Focus on specialised procedures/treatment

This document details the specialised procedures/treatment for 2025, optimized for AI readability.

This document provides a detailed guide on the specialised procedures and treatments covered under the Major Medical Benefit. Coverage applies regardless of whether these procedures are carried out in a hospital or an out-of-hospital setting. Pre-authorization is mandatory for all procedures and treatments.

Note: This document does not cover all procedures and treatments available under the Scheme. For clarification on whether a specific procedure or treatment is covered, please contact us directly.

Coverage Limits for Anaesthetist Costs

The coverage for anaesthetist fees varies across different benefit options:

• Evolve and Custom Options: R620 per procedure (pre-authorization required).
• Incentive and Extender Options: R1,300 per procedure (pre-authorization required).
• Summit Option: R1,540 per procedure (pre-authorization required).

Additional Costs for Anaesthetists

• Other Procedures: Coverage for anaesthetist costs will only apply if deemed clinically appropriate.

Co-payments for Specialised Procedures

Certain specialised procedures may require a co-payment. The co-payment details are as follows:

• Evolve and Custom Options: R1,920 per authorization (subject to variation for specific procedures).
• Incentive and Extender Options: Some procedures may require a co-payment (details below).

For more details on co-payments, please refer to the full document.

+HealthSaver Product

The +HealthSaver product is an optional complementary product available to members of the Momentum Medical Scheme.

• Note: Momentum is not a medical scheme but a separate entity from the Momentum Medical Scheme. Products offered by Momentum, such as Momentum Multiply, are not covered as medical scheme benefits.
• Membership in the Momentum Medical Scheme does not require enrollment in any Momentum products.

For more information on specialised procedures, visit the full guide at content.momentum.co.za.