marketing brochure 2012

Transcription

1 marketing brochure 2012

2 contents Why Momentum Health? 2 Options: 3 Ingwe Option 5 Access Option 7 Custom Option 9 Incentive Option 11 Extender Option 13 Summit Option Health Platform Benefit Individual Contribution Tables This brochure provides a high-level overview of Momentum Health s 2012 benefits and contributions for Financial Advisers. A comprehensive marketing brochure will follow. On joining the Scheme, all Momentum Health members receive a detailed member brochure. Scheme Rules will always take precedence and are available on request. Contact details Broker call centre Member call centre for queries member@momentumhealth.co.za for claims claims@momentumhealth.co.za Website Postal address PO Box 2338 Durban 4000

3 Why Momentum Health? At Momentum Health, we offer unrivalled flexibility, so you can find healthcare cover that best meets your individual needs and pocket. Through innovative benefit design and strategic partnerships, we provide you with exceptional value of choice. Momentum Health s Value of Choice philosophy means you can: save up to 30% on your contribution - without sacrificing any benefits - through our choice of providers earn up to R3 600 in cash from Momentum s HealthReturns programme in only a few steps including going for a free Health Assessment, complying with appropriate treatment where applicable, and being active enjoy a variety of free preventative care benefits under the Health Platform, including an annual health assessment, pregnancy scans and more make provision for additional healthcare benefits, such as vitamins, through the HealthSaver access emergency numbers, member details, claims statements and more through your cellphone join Momentum s wellness programme, Multiply, and receive great discounts from more than 30 providers, such as Virgin Active, NuMetro, Garmin and more Momentum Health. Fit for the future. 2 2

4 Ingwe Option Overview The Ingwe Option provides affordable access to entry-level cover. You have cover for hospitalisation up to R for your family per year. For your hospitalisation cover, you can choose to use either the Ingwe Network of private hospitals, or State hospitals for an even lower monthly contribution. For chronic treatment and day-to-day benefits, such as doctors visits or prescribed medicine, you may choose between CareCross or Prime Cure facilities. How much will you pay per month? Monthly family income In-hospital provider Out-of-hospital provider <= R3 950 State CareCross R357 R714 R551 R908 R1 102 R1 296 <= R3 950 State Prime Cure R428 R856 R634 R1 062 R1 268 R1 474 R R6 300 R R8 400 State State CareCross or Prime Cure CareCross or Prime Cure R428 R856 R634 R1 062 R1 268 R1 474 R491 R982 R704 R1 195 R1 408 R1 621 > R8 400 State CareCross or Prime Cure R828 R1 620 R1 078 R1 870 R2 120 R2 370 <= R3 950 Ingwe Network CareCross R445 R890 R658 R1 103 R1 316 R1 529 <= R3 950 Ingwe Network Prime Cure R627 R1 254 R857 R1 484 R1 714 R1 944 R R6 300 R R8 400 Ingwe Network Ingwe Network > R8 400 Ingwe Network CareCross or Prime Cure CareCross or Prime Cure CareCross or Prime Cure R627 R1 254 R857 R1 484 R1 714 R1 944 R839 R1 636 R1 091 R1 888 R2 140 R2 392 R1 125 R2 194 R1 463 R2 532 R2 870 R

