Healthcare expenses involve more than just the cost of your stay in hospital, it could be the cost of chronic medication (like medicine to lower high blood pressure), day-to-day expenses (like visiting your GP), or emergency care. The option that you choose will determine how much your contribution will be, and what benefits you will have access to for the different healthcare expenses. You need to choose the option that best fits both your wallet and your healthcare needs.
Ingwe Option
Major Medical Benefit |  |
Any hospital, Ingwe Network hospitals*or Connect Network hospitals*
|
| The Major Medical Benefit provides cover for hospitalisation and certain out-of-hospital procedures that can safely be performed in a doctor’s room or day hospital, provided treatment is clinically appropriate and has been preauthorised. | - Specialists covered up to 100% of Momentum Medical Scheme Rate
- Hospital accounts covered in full at negotiated rate
- No overall annual limit applies
|
Chronic Benefit | Medical management including doctor, pharmacy, blood tests, x-rays, etc Ingwe Primary Care Network providers** or Ingwe Active Network providers** or State facilities |
| The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. The Chronic Benefit includes cover for the 26 ChronicDisease List (CDL) conditions, which form part of the Prescribed MinimumBenefits (PMBs). Chronic benefits are subject to registration and approval. | - 26 conditions - no annual limit applies
- Chronic Benefit formulary: Fixed formulary
|
Day-to-day Benefit | Ingwe Primary Care Network providers** or Ingwe Active Network providers** or State facilites |
| This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medication. You have the choice of adding more day-to-day cover through the HealthSaver+ | - Primary care (such as GP visits, prescribed medicine, etc)
- Secondary care (Specialist visits)
|
Health Platform Benefit |
On the Ingwe Option, if you choose Ingwe Network hospitals or Any hospital, Health Platform Benefits
are only available from your chosen Primary Care Network provider, except for health assessments,
maternity programme benefits and baby immunisations, which are available at any healthcare provider
If you choose Connect Network hospitals on the Ingwe Option, you may use any healthcare provider
|
| The Health Platform Benefit encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection and a leading maternity programme. |
Evolve Option
Major Medical Benefit |  |
Evolve Network hospitals* |
| The Major Medical Benefit provides cover for hospitalisation and certain out-of-hospital procedures that can safely be performed in a doctor’s room or day hospital, provided treatment is clinically appropriate and has been preauthorised. | - Associated specialists covered in full.
Other specialists covered up to 100% of
Momentum Medical Scheme Rate - Hospital accounts covered in full
at negotiated rate - No overall annual limit applies
- R1 920 co-payment applies
|
Chronic Benefit | Medical management including doctor, pharmacy, blood tests, x-rays, etcState facilities |
| The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. The Chronic Benefit includes cover for the 26 ChronicDisease List (CDL) conditions, which form part of the Prescribed MinimumBenefits (PMBs). Chronic benefits are subject to registration and approval. | - 26 conditions - no annual limit applies
- Chronic Benefit formulary: State formulary
|
Day-to-day Benefit | Any provider |
| This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medication. You have the choice of adding more day-to-day cover through the HealthSaver+ | - You may add the HealthSaver+ to provide cover for your day-to-day healthcare expenses
|
Health Platform Benefit | |
| The Health Platform Benefit encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection and a leading maternity programme. |
Custom Option
Major Medical Benefit |  |
Any or Associated hospitals* |
| The Major Medical Benefit provides cover for hospitalisation and certain out-of-hospital procedures that can safely be performed in a doctor’s room or day hospital, provided treatment is clinically appropriate and has been preauthorised. | - Associated specialists covered in full.
- Other specialists covered up to 100% of Momentum Medical Scheme Rate
- Hospital accounts covered in full at negotiated rate
- No overall annual limit appliesR1 920 co-payment applies
|
Chronic Benefit | Medical management including doctor, pharmacy, blood tests ,x-rays, etc Any (Any GP and any pharmacy), Associated** (Selected preferred GPs and Medipost Courier pharmacy for chronic medication), or State facilities |
| The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. The Chronic Benefit includes cover for the 26 ChronicDisease List (CDL) conditions, which form part of the Prescribed MinimumBenefits (PMBs). Chronic benefits are subject to registration and approval. | - 26 conditions - no annual limit applies
- Chronic Benefit formulary:
- Any: Basic formulary
- Associated: Core formulary
- State: State formulary
|
Day-to-day Benefit | Any provider |
| This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medication. You have the choice of adding more day-to-day cover through the HealthSaver+ | - You may add the HealthSaver+ to provide cover for your day-to-day healthcare expenses
|
Health Platform Benefit | - Health Platform Benefits are paid by the Scheme up to a maximum rand amount per benefit.
- You need to pre-notify for certain benefits
|
| The Health Platform Benefit encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection and a leading maternity programme. |
Incentive Option
Major Medical Benefit |  |
Any or Associated hospitals* |
| The Major Medical Benefit provides cover for hospitalisation and certain out-of-hospital procedures that can safely be performed in a doctor’s room or day hospital, provided treatment is clinically appropriate and has been preauthorised. | - Associated specialists covered in full.
