Removal of benefits and inadequate communication

A member of Momentum Ingwe Medical Aid was denied cover for cataract surgery at a private facility, despite cataracts being a Prescribed Minimum Benefit under the Medical Schemes Act. Momentum stated the procedure was removed from their list benefits in 2016 and is now only covered at a state hospital, which is free to South African citizens. This defeats the purpose of having private medical aid. The member paid cash and was informed the surgery was not covered, with no pre-authorisation issued. Amendments to the scheme appear not to have been effectively communicated to members. Trustees have therefore failed in their fiduciary to clearly commuinicate to members. The Council for Medical Schemes should investigate Momentum for their actions, or in this case their inaction and complacency.