5 Major Medical Benefit Benefit Co-payment High and intensive care Renal dialysis and Oncology Organ transplants In-hospital dentistry Maternity confinements (limit for hospital account only) Elective caesareans covered up to the uncomplicated delivery limit Neonatal intensive care Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) Prosthesis internal (incl. knee and hip replacements, permanent pacemakers etc.) Prosthesis external (such as artificial arms or legs etc.) MRI and CT scans Mental health - incl. psychiatry and psychology - drug and alcohol rehabilitation Take-home medicines Rehabilitation and step-down facilities Private nursing and Hospice Immune deficiency related to HIV Anti-retroviral treatment In-hospital Aids cases Chronic Benefit Cover Day-to-day Benefit Savings Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody and Podiatry Mental health (incl. psychiatry and psychology) Dentistry basic (such as extractions or fillings) Dentistry specialised (such as bridges or crowns) External medical and surgical appliances (incl. hearing aids, glucometers, blood pressure monitors, wheelchairs etc.) General practitioners Out-of-network GP, casualty or after-hours visits Specialists Physiotherapy Optical and optometry (excl. contact lenses and refractive eye surgery) Pathology basic (such as blood sugar or cholesterol tests) Radiology basic (such as X-rays) MRI and CT scans Prescribed medication Over-the-counter medication Specialists covered up to 100% of Momentum Health Rate Hospital accounts are covered in full at the rate agreed upon with the hospital group Limited to R per family per year Ingwe Network or State hospitals None You need to phone us for authorisation before making use of your Major Medical Benefits. For some conditions like cancer you will need to register on a Disease Management Programme. Momentum Health will pay benefits in line with the Scheme Rules and the clinical protocols that the Scheme has established for the treatment of each condition. The sub-limits specified below apply per year. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) 10 days per admission Limited to Prescribed Minimum Benefits at State facilities Limited to Prescribed Minimum Benefits at State facilities, maxillo-facial trauma covered at State facilities R for uncomplicated delivery R for complicated delivery Covered in private Ingwe Network hospitals R per confinement R3 500 per family Subject to Prescribed Minimum Benefits Limited to Prescribed Minimum Benefits at State facilities, 21-day sub-limit applies to drug and alcohol rehabilitation 7 days supply R8 400 per beneficiary At preferred provider R per family R per family CareCross or Prime Cure 26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits Benefits are only available at the provider you have selected, and are subject to a list of medicines, called an entry-level formulary CareCross or Prime Cure None Benefits are only available at the provider you selected, and are subject to certain rules and provisions set by the provider, commonly referred to as protocols. This benefit is also subject to the provider s formulary, which is a handbook for day-to-day treatments. The sub-limits specified below apply per year. Should you not join in January, your sublimits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) within the provisions of the General Rule mentioned above within the provisions of the General Rule mentioned above 1 visit per beneficiary per year, subject to authorisation Maximum of two visits per family per year Limited to R770 per event, 20% co-payment applies 2 visits per family per year, up to R1 150 per family per year, and/or R700 per event 10% co-payment applies. Subject to referral by preferred provider and preauthorisation Included in the specialist limit One eye test and one pair of clear standard or bi-focal lenses with standard frame as per formulary per beneficiary every two years. Subject to qualifying criteria within the provisions of the General Rule mentioned above within the provisions of the General Rule mentioned above Subject to Prescribed Minimum Benefits Subject to an entry-level formulary This table represents a summary of the benefits for 2012 Chronic and Day-to-day Benefits are only available from your chosen preferred provider If you choose Ingwe Network hospitals as your preferred provider for the Major Medical Benefit and do not use this provider, you will have a co-payment of 30% on the hospital account. If you choose State hospitals as your preferred provider for the Major Medical Benefit and do not use this provider, a co-payment will apply. This co-payment will be the difference in the cost between State facility charges and the amount charged by the provider you use 4

6 Access Option Overview The Access Option provides unlimited cover for hospitalisation at the Access Network of private hospitals. For chronic treatment and day-to-day benefits, such as doctors visits or prescribed medicine, you may choose between CareCross, Medicross or Prime Cure facilities. How much will you pay per month? In-hospital provider Access Network Out-of-hospital provider CareCross, Medicross or Prime Cure R1 188 R2 317 R1 544 R2 673 R3 029 R

7 Major Medical Benefit Benefit Co-payment High and intensive care Renal dialysis and Oncology Organ transplants In-hospital dentistry Maternity confinements Neonatal intensive care Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) Prosthesis internal (incl. knee and hip replacements, permanent pacemakers, etc.) Prosthesis external (such as artificial arms or legs etc.) MRI and CT scans Mental health - incl. psychiatry and psychology - drug and alcohol rehabilitation Take-home medicines Rehabilitation, private nursing, Hospice and step-down facilities Immune deficiency related to HIV Anti-retroviral treatment In-hospital Aids cases Chronic Benefit Cover Day-to-day Benefit Savings Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody, Physiotherapy and Podiatry Mental health (incl. psychiatry and psychology) Dentistry basic (such as extractions or fillings) Dentistry specialised (such as bridges or crowns) External medical and surgical appliances (incl. hearing aids, glucometers, blood pressure monitors, wheelchairs etc.) General practitioners Out-of-network GP, casualty or after-hours visits Specialists Optical and optometry (excl. contact lenses and refractive eye surgery) Pathology basic (such as blood sugar or cholesterol tests) Radiology basic (such as X-rays) MRI and CT scans Prescribed medication Over-the-counter medication Specialists covered up to 100% of Momentum Health Rate Hospital accounts are covered in full at the rate agreed upon with the hospital group Access Network hospitals None You need to phone us for authorisation before making use of your Major Medical Benefits. For some conditions like cancer you will need to register on a Disease Management Programme. Momentum Health will pay benefits in line with the Scheme Rules and the clinical protocols that the Scheme has established for the treatment of each condition. The sub-limits specified below apply per year. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) 12 days per admission Limited to Prescribed Minimum Benefits at State facilities Limited to Prescribed Minimum Benefits at State facilities, maxillo-facial trauma covered at State facilities R4 250 per family Intraocular lenses: R3 600 per beneficiary per event, maximum 2 events per year Other internal prostheses: R per beneficiary per event, maximum 2 events per year Subject to Prescribed Minimum Benefits Annual limit for mental health of R per beneficiary, 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment at preferred provider 7 days supply R per family At preferred provider R per family R per family CareCross, Medicross or Prime Cure 26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits. Benefits are only available at the provider you have selected, and are subject to a list of medicines, called an entry-level formulary CareCross, Medicross or Prime Cure None Benefits are only available at the provider you selected, and are subject to certain rules and provisions set by the provider, commonly referred to as protocols. This benefit is also subject to the provider s formulary, which is a handbook for day-to-day treatments. The sub-limits specified below apply per year. Should you not join in January, your sublimits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) within the provisions of the General Rule mentioned above. 10 visits per beneficiary, thereafter a R50 co-payment applies 1 visit per beneficiary per year, subject to authorisation Maximum of two visits per family per year Limited to R770 per event, 20% co-payment applies 3 visits per beneficiary, max. 5 visits per family, subject to referral by preferred provider One eye test and one pair of clear standard or bi-focal lenses with standard frame as per formulary per beneficiary every two years. Subject to qualifying criteria within the provisions of the General Rule mentioned above within the provisions of the General Rule mentioned above Subject to Prescribed Minimum Benefits Subject to an entry-level formulary If the item is not on the formulary, a co-payment applies This table represents a summary of the benefits for 2012 Chronic and Day-to-day Benefits are only available from your chosen preferred provider If you do not use Access Network hospitals, you will have a co-payment of 30% on the hospital account 6

