In-hospital Benefit
This Major Medical Benefit includes cover for hospitalisation, as well as certain specialised procedures and treatment, and specialised scans. It gives you option-specific benefits that cover you if you’re hospitalised or need to have surgery.
- 7 days’ supply of take-home medication on discharge.
- Covers certain scans done in hospital.
- Easy pre-authorisation done on the Momentum App.
What does the In-hospital Benefit cover?
Your hospital accounts and costs related to your stay in a hospital, as well as certain procedures performed both in- or out-of-hospital, are covered, subject to pre-authorisation.
The following is an overview of the cover provided across our 6 medical aid options.
Ingwe
Cover
- Hospital accounts are covered in full at the rate agreed with the hospital group.
- Specialists are covered up to 100% of the Momentum Medical Scheme Rate.
- No annual limit applies.
Hospital provider
- Any hospital, Ingwe Connect Network, Ingwe Network or State hospitals.
Evolve
Cover
- Hospital accounts are covered in full at the rate agreed with the hospital group.
- Specialists are covered up to 100% of the Momentum Medical Scheme Rate. A R1 920 co-payment per authorisation applies, except for car accidents, maternity confinements, and emergency treatment. An additional co-payment may apply for specialised procedures.
- No annual limit applies.
Hospital provider
- Evolve Network hospitals. Certain procedures are only covered in day hospitals.
Custom
Cover
- Hospital accounts are covered in full at the rate agreed with the hospital group.
- Specialists are covered up to 100% of the Momentum Medical Scheme Rate. A R1 920 co-payment per authorisation applies, except for car accidents, maternity confinements, and emergency treatment. An additional co-payment may apply for specialised procedures.
- No annual limit applies.
Hospital provider
- Any or Associated hospitals.
Incentive
Cover
- Hospital accounts are covered in full at the rate agreed with the hospital group.
- Specialists are covered up to 200% of the Momentum Medical Scheme Rate. Co-payments may apply for certain specialised procedures or treatment.
- No annual limit applies.
Hospital provider
- Any or Associated hospitals.
Extender
Cover
- Hospital accounts are covered in full at the rate agreed with the hospital group.
- Specialists are covered up to 200% of the Momentum Medical Scheme Rate. Co-payments may apply for certain specialised procedures or treatment.
- No annual limit applies.
Hospital provider
- Any or Associated hospitals.
Pre-authorisation for in-hospital benefits
You can get pre-authorisation once benefits have been verified and the Scheme Rules and protocols have been applied. If the hospital or your doctor obtains the authorisation on your behalf, you will need to verify with us if there are any co-payments or shortfalls because of not using a Designated Service Provider or resulting from benefit limits or protocols.