Benefits

Health Platform Benefits are available to all Momentum Medical Scheme members and are paid for by the Scheme. These benefits encourage health awareness, enhance quality of life and give peace of mind through preventative care, early detection,...

Chronic Benefit structure The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment and includes cover for the 26 Chronic Disease List conditions, which form part of the Prescribed Minimum Benefits. Chronic bene...

Clinical criteria for registration on the chronic benefit (all options)  Prescribed Minimum Benefit Chronic Disease List (CDL)  conditions Further information or tests required Addison’s disease Diagnosis by a specialist physi...

What is a co-payment? Members join a medical scheme to ensure that they will be taken care of when they require healthcare services, should they ever be faced with a medical condition or emergency. Schemes are able to provide such protection...

Momentum Medical Scheme has contracted with Netcare 911 to provide our members with emergency medical transport benefits within the borders of South Africa. Netcare 911 is available 24 hours a day, seven days a week to assist our members in th...

Who is covered?  Beneficiaries on the Evolve, Custom, Incentive, Extender and Summit Options are covered per 90-day leisure journey as follows: Ingwe Option Not covered Evolve Option R5 million per beneficiary Custom Option ...

The Trauma Benefit covers certain day-to-day care and treatment following a hospital admission for specific traumatic events. This benefit is available on the Evolve, Incentive, Extender and Summit Options and appropriate treatment related...

What is a doula? A doula provides non-clinical support and care to a woman (and her partner) during childbirth and the postpartum (after delivery) period. What are the criteria for using the benefit? There are three criteria that need to be...

MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans are subject to pre-authorisation. Even if you have authorisation for an in-hospital admission, a separate pre-authorisation will be requi...

You need to obtain pre-authorisation from Momentum Medical Scheme for:  Hospitalisation  Day hospital admissions  Specialised procedures/treatment  MRI, CT, Magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET...

Third party injuries are incidents where a third party was responsible for the injury and therefore maybe liable for medical expenses, such as a motor vehicle accident (MVA). Any amount recovered from a third party or from the Road Accident Fund...

Anorectal -  Treatment of haemorrhoids, fissure, fistula Covered for complicated cases that cannot be treated as an out-patient or where the out-patient treatment options failed and treatment is required in a medical facility Biops...

Specialised procedure and treatment This document provides a guideline of the procedures and treatment covered on the various benefit options and paid from the Major Medical Benefit, irrespective of whether the procedure and treatment is perf...