2013 Free Momentum Medical Aid Quote

To see how much Momentum Health medical aid plans will cost, complete the blocks below and send to me.

GOTO MOMENTUM MEDICAL AID for full details.

Do you have to join a company medical aid or can you choose a scheme?	Company scheme	Own
How many ADULTS?
How many CHILDREN?
Your email address:
Your telephone/cell number:
Your name and surname:
Current medical aid AND plan:
SEND ME ONLY THESE DETAILS OR CHOOSE PLAN BELOW

SUMMIT OPTION - no overall annual limit private hospitalisation at any hospital. Associated specialists paid in full. Unlimited dialysis and oncology. In hospital dental. Unlimited maternity. In and out hospital MRI/CT scan. 7-days take home medicines. 62 Chronic conditions. Limited day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs! AVOID SHORTFALLS and CO PAYMENTS WITH THE RECOMMENDED TOP UP! Single rate R 4,940 and family of four R 11,161 pm (TOP UP extra R 165 pm)	Yes
EXTENDER OPTION - no overall annual limit private hospitalisation at any hospital. Network hospitals for a discount premium. Associated specialists paid in full. Limited oncology. Unlimited maternity. In and out hospital MRI/CT scan. 7-days take home medicines. 62 Chronic conditions. Savings for day-to-day, with safety net when savings used. Limited day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs! AVOID SHORTFALLS and CO PAYMENTS WITH THE RECOMMENDED TOP UP! Choose your providers and determine your rate. Single rate R 3,433 and family of four R 8,326 pm (TOP UP extra R 165 pm)	Yes
INCENTIVE OPTION - no overall annual limit private hospitalisation at any hospital. Network hospitals for a discount premium. Associated specialists paid in full. Limited oncology. Unlimited maternity. In and out hospital MRI/CT scan. 7-days take home medicines. 32 Chronic conditions. 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 and CO PAYMENTS WITH THE RECOMMENDED TOP UP! Choose your providers and determine your rate. Single rate R 1,837 and family of four R 4,756 pm (TOP UP extra R 165 pm)	Yes
CUSTOM OPTION - IN HOSPITAL ONLY - no overall annual limit private hospitalisation in any hospital. Network hospitals for a discount premium. Associated specialists paid in full. Limited oncology, dialysis. Unlimited maternity. In and out hospital MRI/CT scan. 7-days take home medicines. 26 PMB Chronic conditons. No day-to-day benefits, SO CHOOSE HEALTH SAVER or the HEALTH CARD to help pay these costs! AVOID SHORTFALLS and CO PAYMENTS WITH THE RECOMMENDED TOP UP! Choose your providers and determine your rate. Single rate R 1,394 and family of four R 3,510 pm	Yes
ACCESS OPTION - no overall annual limit private hospitalisation at network hospitals. No co-payments. Oncology, dialysis at PMB benefits. 7-days take home medicines. 26 PMB Chronics at network provider. 10 GP visits (then a R60 co-pay), unlimited basic dentistry, 3 network specialist visits, basic optical. Single rate R 1,306 and family of four R 3,330 pm	Yes
INGWE OPTION - provides affordable access to entry-level cover at network providers. Hospitalisation is available either, Ingwe Network or State limited to of R 950 000 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 network provider. R 1,250 per family specialist visit pa with co-payments. Income-related rates - single rate from R 397 and family of four R1,226 pm.	Yes

Exclusions and sub - limits apply, see brochures.
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

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

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pyburn@peterpyburn.co.za