2012 Momentum Health Medical Aid Quote

2012 Momentum Medical Aid Quote
Should you wish to get an idea of what a Momentum Medical Aid will cost, please complete the blocks below and send to me.
I will send you costs, based on your plan selection - no obligation at all.
GOTO MOMENTUM MEDICAL AID for full details.
Your Details
Do you have to join your company medical aid scheme or can you choose a scheme?
Company scheme
Own

Your email address:
Your telephone/cell number:
Your name and surname:
Your Date of Birth:
Your partner's name and surname (if required):
Your partner's Date of Birth:
First child's name:
Child's Date of Birth:
Second child's name:
Child's Date of Birth:
Third child's name:
Child's Date of Birth:
Any OTHER (NOT ALREADY STATED ABOVE) dependants - adults or children you want to add?
Type of plan. Please select from the following; Refer to Make the Right MOMENTUM HEALTH MEDICAL AID Choice for help in deciding your plan.
SUMMIT OPTION - no overall annual limit private hospitalisation at 300% of scheme rates. Associated specialists paid in full. Unlimited dialysis and oncology. Limited in-hospital dental. Unlimited maternity. Co-pay in and out hospital MRI/CT scan. Unlimited prosthesis at chosen providers. Mental health. 7-days take home medicines. 26 PMB Chronic list at choice of provider. Limit for 36 additional chronics. R 16,700 per beneficiary day-to-day limit. Limited specialised dentist. Limited threshold benefit if savings exhausted. Limited day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs!
AVOID SHORTFALLS. TAKE THE CO-PAYMENTS WITH THE GAP COVER CO-PAY PLAN FOR AN ADDITIONAL R 170 pm!
Average monthly single rate R 4,416 and family of four R 9,978 pm
Yes
EXTENDER OPTION - no overall annual limit private hospitalisation at 200% of scheme rates. Associated specialists paid in full. Referral co-payments. Limited oncology. Limited and co-pay in-hospital dental. Unlimited maternity. Co-pay in and out hospital MRI/CT scan. Unlimited prosthesis at chosen providers. Mental health. 7-days take home medicines. 26 PMB Chronic conditions. Limit for 36 additional chronics. Savings for day-to-day. Limited specialised dentist. Limited threshold benefit if savings exhausted. Limited day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs!
AVOID SHORTFALLS. TAKE THE CO-PAYMENTS WITH THE GAP COVER CO-PAY PLAN FOR AN ADDITIONAL R 170 pm!
Choose your providers and determine your rate. Average monthly single rate R 3,069 and family of four R 7,443 pm
Yes
INCENTIVE OPTION - no overall annual limit private hospitalisation at 200% of scheme rates. Associated specialists paid in full. Referral co-payments. Limited oncology. Limited and co-pay in-hospital dental. Unlimited maternity. Co-pay in and out hospital MRI/CT scan. Unlimited prosthesis at chosen providers. Mental health. 7-days take home medicines. 26 PMB Chronic conditions. Limit for 6 additional chronics. Savings for day-to-day. Limited day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs!
AVOID SHORTFALLS. TAKE THE CO-PAYMENTS WITH THE GAP COVER CO-PAY PLAN FOR AN ADDITIONAL R 170 pm!
Choose your providers and determine your rate. Average monthly single rate R 1,649 and family of four R 4,270 pm
Yes
CUSTOM OPTION - IN HOSPITAL ONLY BENEFIT - no overall annual limit private hospitalisation at 100% scheme rates. There is a co-payment of R 950 per authorisation, (not emergencies, vehicle accidents and maternity). Associated specialists paid in full. Limited oncology, dialysis. Limited in-hospital dental. Unlimited maternity. Co-pay in and out hospital MRI/CT scan. Unlimited prosthesis at chosen providers. Mental health. 7-days take home medicines. 26 PMB Chronic list at choice of provider. No day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs!
AVOID SHORTFALLS TAKE THE CO-PAYMENTS WITH THE GAP COVER CO-PAY PLAN FOR AN ADDITIONAL R 170 pm!
Choose your providers and determine your rate. Average monthly single rate R 1,259 and family of four R 3,170 pm
Yes
ACCESS OPTION - no overall annual limit private hospitalisation at Access network hospitals. No co-payments. Oncology, dialysis at PMB benefits. Mental health. Unlimited prosthesis at chosen providers. 7-days take home medicines. 26 PMB Chronic at CareCross, Medicross or Prime Cure. 10 GP visits (then a R50 co-pay), unlimited basic dentistry, 3 specialist visits per year, basic optical.
Average monthly single rate R 1,188 and family of four R 3,029 pm
Yes
INGWE OPTION - provides affordable access to entry-level cover at preferred providers. Hospitalisation is available either, Ingwe Network or State limited to of R 900 000 per family per year. No co-payments. Oncology, Dialysis at PMB benefits. Limited maternity. 26 PMB Chronic and unlimited basic dentistry, GP, basic optical and list of medicines at CareCross or Prime Cure. R 1,150 per family specialist visit pa.
Income-related rates - single rate from R 357 and family of four R1,102 pm.
Yes
OPTIONAL EXTRA This medical aid DOES NOT pay in-hospital claims at private rates on all options.
You can also have CO-PAYMENTS!
It is recommended you consider the TOP UP PLAN to prevent any shortfall of claims.

