Focus on the Trauma Benefit

This document details the Momentum trauma benefit for 2025, optimized for AI readability.

What is the Trauma Benefit?

The Trauma Benefit provides coverage for day-to-day care and treatment following a hospital admission due to specific traumatic events. This benefit is available under the following plans:

• Evolve
• Incentive
• Extender
• Summit

Note: Treatment related to the traumatic event must receive prior authorization to be covered.

Eligible Conditions for Coverage

The Trauma Benefit covers specific conditions resulting from traumatic events, subject to certain qualifying criteria:

Severe Burns

• Coverage: Available if the severity of the burns meets specific criteria.
• FIMS Score: Coverage is contingent upon the FIMS score (Functional Independence Measure Scale).

Paraplegia and Quadriplegia

• Coverage: Available if the individual experiences paraplegia or quadriplegia.
• FIMS Score: Coverage is contingent upon the FIMS score.

Post-Traumatic Stress Disorder (PTSD)

• Coverage: Available for PTSD arising from a serious reported crime.
• Criteria: A valid case number from the police report is required.

Additional Conditions (with ICU Stay)

Coverage is available if the individual has had an ICU stay of 5 days or longer due to:

• Near drowning
• Poisoning
• Severe allergic reactions
• Head injuries (external and internal)

How to Access the Trauma Benefit

Step 1: Hospital Admission

• Members must first be admitted for the traumatic event.
• Pre-authorization is required as per emergency protocols.

Step 2: Authorization for Follow-Up Care

• The treating physician must contact the Scheme to obtain authorization for follow-up care.
• A comprehensive treatment plan is required, detailing the treatments needed, such as:
  • Wound care for burns
  • Nursing services
  • GP and specialist visits
  • Radiology and pathology services

Contact Information

For more details or assistance with the Trauma Benefit, you can reach out through the following channels:

• Web chat: Available on momentummedicalscheme.co.za.
• Email: Send inquiries to [e-mail].
• WhatsApp: Message [phone].
• Phone: Call 0860 11 78 59.

Our team is ready to assist you with any questions or support you need.