8 Custom Option Overview The Custom Option provides unlimited cover for hospitalisation in private hospitals. You can choose to have access to any hospital, or you can choose to save on your contribution by selecting to use a specific list of private hospitals (Associated hospitals). For chronic treatment, you can choose to have access to any doctor for your chronic scripts and any pharmacy for your chronic medication. Or you can choose to save on your contribution by using a specific list of doctors for your chronic script and Atlas or Medipost for your chronic medication. Alternatively, you can choose to use State facilities for your chronic needs to obtain the maximum contribution saving. The Health Platform Benefit provides cover for a range of day-to-day benefits such as preventative screening tests, certain check-ups and more. If you want cover for other day-to-day expenses, like doctors visits or prescribed medicine, you can make use of the HealthSaver. The HealthSaver is a Momentum product that lets you save for medical expenses. It has no transaction or administration fees. There is a co-payment when you are admitted to hospital, except in the case of car accidents, maternity confinements or emergency treatment. How much will you pay per month? In-hospital provider Out-of-hospital provider Any Any R1 259 R2 270 R1 709 R2 720 R3 170 R3 620 Any Associated R1 187 R2 113 R1 618 R2 544 R2 975 R3 406 Any State R1 072 R1 881 R1 465 R2 274 R2 667 R3 060 Associated Any R1 079 R1 930 R1 460 R2 311 R2 692 R3 073 Associated Associated R988 R1 753 R1 338 R2 103 R2 453 R2 803 Associated State R842 R1 479 R1 140 R1 777 R2 075 R

9 Major Medical Benefit Benefit Co-payment High and intensive care Casualty or after-hour visits Renal dialysis Oncology* Organ transplants (recipient) Organ transplants (donor) Only covered when recipient is a member of the Scheme In-hospital dentistry: (excl. implants) - maxillo-facial surgery and impacted wisdom teeth - general anaesthesia for children under 7 Maternity confinements Neonatal intensive care MRI and CT scans (in- and out-of-hospital) Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) Prosthesis internal (incl. knee and hip replacements, permanent pacemakers etc.) Prosthesis - external (such as artificial arms or legs etc.) MRI and CT scans Mental health - incl. psychiatry and psychology - drug and alcohol rehabilitation Take-home medicines Rehabilitation, private nursing, Hospice and step-down facilities Immune deficiency related to HIV Anti-retroviral treatment In-hospital Aids cases Chronic Benefit Cover Day-to-day Benefit Savings Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody, Physiotherapy and Podiatry Mental health (incl. psychiatry and psychology) Dentistry basic (such as extractions or fillings) Dentistry specialised (such as bridges or crowns) External medical and surgical appliances (incl. hearing aids, glucometers, blood pressure monitors, wheelchairs etc.) General practitioners Specialists Optical and optometry (incl. contact lenses and refractive eye surgery) Pathology (such as blood sugar or cholesterol tests) Radiology (such as X-rays) MRI and CT scans Prescribed medication Over-the-counter medication Associated specialists covered in full Other specialists covered up to 100% of Momentum Health Rate Hospital accounts are covered in full at the rate agreed upon with the hospital group Any or Associated hospitals R950 per authorisation, except for motor vehicle accidents, maternity confinements and emergency treatment. An additional co-payment may apply per authorisation for 17 referral procedures, if you do not have an appropriate GP referral You need to phone us for authorisation before making use of your Major Medical Benefits. For some conditions like cancer you will need to register on a Disease Management Programme. Momentum Health will pay benefits in line with the Scheme Rules and the clinical protocols that the Scheme has established for the treatment of each condition. The sub-limits specified below apply per year. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) R per beneficiary per year, thereafter a 20% co-payment applies R cadaver costs R live donor costs (incl. transportation) Hospital and anaesthetist account paid from Major Medical Benefit, subject to R950 co-payment per authorisation. Dental, dental specialist and maxillo-facial surgeon accounts paid from HealthSaver, if available, subject to R1 700 co-payment per scan R4 250 per family Intraocular lenses: R3 600 per beneficiary per event, maximum 2 events per year Other internal prostheses: R per beneficiary per event, maximum 2 events per year R per family Subject to Prescribed Minimum Benefits Annual limit for mental health of R per beneficiary, 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment at preferred provider 7 days supply R per family At preferred provider R per family Any, Associated or State 26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits Benefits are subject to registration on the Chronic Management Programme and approval by the Scheme Any None Benefits are subject to HealthSaver, if available. Covered from Major Medical Benefit, subject to R1 700 co-payment per scan This table represents a summary of the benefits for 2012 If you choose Associated hospitals as your preferred provider for Major Medical Benefit, and do not use this provider, you will have a co-payment of 30% on the hospital account *Newly diagnosed beneficiaries who selected State as their out-of-hospital provider must obtain their treatment from an authorised oncologist 8

