Benefits

Summary of changes for 2025 Momentum Medical Scheme, for the tenth consecutive year, was able to avoid reducing benefits on any of the Scheme’s options. In fact, we have increased benefit limits for 2025 in line with inflation.  Members can ...

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 detectio...

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 be...

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...

Introduction This benefit provides for day-to-day medical expenses, such as doctors’ visits and prescribed medication.  On the Ingwe Option , members obtain their day-to-day benefits from Ingwe Network or Ingwe Active Network providers. ...

Ingwe Option Dentistry – basic (such as extractions or fillings) Examinations, fillings and x-rays as per the list of tariff codes. One dental consultation is covered per year per beneficiary. You need to call us for pre-authorisation if ...

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 ...

Momentum Medical Scheme members are covered for as part of their Health Platform benefits for these vaccines and immunisations (subject to availability). Vaccines and immunisations covered under the Health Platform benefit Infant im...

Medical aid plays an important role in providing healthcare cover and peace of mind to consumers. There are several practical ways for members to optimally use their benefits, thereby keeping their out-of-pocket expenses to the minimum. Preve...

Momentum Medical Scheme provides cover for members on the Custom, Incentive, Extender and Summit Options, who work in sub-Saharan Africa, for certain benefits. Benefits are subject to the Scheme Rules and clinical protocols.   Benefits Co...

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 require...

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...

The Major Medical Benefit includes cover for hospitalisation, as well as certain specialised procedures/ treatment and specialised scans. Overview of the cover provided in hospital across the six options Option Cover Lim...

Evolve Option members who sustain a sports injury and require treatment are covered for two physiotherapy or biokineticist treatment sessions, up to a limit of R1 060 per year.  Members do not need a referral from a GP or doctor before using th...

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...

Optometry Benefit for Ingwe Option members On the Ingwe Option, you have the following benefits for optometry:  One eye examination (eye test) per beneficiary every two years.  One pair of spectacles (frame plus lenses) per beneficiary eve...

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...

Summary of Momentum Medical Scheme’s formulary structure Option Formulary Preferred products Non-preferred products Outliers Ingwe Primary Care Network and Ingwe Active Network Fixed formulary Momentum Medic...

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 ...