failure.
• Injuries, illnesses, and emergency conditions occurring during a three-month waiting period or a twelve-month condition-specific waiting period.
• Any insured person traveling against medical advice, seeking medical attention or advice, or with a terminal condition diagnosed prior to the insured journey, when they are unfit to do so.
• Any insured person who did not comply with the criteria for obtaining a fit-to-fly confirmation as described above.