10 Incentive Option Overview The Incentive Option provides unlimited cover for hospitalisation in private hospitals. You can choose to have access to any hospital, or you can choose to save on your contribution by selecting to use a specific list of private hospitals (Associated hospitals). For chronic treatment, you can choose to have access to any doctor for your chronic scripts and any pharmacy for your chronic medication. Or you can choose to save even further on your contribution by using a specific list of doctors for your chronic script and Atlas or Medipost for your chronic medication. Alternatively, you can choose to use State facilities for your chronic needs to obtain the maximum contribution saving. The Health Platform Benefit provides cover for a range of day-to-day benefits such as preventative screening tests, certain check-ups and more. 10% of your contribution goes to a dedicated Savings account to cover your other day-to-day expenses. If you need more day-to-day cover, you can make use of the HealthSaver. The HealthSaver is a Momentum product that lets you save for medical expenses. It has no transaction or administration fees. How much will you pay per month? In-hospital provider Out-of-hospital provider Any Any R1 649 R2 988 R2 290 R3 629 R4 270 R4 911 Any Associated R1 542 R2 779 R2 148 R3 385 R3 991 R4 597 Any State R1 377 R2 461 R1 920 R3 004 R3 547 R4 090 Associated Any R1 528 R2 758 R2 099 R3 329 R3 900 R4 471 Associated Associated R1 403 R2 520 R1 936 R3 053 R3 586 R4 119 Associated State R1 179 R2 103 R1 637 R2 561 R3 019 R

11 Major Medical Benefit Benefit Co-payment High and intensive care Casualty or after-hour visits Renal dialysis Oncology* Organ transplants (recipient) Organ transplants (donor) Only covered when recipient is a member of the Scheme In-hospital dentistry (excl. implants) - maxillo-facial surgery and impacted wisdom teeth - general anaesthesia for children under 7 Maternity confinements Neonatal intensive care MRI and CT scans (in- and out-of-hospital) Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) Prosthesis internal (incl. knee and hip replacements, permanent pacemakers etc.) Prosthesis - external (such as artificial arms or legs etc.) Mental health - incl. psychiatry and psychology - drug and alcohol rehabilitation Take-home medicines Trauma benefit Rehabilitation, private nursing, Hospice and step-down facilities Immune deficiency related to HIV Anti-retroviral treatment In-hospital Aids cases Chronic Benefit Cover Day-to-day Benefit Savings Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody, Physiotherapy and Podiatry Mental health (incl. psychiatry and psychology) Dentistry basic (such as extractions or fillings) Dentistry specialised (such as bridges or crowns) External medical and surgical appliances (incl. hearing aids, glucometers, blood pressure monitors, wheelchairs etc.) General practitioners Specialists Optical and optometry (incl. contact lenses and refractive eye surgery) Pathology (such as blood sugar or cholesterol tests) Radiology (such as X-rays) MRI and CT scans Prescribed medication Over-the-counter medication Associated specialists covered in full Other specialists covered up to 200% of Momentum Health Rate Hospital accounts are covered in full at the rate agreed upon with the hospital group Any or Associated hospitals Co-payments may apply per specialist for 17 referral procedures You need to phone us for authorisation before making use of your Major Medical Benefits. For some conditions like cancer you will need to register on a Disease Management Programme. Momentum Health will pay benefits in line with the Scheme Rules and the clinical protocols that the Scheme has established for the treatment of each condition. The sub-limits specified below apply per year. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) Subject to Savings R per beneficiary per year, thereafter a 20% co-payment applies R cadaver costs R live donor costs (incl. transportation) Hospital and anaesthetist account paid from Major Medical Benefit, subject to R1 300 co-payment per authorisation. Dental, dental specialist and maxillo-facial surgeon accounts paid from Savings, if available, subject to R1 700 co-payment per scan R4 250 per family Cochlear implants: R per beneficiary, maximum 1 event per year Intraocular lenses: R4 700 per beneficiary per event, maximum 2 events per year Other internal prostheses: R per beneficiary per event, maximum 2 events per year R per family Annual limit for mental health of R per beneficiary, 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment at preferred provider 7 days supply Cover for certain day-to-day claims that form part of the recovery following specific traumatic events, such as conditions resulting from near drowning, poisoning, severe allergic reaction, external and internal head injuries, burns and post traumatic stress events R per family At preferred provider R per family Any, Associated or State Cover for 32 conditions: 26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits - unlimited 6 additional conditions - limited to R6 600 per family per year Benefits are subject to registration on the Chronic Management Programme and approval by the Scheme Any Fixed at 10% of total contribution Claims are paid at cost with no sub-limits, subject to available Savings Covered from Major Medical Benefit, subject to R1 700 co-payment per scan This table represents a summary of the benefits for 2012 If you choose Associated hospitals as your preferred provider for Major Medical Benefit, and do not use this provider, you will have a co-payment of 30% on the hospital account *Newly diagnosed beneficiaries who selected State as their out-of-hospital provider must obtain their treatment from an authorised oncologist 10

