Medical Gap Cover for Momentum Health Members

Gap Cover for Momentum is not a medical aid, but a type of top-up insurance. We designed Gap Cover to pay the difference between what experts charge, and what your aid pays out.

 

Also, this top-up insurance will usually cover your added health costs, cancer treatment co-payments, and health expert’s shortfalls.

 

Indeed, Momentum Health members have great Gap Cover created to suit their needs. Gap covers those extra costs and co-payments members face when receiving medical treatment.

Gap Cover for MomentumThis Gap Cover is known as TruGap.

 

All the following options have different monthly costs, depending on the cover chosen. Further, most members will pay between R229 per month to R350 a month. We look at a few –

Custom Gap Cover for Momentum

Benefits –

TruGap pays up to 400% for in-hospital events, covering the gap between the medical aid, and the expert’s rates. We also cover up to 400% of the shortfall on your doctor’s accounts.

Further, we cover R1,200 for every admission to hospital. Albeit, this excludes motor vehicle accident or maternity admissions. Also, if a non-designated hospital is used, you won’t be covered.

Co-payments –

  • R2 030 for MRI and CT scans, whether in- or out-of-hospital
  • R1 200 on 52 procedures performed in the doctor’s rooms
  • 20% co-payment after the limit of R300 000 is reached on your Oncology benefit. This is limited to R120 000 per family.

 

Custom Alternative Cover

 

Benefits –

  • All the above benefits apply.
  • Further, this option includes all PMB related claims by health experts, who are not designated service providers.
  • As well as internal prosthesis cover of up to R60 000 per annum per family.

 

Incentive and Extender Cover

 

Benefits –

  • Up to 500% cover for in-hospital events.
  • Up to 500% of the medical scheme rates

Co-payments –

  • R2 030 for MRI and CT scans
  • R1 200 for 17 special procedures taking place in the doctor’s rooms
  • Oncology Incentive. TruGap reimburses up to 20% after the limit of R400,000 is reached. The limit is R120 000 per family.
  • Oncology Extender. You will be reimbursed 20% after the limit of R500 000 is reached.

 

Incentive and Extender Alternative Cover

 

Benefits –

  • All benefits the same as above.
  • Cover for PMB related specialists who are non-designated service providers.

 

Student Option

 

Benefits:

  • Up to 400% of medical aid rates for in-hospital events.

 

Standard In-Hospital Cover

 

Benefits:

  • Up to 400% of medical aid rates for in-hospital events.

 

Waiting Periods

 

  • There is no standard waiting period when you apply for Gap Cover for Momentum.
  • Six months waiting period for pre-existing conditions.
  • 12 months waiting period for cancer, pregnancy, hysterectomy, grommets, tonsillectomies.
  • Ten month waiting period for specific conditions.

 

General Information

 

  • R1 million maximum benefit per annum.
  • Also, we only process claims above R500.
  • Maximum entry age is less than 65 years at next birthday.
  • Children older than 21 years pay adult rates.
  • Further, we only cover PMB claims if you are on an Alternative option.

 

Hence, Gap Cover is crucial, and with TruGap you can avoid any surprises and unexpected expenses associated with sudden illness or surgery.

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All info was correct at time of publishing