Focus on specialised procedures/treatment

The document accessible at this link serves as a comprehensive guideline detailing the various procedures and treatments that are covered under different benefit options. These benefits are drawn from the Major Medical Benefit, and it is crucial to understand that this coverage applies regardless of whether the procedures or treatments take place within a hospital setting or outside of it. It is mandatory to obtain pre-authorisation prior to undergoing any of these procedures or treatments, irrespective of the location where they are performed. However, it is essential to highlight that the document does not encompass the entirety of all procedures and treatments that the Scheme covers. If you have any questions or require clarification about whether a specific procedure or treatment is included in the coverage, we encourage you to reach out to us for confirmation.

When it comes to the costs associated with anaesthetists for procedures such as gastroscopies and colonoscopies, the coverage varies based on the specific benefit option you are enrolled in. For those on the Evolve and Custom options, the costs are covered up to R590. If you are on the Incentive and Extender options, the coverage increases to R1,230, and for those on the Summit option, the coverage is up to R1,460, provided that pre-authorisation has been obtained. For all other medical procedures, the costs related to anaesthetists will be covered if they are deemed clinically appropriate. Additionally, it is important to note that the specialised procedures and treatments listed in the document may incur a co-payment of R1,830 per authorisation for members on the Evolve and Custom options. This co-payment might differ for certain procedures, and further details can be found in the document linked above. Furthermore, some specialised procedures and treatments may also result in a co-payment for members on the Incentive and Extender options, as illustrated in the same resource.

HealthSaver is offered as a complementary product designed to enhance your medical aid experience. Members have the option to utilize various additional products provided by Momentum Metropolitan Holdings Limited (Momentum). It is important to clarify that Momentum is not a medical scheme and operates as a separate entity from the Momentum Medical Scheme. The complementary products offered do not constitute medical scheme benefits. Therefore, it is entirely possible to be a member of the Momentum Medical Scheme without opting for any of the complementary products available.