12 Extender Option Overview The Extender Option provides unlimited cover for hospitalisation in private hospitals. You can choose to have access to any hospital, or you can choose to save on your contribution by selecting to use a specific list of private hospitals (Associated hospitals). For chronic treatment, you can choose to have access to any doctor for your chronic scripts and any pharmacy for your chronic medication. Or you can choose to save even further on your contribution by using a specific list of doctors for your chronic script and Atlas or Medipost for your chronic medication. Alternatively, you can choose to use State facilities for your chronic needs to obtain the maximum contribution saving. 25% of your contribution is available in a Savings account to cover day-to-day expenses. If this component is not enough to cover your annual day-to-day expenses, you will also have access to the Extended Cover benefit which provides further cover for day-to-day benefits once your day-to-day claims have reached a certain amount (a pre-determined amount that is based on your family size). Once you have reached this Threshold amount, your claims will be paid by the Scheme from the Extended Cover benefit. You can make use of the HealthSaver for additional day-to-day expenses and to pay for out-of-pocket expenses before your Extended Cover is activated. The HealthSaver is a Momentum product that lets you save for medical expenses. It has no transaction or administration fees. The Health Platform Benefit provides cover for a range of day-to-day benefits such as preventative screening tests, certain check-ups and more. How much will you pay per month? In-hospital provider Out-of-hospital provider Any Any R3 069 R5 517 R4 032 R6 480 R7 443 R8 406 Any Associated R2 812 R5 057 R3 693 R5 938 R6 819 R7 700 Any State R2 628 R4 724 R3 451 R5 547 R6 370 R7 193 Associated Any R2 751 R4 947 R3 614 R5 810 R6 673 R7 536 Associated Associated R2 535 R4 556 R3 331 R5 352 R6 148 R6 944 Associated State R2 336 R4 057 R3 069 R4 790 R5 523 R

13 Major Medical Benefit Benefit Co-payment High and intensive care Casualty or after-hour visits Renal dialysis Oncology* Organ transplants (recipient) Organ transplants (donor) Only covered when recipient is a member of the Scheme In-hospital dentistry (excl. implants) - maxillo-facial surgery and impacted wisdom teeth - general anaesthesia for children under 7 Maternity confinements Neonatal intensive care MRI and CT scans (in- and out-of-hospital) Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) Prosthesis internal (incl. knee and hip replacements, permanent pacemakers etc.) Prosthesis - external (such as artificial arms or legs etc.) Mental health - incl. psychiatry and psychology - drug and alcohol rehabilitation Take-home medicines Trauma benefit Rehabilitation, private nursing, Hospice and step-down facilities Immune deficiency related to HIV Anti-retroviral treatment In-hospital Aids cases Chronic Benefit Cover Day-to-day Benefit Savings Annual Threshold levels: Member: R Per adult dependant: R9 400 Per child: R3 000 (max. 3 children) Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody, Physiotherapy and Podiatry Mental health (incl. psychiatry and psychology) Dentistry basic (such as extractions or fillings) Dentistry specialised (such as bridges or crowns) External medical and surgical appliances (incl. hearing aids, glucometers, blood pressure monitors, wheelchairs etc.) General practitioners Specialists Optical and optometry (incl. contact lenses and refractive eye surgery) Pathology (such as blood sugar or cholesterol tests) Radiology (such as X-rays) MRI and CT scans Prescribed medication Over-the-counter medication (incl. prescribed vitamins) Associated specialists covered in full Other specialists covered up to 200% of Momentum Health Rate Hospital accounts are covered in full at the rate agreed upon with the hospital group Any or Associated hospitals Co-payments may apply per specialist for 17 referral procedures You need to phone us for authorisation before making use of your Major Medical Benefits. For some conditions like cancer you will need to register on a Disease Management Programme. Momentum Health will pay benefits in line with the Scheme Rules and the clinical protocols that the Scheme has established for the treatment of each condition. The sub-limits specified below apply per year. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) Subject to Day-to-day Benefit R per beneficiary per year, thereafter a 20% co-payment applies R cadaver costs R live donor costs (incl. transportation) Hospital and anaesthetist account paid from Major Medical Benefit, subject to R1 300 co-payment per authorisation. Dental, dental specialist and maxillo-facial surgeon accounts paid from Day-to-day Benefit and accumulate towards limit, subject to R1 700 co-payment per scan R4 250 per family Cochlear implants: R per beneficiary, maximum 1 event per year Intraocular lenses: R4 700 per beneficiary per event, maximum 2 events per year Other internal prostheses: R per beneficiary per event, maximum 2 events per year R per family Annual limit for mental health of R per beneficiary, 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment at preferred provider 7 days supply Cover for certain day-to-day claims that form part of the recovery following specific traumatic events, such as conditions resulting from near drowning, poisoning, severe allergic reaction, external and internal head injuries, burns and post traumatic stress events R per family At preferred provider R per family Any, Associated or State Cover for 62 conditions: 26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits - unlimited 36 additional conditions - limited to R6 600 per family per year Benefits are subject to registration on the Chronic Management Programme and approval by the Scheme Any, Associated or State Fixed at 25% of total contribution 25% of your contribution is available to cover day-to-day expenses. This is known as Savings. If this component is not enough to cover your annual day-to-day expenses, you will have a selffunding gap to pay out of your own pocket, up to the Threshold determined by your family size. Where a claim is more than the Momentum Health Rate, only the amount up to the Momentum Health Rate will accumulate towards the Threshold. Once you have reached the Threshold, your claims will be paid by the Scheme from Extended Cover, at the Momentum Health Rate within the provisions of the General Rule mentioned above R per family within the provisions of the General Rule mentioned above R8 700 per beneficiary, R per family. Both in- and out-of-hospital dental specialist accounts accumulate towards the limit R per family R4 900 sub-limit for hearing aids Depending on the out-of-hospital provider selected Any or State provider: Associated providers: 100% of Momentum Health Rate for Associated GPs 70% of Momentum Health Rate for non-associated GPs within the provisions of the General Rule mentioned above Overall limit of R2 700 per beneficiary Frame sub-limit of R1 450 within the provisions of the General Rule mentioned above within the provisions of the General Rule mentioned above Covered from Major Medical Benefit, subject to R1 700 co-payment per scan R per beneficiary, R per family Subject to Savings (does not accumulate to Threshold) This table represents a summary of the benefits for 2012 If you choose Associated hospitals as your preferred provider for Major Medical Benefit, and do not use this provider, you will have a co-payment of 30% on the hospital account *Newly diagnosed beneficiaries who selected State as their out-of-hospital provider must obtain their treatment from an authorised oncologist 12

