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.
On the Evolve and Custom Options, members can add the Momentum HealthSaver+ to fund their day-to-day healthcare expenses.
On the Incentive Option, 10% of the total contribution goes to a dedicated Personal Medical Savings Account (Savings) to cover day-to-day healthcare expenses. Credit can be advanced upfront for the remaining months in the year and any unused Savings balance at the end of the year will be carried forward to the following benefit year.
On the Extender Option, 25% of the total contribution goes to a dedicated Savings account to cover day-to-day healthcare expenses. Credit can be advanced upfront for the remaining months in the year. Any unused Savings balance at the end of the year will be carried forward to the following benefit year. If this component is not enough to cover annual day-to-day expenses, members will have a self-funding gap to pay out of their own pocket up to the Threshold, which is determined by the family size (see below). Although claims add up to the Threshold at 100% of the Momentum Medical Scheme Rate, members may claim a higher amount from Savings if the provider charges more than the Momentum Medical Scheme Rate. This will result in a bigger self-funding gap. Members can add the Momentum HealthSaver+ , a complementary product available from Momentum, to fund their self-funding gap.
The annual Threshold levels for 2024 are:
- Principal member: R30 400
- Per adult dependant: R26 400
- Per child dependant: R8 700 (maximum of 3 children)
Once the Threshold has been reached, claims will be paid from Extended Cover at the Momentum Medical Scheme Rate, subject to certain sub-limits. These day-to-day limits accumulate before and after the Threshold.
On the Summit Option, claims are paid at 100% of the Momentum Medical Scheme Rate, subject to certain sub-limits and an overall day-to-day limit of R31 300 per beneficiary.
How to claim
The easiest way to submit a claim is by taking a photo of it with your cellphone and uploading it via the Momentum App.
You can also submit your claim via email or post as follows:
- Email your claim to [email protected]
- Post your claim to: Momentum Medical Scheme Claims, PO Box 2338, Durban, 4000
Please make sure that the following information is clearly visible on the claim:
- Your membership number
- The principal member’s name and surname
- The patient’s name and surname
- The treatment date
- The amount charged
- The ICD-10 code, tariff code and/or nappi code
- The service provider’s name and practice number
- Proof of payment, if you have paid the claim.
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.