Understanding your Momentum Medical Scheme claims statement

 

Below is information about understanding your Momentum Medical Scheme claims statement

Notes to understanding the Summary claims statement

1. The Summary claims statement begins by detailing the specific benefit option that you have selected. This information is crucial as it outlines the coverage and services available to you under your chosen plan.

2. Next, the statement indicates the total amount that the Scheme has paid from the Major Medical Benefit during the current month. This reflects the financial support you received for significant medical expenses incurred within that timeframe.

3. Additionally, it provides the amount covered by the Scheme from the Chronic Benefit for the same month. This is particularly important for members who require ongoing treatment for chronic conditions, as it highlights the financial assistance available for such needs.

4. The statement also summarizes the cumulative amount that the Scheme has paid from the Major Medical Benefit throughout the calendar year. This helps you keep track of your total benefits utilized over the year.

5. Similarly, the total amount paid from the Chronic Benefit for the entire calendar year is also listed. This figure is essential for understanding your overall healthcare expenditures related to chronic conditions.

6. You will find the balance of your Personal Medical Savings Account (PMSA) that was carried over from the previous benefit year. This balance is important as it indicates the funds available for your medical expenses going forward.

7. The statement also includes the contributions made to your Savings (PMSA) within the current calendar year. This reflects any deposits that have been added to your account, contributing to your available funds for medical expenses.

8. Furthermore, it shows the amount of Savings (PMSA) that has been advanced for the remaining months of the calendar year. This amount represents the funds that have been made available to you in advance, allowing you to manage your healthcare costs effectively.

9. The interest earned on your Savings (PMSA) balance is also reported. This is an important aspect as it illustrates how your savings can grow over time, providing additional financial support for your medical needs.

10. The total claims that have been paid from your Savings (PMSA) during the current month are detailed here. This figure will correspond with the Medical Savings column in your Detailed claims statement, ensuring consistency in reporting.

11. You will also see the total claims paid from your Savings (PMSA) for the entire calendar year. This helps you understand your overall spending from this account over the year.

12. Lastly, the statement indicates whether there is an amount owed by you to the Scheme or vice versa. If the Scheme owes you money, the payment date and the relevant bank details for the transaction will be provided in a message field below this line.

Notes to understanding the Detailed claims statement

1. The Payment Information columns in the Detailed claims statement provide a breakdown of any payments made for each claim transaction, whether to a healthcare provider or to you directly. It also includes any outstanding amounts that you may owe to the Scheme.

2. The Benefit Information columns indicate the source of funding for each claim transaction. This includes:

2.1 The Major Medical Benefit, which is designed to cover claims related to hospital stays and certain medical procedures, provided that they have received the necessary authorization.

2.2 The Medical Savings Account (PMSA), which is utilized for day-to-day medical expenses from your available savings, allowing for more manageable healthcare costs.

2.3 The HealthSaver account, a voluntary account that you can opt into for paying medical expenses not covered by your primary option. All transactions made through this account will also appear on your separate HealthSaver statement, which is generated on the first of every month.

2.4 The Chronic Medicine Benefit, which is specifically allocated for registered and approved chronic medications and treatments, ensuring that members with chronic health issues receive the necessary support.

3. The Pay Code column specifies the relevant pay code associated with each claims transaction, and further explanations of these codes can be found in the accompanying notes.

4. You will also find the practice name and number of the healthcare provider associated with each claims transaction listed below the line, providing transparency regarding the services rendered.

5. The total amount paid from your Medical Savings Account (PMSA) for the claims transactions listed will be included here, and this amount will also be reflected under Note 10 in the Summary claims statement.

6. The total for your HealthSaver account will match the total indicated in Note 7 on your HealthSaver statement, ensuring that you have a clear understanding of your financial situation.

Submit claims:

• To submit a claim, you can take a photo of your claim and upload it through the Momentum App.
• If you prefer, you can also email your claims to [e-mail].
• For any inquiries regarding your claims, please reach out to [e-mail].
• You can also contact us via WhatsApp or by calling 0860 11 78 59 for assistance.