14 Summit Option Overview The Summit Option provides unlimited cover for hospitalisation at any hospital. Extensive day-to-day and chronic benefits are available from any provider. The Health Platform Benefit provides cover for a range of day-to-day benefits such as preventative screening tests, certain check-ups and more. Should you want to, you can use the HealthSaver to increase your day-to-day cover even further. The HealthSaver is a Momentum product that lets you save for medical expenses. It has no transaction or administration fees. How much will you pay per month? In-hospital provider Out-of-hospital provider Any Freedom-of-choice R4 416 R7 948 R5 431 R8 963 R9 978 R

15 Major Medical Benefit Benefit Co-payment High and intensive care Casualty or after-hour visits Renal dialysis and Oncology Organ transplants (recipient) Organ transplants (donor) Only covered when recipient is a member of the Scheme In-hospital dentistry (excl. implants) - maxillo-facial surgery and impacted wisdom teeth - general anaesthesia for children under 7 Maternity confinements Neonatal intensive care MRI and CT scans (in- and out-of-hospital) Medical and surgical appliances in-hospital (such as support stockings, knee and back braces etc.) Prosthesis internal (incl. knee and hip replacements, permanent pacemakers etc.) Prosthesis external (such as artificial arms or legs etc.) Mental health - incl. psychiatry and psychology - drug and alcohol rehabilitation Take-home medicines Trauma benefit Rehabilitation, private nursing, Hospice and step-down facilities Immune deficiency related to HIV Anti-retroviral treatment In-hospital Aids cases Chronic Benefit Cover Day-to-day Benefit Savings Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody, Physiotherapy and Podiatry Mental health (incl. psychiatry and psychology) Dentistry basic (such as extractions or fillings) Dentistry specialised (such as bridges or crowns) External medical and surgical appliances (incl. hearing aids, glucometers, blood pressure monitors, wheelchairs etc.) General practitioners Specialists Optical and optometry (incl. contact lenses and refractive eye surgery) Pathology (such as blood sugar or cholesterol tests) Radiology (such as X-rays) MRI and CT scans Prescribed medication Over-the-counter medication (including prescribed vitamins) Associated specialists covered in full Other specialists covered up to 300% of Momentum Health Rate Hospital accounts are covered in full at the rate agreed upon with the hospital group Any hospital No You need to phone us for authorisation before making use of your Major Medical Benefits. For some conditions like cancer you will need to register on a Disease Management Programme. Momentum Health will pay benefits in line with the Scheme Rules and the clinical protocols that the Scheme has established for the treatment of each condition. The sub-limits specified below apply per year. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) Subject to Day-to-day Benefit R cadaver costs R live donor costs (incl. transportation) Hospital and anaesthetist accounts paid from Major Medical Benefit. Dental, dental specialist and maxillo-facial surgeon accounts paid from Day-to-day Benefit and accumulate towards overall day-to-day limit of R per beneficiary, subject to R1 700 co-payment per scan R4 250 per family Cochlear implants: R per beneficiary, maximum 1 event per year Intraocular lenses: R4 700 per beneficiary per event, maximum 2 events per year Other internal prostheses: R per beneficiary per event, maximum 2 events per year R per family Annual limit for mental health of R per beneficiary, 21-day sub-limit applies to drug and alcohol rehabilitation, subject to treatment at preferred provider 7 days supply Cover for certain day-to-day claims that form part of the recovery following specific traumatic events, such as conditions resulting from near drowning, poisoning, severe allergic reaction, external and internal head injuries, burns and post traumatic stress events R per family At preferred provider R per family You can use any provider of your choice Cover for 62 conditions 26 conditions according to Chronic Disease List in Prescribed Minimum Benefits - unlimited 36 additional conditions - accumulate to overall day-to-day limit of R per beneficiary. This is a combined limit incorporating both day-to-day cover and cover for the 36 additional conditions Benefits are subject to registration on the Chronic Management Programme and approval by the Scheme You can use any provider of your choice Not applicable Benefits are paid at 100% of the Momentum Health Rate, subject to the annual sublimits specified below and an overall day-to-day limit of R per beneficiary. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year) R4 900 per family. Subject to overall annual day-to-day limit of R per beneficiary R per family. Subject to overall annual day-to-day limit of R per beneficiary Subject to overall day-to-day limit of R per beneficiary R per beneficiary, R per family. Both in- and out-of-hospital dental specialist accounts accumulate towards the limit. Subject to overall annual day-to-day limit of R per beneficiary R per family. Subject to overall annual day-to-day limit of R per beneficiary R sub-limit for hearing aids. Subject to overall annual day-to-day limit of R per beneficiary Subject to overall day-to-day limit of R per beneficiary Subject to overall day-to-day limit of R per beneficiary Overall limit of R3 000 per beneficiary. Subject to annual day-to-day limit of R per beneficiary Frame sub-limit of R Subject to overall annual day-to-day limit of R per beneficiary Subject to overall day-to-day limit of R per beneficiary Subject to overall day-to-day limit of R per beneficiary Covered from Major Medical Benefit, subject to R1 700 co-payment per scan R per beneficiary, R per family. Subject to overall annual day-to-day limit of R per beneficiary This table represents a summary of the benefits for