Any other information we should know about?
Your current medical aid plan (if any): Please state the actual plan as well.
Are you interested in subsidised gym membership, movie tickets, travel etc? Yes No
Would you like to receive my informative letter on personal financial matters? Yes
NEED A MOMENTUM HEALTH APPLICATION?
Please note:
The submission of this request does not constitute any legal obligation, either on your or Peter J Pyburn's behalf.
It is simply a request to get some medical aid options.
All information provided will be strictly confidential at all times and will be freely transmitted to the email address provided.
Peter J Pyburn will not be responsible should the information be incorrectly transmitted or not reach the correct recipient.
Your email address will never be given to any other person or organisation.
(I would never be in business if this happened!)
YOU MUST CONSULT THE SCHEMES BROCHURES FOR COMPREHENSIVE BENEFIT DESCRIPTIONS AND CONSULT THE SCHEME DIRECTLY FOR ANY UNDERWRITING CONCERNS.
AT ALL TIMES, THE SCHEME RULES WILL OVERRIDE ANYTHING PETER J PYBURN HAS SAID OR WRITTEN AND AS SUCH YOU AGREE WITH THE DISCLAIMER AS PRESENTED IN THE QUOTE/S YOU HAVE ACTED UPON.
I confirm that I have read and understood the notes above. Yes
pyburn@peterpyburn.co.za

Peter Pyburn 2012 Momentum Health Medical Aid Quote

Your email address:
Your telephone/cell number:
Your name and surname:
Your Date of Birth:
Your partner's name and surname (if required):
Your partner's Date of Birth:
First child's name:
Child's Date of Birth:
Second child's name:
Child's Date of Birth:
Third child's name:
Child's Date of Birth:
Any OTHER (NOT ALREADY STATED ABOVE) dependants - adults or children you want to add?

SUMMIT OPTION - no overall annual limit private hospitalisation at 300% of scheme rates. Associated specialists paid in full. Unlimited dialysis and oncology. Limited in-hospital dental. Unlimited maternity. Co-pay in and out hospital MRI/CT scan. Unlimited prosthesis at chosen providers. Mental health. 7-days take home medicines. 26 PMB Chronic list at choice of provider. Limit for 36 additional chronics. R 16,700 per beneficiary day-to-day limit. Limited specialised dentist. Limited threshold benefit if savings exhausted. Limited day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs! AVOID SHORTFALLS. TAKE THE CO-PAYMENTS WITH THE GAP COVER CO-PAY PLAN FOR AN ADDITIONAL R 170 pm! Average monthly single rate R 4,416 and family of four R 9,978 pm	Yes
EXTENDER OPTION - no overall annual limit private hospitalisation at 200% of scheme rates. Associated specialists paid in full. Referral co-payments. Limited oncology. Limited and co-pay in-hospital dental. Unlimited maternity. Co-pay in and out hospital MRI/CT scan. Unlimited prosthesis at chosen providers. Mental health. 7-days take home medicines. 26 PMB Chronic conditions. Limit for 36 additional chronics. Savings for day-to-day. Limited specialised dentist. Limited threshold benefit if savings exhausted. Limited day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs! AVOID SHORTFALLS. TAKE THE CO-PAYMENTS WITH THE GAP COVER CO-PAY PLAN FOR AN ADDITIONAL R 170 pm! Choose your providers and determine your rate. Average monthly single rate R 3,069 and family of four R 7,443 pm	Yes
INCENTIVE OPTION - no overall annual limit private hospitalisation at 200% of scheme rates. Associated specialists paid in full. Referral co-payments. Limited oncology. Limited and co-pay in-hospital dental. Unlimited maternity. Co-pay in and out hospital MRI/CT scan. Unlimited prosthesis at chosen providers. Mental health. 7-days take home medicines. 26 PMB Chronic conditions. Limit for 6 additional chronics. Savings for day-to-day. Limited day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs! AVOID SHORTFALLS. TAKE THE CO-PAYMENTS WITH THE GAP COVER CO-PAY PLAN FOR AN ADDITIONAL R 170 pm! Choose your providers and determine your rate. Average monthly single rate R 1,649 and family of four R 4,270 pm	Yes
CUSTOM OPTION - IN HOSPITAL ONLY BENEFIT - no overall annual limit private hospitalisation at 100% scheme rates. There is a co-payment of R 950 per authorisation, (not emergencies, vehicle accidents and maternity). Associated specialists paid in full. Limited oncology, dialysis. Limited in-hospital dental. Unlimited maternity. Co-pay in and out hospital MRI/CT scan. Unlimited prosthesis at chosen providers. Mental health. 7-days take home medicines. 26 PMB Chronic list at choice of provider. No day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs! AVOID SHORTFALLS TAKE THE CO-PAYMENTS WITH THE GAP COVER CO-PAY PLAN FOR AN ADDITIONAL R 170 pm! Choose your providers and determine your rate. Average monthly single rate R 1,259 and family of four R 3,170 pm	Yes
ACCESS OPTION - no overall annual limit private hospitalisation at Access network hospitals. No co-payments. Oncology, dialysis at PMB benefits. Mental health. Unlimited prosthesis at chosen providers. 7-days take home medicines. 26 PMB Chronic at CareCross, Medicross or Prime Cure. 10 GP visits (then a R50 co-pay), unlimited basic dentistry, 3 specialist visits per year, basic optical. Average monthly single rate R 1,188 and family of four R 3,029 pm	Yes
INGWE OPTION - provides affordable access to entry-level cover at preferred providers. Hospitalisation is available either, Ingwe Network or State limited to of R 900 000 per family per year. No co-payments. Oncology, Dialysis at PMB benefits. Limited maternity. 26 PMB Chronic and unlimited basic dentistry, GP, basic optical and list of medicines at CareCross or Prime Cure. R 1,150 per family specialist visit pa. Income-related rates - single rate from R 357 and family of four R1,102 pm.	Yes