- Other specialists covered up to 200% of Momentum Medical Scheme Rate
- Hospital accounts covered in full at negotiated rate
- No overall annual limit applies
|
Chronic Benefit | Medical management including doctor, pharmacy, blood tests ,x-rays, etc Any (Any GP and any pharmacy), Associated** (Selected preferred GPs and Medipost Courier pharmacy for chronic medication), or State facilities |
| The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. The Chronic Benefit includes cover for the 26 ChronicDisease List (CDL) conditions, which form part of the Prescribed MinimumBenefits (PMBs). Chronic benefits are subject to registration and approval. | - 26 conditions - no annual limit applies
- Additional 6 conditions limited to R13 100 per family
- Chronic Benefit formulary:
- Any: Standard formulary
- Associated: Core formulary
- State: State formulary
|
Day-to-day Benefit | Any provider, subject to Savings if available |
| This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medication. You have the choice of adding more day-to-day cover through the HealthSaver+ | - Savings 10% of total contribution
|
Health Platform Benefit | - Health Platform Benefits are paid by the Scheme up to a maximum rand amount per benefit.
- You need to pre-notify for certain benefits
|
| The Health Platform Benefit encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection and a leading maternity programme. |
Extender Option
Major Medical Benefit |  |
Any or Associated hospitals* |
| The Major Medical Benefit provides cover for hospitalisation and certain out-of-hospital procedures that can safely be performed in a doctor’s room or day hospital, provided treatment is clinically appropriate and has been preauthorised. | - Associated specialists covered in full.
- Other specialists covered up to 200% of Momentum Medical Scheme Rate
- Hospital accounts covered in full at negotiated rate
- No overall annual limit applies
|
Chronic Benefit | Medical management including doctor, pharmacy, blood tests ,x-rays, etc Any (Any GP and any pharmacy), Associated** (Selected preferred GPs and Medipost Courier pharmacy for chronic medication), or State facilities |
| The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. The Chronic Benefit includes cover for the 26 ChronicDisease List (CDL) conditions, which form part of the Prescribed MinimumBenefits (PMBs). Chronic benefits are subject to registration and approval. | - 26 conditions - no annual limit applies
- Additional 36 conditions limited to R13 100 per family
- Chronic Benefit formulary:
- Any: Extended formulary
- Associated: Core formulary
- State: State formulary
|
Day-to-day Benefit | Any provider or Associated provider (Members who have chosen Associated as their chronic provider must use an Associated GP for GP consultations) |
| This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medication. You have the choice of adding more day-to-day cover through theHealthSaver+ | - Savings 25% of total contribution plus Extended Cover
|
Health Platform Benefit | - Health Platform Benefits are paid by the Scheme up to a maximum rand amount per benefit.
- You need to pre-notify for certain benefits
|
| The Health Platform Benefit encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection and a leading maternity programme. |
Summit Option
Major Medical Benefit |  |
Any or Associated hospitals* |
| The Major Medical Benefit provides cover for hospitalisation and certain out-of-hospital procedures that can safely be performed in a doctor’s room or day hospital, provided treatment is clinically appropriate and has been preauthorised. | - Associated specialists covered in full.
- Other specialists covered up to 300% of Momentum Medical Scheme Rate
- Hospital accounts covered in full at negotiated rate
- No overall annual limit applies
|
Chronic Benefit | Medical management including doctor, pharmacy, blood tests, x-rays, etc Freedom-of-choice |
| The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. The Chronic Benefit includes cover for the 26 ChronicDisease List (CDL) conditions, which form part of the Prescribed MinimumBenefits (PMBs). Chronic benefits are subject to registration and approval. | - 26 conditions - no annual limit applies
- Additional 36 conditions limited to R33 000 per beneficiary
- Chronic Benefit formulary:
|
Day-to-day Benefit | Freedom-of-choice |
| This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medication. You have the choice of adding more day-to-day cover through theHealthSaver+ | - Paid from risk benefit, subject to overall day-to-day limit of R33 000 per beneficiary
- This is a combined limit incorporating both day-to-day cover and cover for the 36 additional chronic conditions
|
Health Platform Benefit | - Health Platform Benefits are paid by the Scheme up to a maximum rand amount per benefit.
- You need to pre-notify for certain benefits
|
| The Health Platform Benefit encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection and a leading maternity programme. |
Disclaimer: +Momentum Medical Scheme members may choose to make use of additional products available from Momentum Group Limited and its subsidiaries as well as Momentum Multiply (herein collectively referred to as Momentum). Momentum is not a medical scheme and is a separate entity to Momentum Medical Scheme. Momentum products are not medical scheme benefits. You may be a member of Momentum Medical Scheme without taking any of the products offered by Momentum.