16 Health Platform Benefit Health Platform benefits are paid by the Scheme up to a maximum Rand amount per benefit, provided you notify us before using the benefit by contacting the member call centre on or logging on to You can also pre-notify via your cellphone at On the Ingwe and Access Options, Health Platform benefits are only available at the provider you have selected (CareCross, Medicross or Prime Cure). Preventative care How often? Baby immunisations (On Ingwe and Access, available at nearest State baby clinic) Children up to age 6 As required by the Department of Health Flu vaccines Beneficiaries under 18 Beneficiaries 60 and older High-risk beneficiaries Once a year Tetanus diphtheria injection All beneficiaries As needed Pneumococcal vaccine Beneficiaries 60 and older Once a year High-risk beneficiaries Early detection tests Dental consultation (incl. sterile tray and gloves) All beneficiaries Once a year Pap smear (pathologist) Women 15 and older Once a year Pap smear Consultation (GP)* Women 15 and older Once a year Pap smear Consultation (GP* or gynaecologist) Women 15 and older Once a year Mammogram Women 40 and older Once every 2 years DEXA bone density scan (radiologist, GP* or specialist) Beneficiaries 50 and older Once every 3 years General physical examination (GP* consultation) Beneficiaries between 21 and 29 Beneficiaries between 30 and 59 Beneficiaries between 60 and 69 Beneficiaries 70 and older Prostate specific antigen (pathologist) Men between 40 and 49 Men between 50 and 59 Men between 60 and 69 Men 70 and older Health Assessment (pre-notification not required): All adult beneficiaries Body Mass Index, Blood pressure test, Cholesterol & blood sugar test (finger prick test) Once every 5 years Once every 3 years Once every 2 years Once a year Once every 5 years Once every 3 years Once every 2 years Once a year Once a year Cholesterol test (pathologist)** All adult beneficiaries Once a year Blood sugar test (pathologist)*** All beneficiaries Once a year Glaucoma test Beneficiaries between 40 and 49 Beneficiaries 50 and older Once every 2 years Once a year HIV test (pathologist) Beneficiaries 15 and older Once every 5 years Maternity programme (subject to registration on the Maternity Management Programme between 8 and 20 weeks of pregnancy) Antenatal visits (Midwives, GP* or gynaecologist) Women registered on the programme 3 visits Women registered on the programme 12 visits Urine tests (dipstick) Women registered on the programme Included in antenatal visits Scans (one before 24th week and one after) Women registered on the programme 2 growth scans Women registered on the programme 2 pregnancy scans Paediatrician visits Babies up to 12 months registered on the programme 2 visits in baby s first year Disease management programmes Diabetes, Hypertension, HIV/Aids, Oncology, Drug and alcohol rehabilitation, Chronic renal failure, Organ transplants, Cholesterol Health line All beneficiaries registered on the appropriate programme As needed 24-hour health advice All beneficiaries As needed Emergency evacuation Emergency evacuation in South Africa by Netcare 911 All beneficiaries In an emergency International evacuation by ISOS All beneficiaries In an emergency International emergency cover R5.8m emergency cover (incl. R for emergency optometry, R for emergency dentistry and R terrorism cover) A R1 200 co-payment applies per out-patient claim Per beneficiary per 90-day journey In an emergency Please note * On the Custom, Incentive and Extender Options, if you choose the Associated out-of-hospital provider, a 30% co-payment will apply if you do not use an Associated GP for the GP consultations ** The cholesterol test is covered if Health Assessment results indicate a total cholesterol of 6 mmol/l and above *** The blood sugar test is covered for adult beneficiaries if Health Assessment results indicate blood sugar levels are 11 mmol/l and above 15

