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Access benefits - Pre-authorisation

Which benefits?

You must obtain pre-authorisation from Momentum Medical Scheme for:
  • An emergency hospital admission needs to be authorised within 72 hours after admission
  • A planned hospital / day clinic admission should be authorised 48 hours before your admission
  • For out-of-network, casualty and after hours doctor visits you need to contact us within 72 hours to notify us that you have used this benefit
  • Specialist visits out-of-hospital - obtain authorisation 48 hours before your specialist appointment, and your Ingwe Active Network doctor must refer you to the specialist
Please note: You do not need to call us before going to the doctor, optometrist or dentist but your provider will call us to confirm benefits.

Hospital / admissions

You need to phone us on 0860 102 493 and make sure you have the following details with you
  • Your membership number
  • The name and details of the patient
  • The reason for hospital admission or procedure
  • The date of admission
  • The contact details and practice number of the referring doctor
  • The contact details and practice number of the specialist
  • The name and practice number of the hospital or day clinic
  • The procedure code (CPT), diagnosis code (ICD-10) and tariff code (these details are available from your treating doctor).

Casualty, emergency and specialist benefits

You need to get pre-authorisation * from us when you *visit/consult a doctor that does not belong to the Ingwe Active Network. Please remember this benefit is limited to 1 visit per person or 2 visits per family per year and it includes out- of- network and emergency visits. The portion you will need to pay is only the first R100 of the claim. To avoid having to pay the bill from your own pocket, phone* 0860 102 493*

You have specialist / physio cover of 2 visits per family per year, limited to R1 100 per visit and up to a maximum of R2 200 per family per year. Your* Ingwe Primary Care or Ingwe Active Primary Care Network* doctor will refer you to a specialist and give you a referral letter. Contact the member call centre on 0860 102 493 for authorisation, and to obtain a list of specialists in your area. Use the referral letter to make an appointment with the specialist and remember that claims must be submitted to Momentum Medical Scheme for payment.