17 16 Ingwe and Access Custom, Incentive, Extender and Summit

18 Individual Contribution Tables Ingwe Option In-hospital provider Out-of-hospital provider Monthly family income P A C State CareCross <= R3 950 R357 R357 R194 State Prime Cure <= R3 950 R428 R428 R206 State CareCross or Prime Cure R R6 300 R428 R428 R206 State CareCross or Prime Cure R R8 400 R491 R491 R213 State CareCross or Prime Cure > R8 400 R828 R792 R250 Ingwe Network CareCross <= R3 950 R445 R445 R213 Ingwe Network Prime Cure <= R3 950 R627 R627 R230 Ingwe Network CareCross or Prime Cure R R6 300 R627 R627 R230 Ingwe Network CareCross or Prime Cure R R8 400 R839 R797 R252 Ingwe Network CareCross or Prime Cure > R8 400 R1 125 R1 069 R338 Access Option In-hospital provider Out-of-hospital provider P A C Access Network CareCross, Medicross or Prime Cure R1 188 R1 129 R356 Custom Option In-hospital provider Out-of-hospital provider P A C Any Any R1 259 R1 011 R450 Any Associated R1 187 R926 R431 Any State R1 072 R809 R393 Associated Any R1 079 R851 R381 Associated Associated R988 R765 R350 Associated State R842 R637 R298 Incentive Option In-hospital provider Out-of-hospital provider Contributions P A C Any Any Total contribution R1 649 R1 339 R641 Risk contribution R1 484 R1 205 R577 Savings 10% R165 R134 R64 Annual Savings R1 980 R1 608 R768 Any Associated Total contribution R1 542 R1 237 R606 Risk contribution R1 388 R1 113 R545 Savings 10% R154 R124 R61 Annual Savings R1 848 R1 488 R732 Any State Total contribution R1 377 R1 084 R543 Risk contribution R1 239 R976 R489 Savings 10% R138 R108 R54 Annual Savings R1 656 R1 296 R648 Associated Any Total contribution R1 528 R1 230 R571 Risk contribution R1 375 R1 107 R514 Savings 10% R153 R123 R57 Annual Savings R1 836 R1 476 R684 Associated Associated Total contribution R1 403 R1 117 R533 Risk contribution R1 263 R1 005 R480 Savings 10% R140 R112 R53 Annual Savings R1 680 R1 344 R636 Associated State Total contribution R1 179 R924 R458 Risk contribution R1 061 R832 R412 Savings 10% R118 R92 R46 Annual Savings R1 416 R1 104 R552 17

19 Individual Contribution Tables (continued) Extender Option In-hospital provider Out-of-hospital provider Contributions P A C Any Any Total contribution R3 069 R2 448 R963 Risk contribution R2 302 R1 836 R722 Savings 25% R767 R612 R241 Annual Savings R9 204 R7 344 R2 892 Threshold R R9 400 R3 000 Any Associated Total contribution R2 812 R2 245 R881 Risk contribution R2 109 R1 684 R661 Savings 25% R703 R561 R220 Annual Savings R8 436 R6 732 R2 640 Threshold R R9 400 R3 000 Any State Total contribution R2 628 R2 096 R823 Risk contribution R1 971 R1 572 R617 Savings 25% R657 R524 R206 Annual Savings R7 884 R6 288 R2 472 Threshold R R9 400 R3 000 Associated Any Total contribution R2 751 R2 196 R863 Risk contribution R2 063 R1 647 R647 Savings 25% R688 R549 R216 Annual Savings R8 256 R6 588 R2 592 Threshold R R9 400 R3 000 Associated Associated Total contribution R2 535 R2 021 R796 Risk contribution R1 901 R1 516 R597 Savings 25% R634 R505 R199 Annual Savings R7 608 R6 060 R2 388 Threshold R R9 400 R3 000 Associated State Total contribution R2 336 R1 721 R733 Risk contribution R1 752 R1 291 R550 Savings 25% R584 R430 R183 Annual Savings R7 008 R5 160 R2 196 Threshold R R9 400 R3 000 Summit Option In-hospital provider Out-of-hospital provider P A C Freedom-of-choice Freedom-of-choice R4 416 R3 532 R

20 Momentum 268 West Avenue Centurion 0157 PO Box 7400 Centurion 0046 South Africa Tel: +27 (0) Call Centre Momentum is an authorised financial services and credit provider.