Focus on the Summit Option - 2026

Introduction

The Summit Option includes cover for hospitalisation at any private hospital. There is no overall annual limit for hospitalisation. Extensive day-to-day and chronic benefits are available from any provider. If you need more day-to-day cover, you can make use of Momentum HealthSaver+. HealthSaver is a complementary product offered by Momentum that lets you save for medical expenses not covered on your option. The Health Platform Benefit provides cover for a range of benefits such as preventative screening tests, certain check-ups and more.


This focus page summarises the 2026 benefits available on the Summit Option. Scheme Rules always take precedence and are available on request.


Momentum Medical Scheme’s 2026 benefit and contribution amendments have been submitted to the Council for Medical Schemes and are subject to approval by the Registrar.

 


Major Medical Benefit

Provider Any hospital
Limit No overall annual limit applies
Benefit Associated specialists covered in full
Other specialists covered up to 300% of the Momentum Medical Scheme Rate
Hospital accounts are covered in full at the rate agreed upon with the hospital group
Specialised procedures/treatment Certain procedures/treatment covered – see Member brochure for the list

This benefit includes cover for hospitalisation and certain specialised procedures/treatment. There is no overall annual limit on hospitalisation. Associated specialists are covered in full, while other specialists are covered up to 300% of the Momentum Medical Scheme Rate. Hospital accounts are covered in full at the rate agreed upon with the hospital group. Under the hospitalisation benefit, hospital accounts and related costs incurred in hospital (from admission to discharge) are covered – provided treatment has been pre-authorised. 

Specialised procedures/treatment do not necessarily require admission to hospital and are included in the Major Medical Benefit – provided that the treatment is clinically appropriate and has been authorised. If pre-authorisation is not obtained, a 30% co-payment will apply on all accounts related to the event and the Scheme would be responsible for 70% of the negotiated tariff, provided authorisation would have been granted according to the Rules of the Scheme. In the case of an emergency, you or someone in your family or a friend must obtain authorisation within 72 hours of admittance.


Chronic Benefit

Chronic provider and Formulary Any provider
Comprehensive formulary applies
Chronic conditions covered Cover for 62 conditions:
26 conditions according to the Chronic Disease List in Prescribed Minimum Benefits: no annual limit applies
36 additional conditions: accumulate to overall day-to-day limit of R34 500 per beneficiary. This is a combined limit incorporating both day-to-day cover and cover for the 36 additional conditions

The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. You have the freedom of choice to get your chronic prescription and medication from any provider, subject to a comprehensive formulary. If you choose to get your medication from outside the formulary, a co-payment of the cost difference between the selected item and the formulary price is payable. There is no annual limit for chronic cover for the 26 conditions according to the Chronic Disease List, which forms part of the Prescribed Minimum Benefits. An additional 36 conditions are covered subject to the overall day-to-day limit of R34 500 per beneficiary (this is a combined limit incorporating both day-to-day cover and cover for the 36 additional chronic conditions). Chronic benefits are subject to registration on the Chronic Management Programme and approval by the Scheme.


Day-to-day Benefit

Day-to-day provider Any provider 
Day-to-day benefit Covered from risk benefit, subject to overall day-to-day limit of R34 500 per beneficiary and sub-limits. This is a combined limit incorporating both day-to-day cover and cover for the 36 additional conditions

This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medicine, and is paid from the risk benefit. The benefits are subject to an overall day-to-day limit of R34 500 per beneficiary and certain sub-limits apply. (The overall day-to-day limit of R34 500 is a combined limit incorporating both day-to-day cover and cover for the 36 additional chronic conditions).


Health Platform Benefit

Provider Any 

Health Platform Benefits are paid by the Scheme up to a maximum rand amount per benefit, provided you notify us before using certain benefits. This unique benefit encourages health awareness, enhances the quality of life and gives peace of mind through:

  •  preventative care and early detection;
  •  maternity programme; and 
  • health education and advice.

Contributions


Benefit schedule

Major Medical Benefit

Major Medical Benefit
General rule applicable to the Major Medical Benefit: You need to contact us for authorisation before making use of your Major Medical Benefits. For some conditions, like cancer, you will need to register on a health management programme. Momentum Medical Scheme will pay benefits in line with the Scheme Rules and the clinical protocols that the Scheme has established for the treatment of each condition. The sub-limits specified below apply per year. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year).
Provider Any hospital
Overall annual limit None
Hospitalisation
Benefit Associated specialists covered in full.
Other specialists covered up to 300% of the Momentum Medical Scheme Rate
Hospital accounts are covered in full at the rate agreed upon with the hospital group
High and intensive care No annual limit applies
Casualty or after-hour visits Subject to Day-to-day Benefit
Renal dialysis No annual limit applies
Oncology No annual limit applies.
Momentum Medical Scheme Reference Pricing will apply to chemotherapy and adjuvant medication.
Specialised oncology benefits are available for certain biologicals and immunologicals, subject to criteria
Organ transplants (recipient) No annual limit applies
Organ transplants (donor): Only covered when recipient is a member of the Scheme R28 700 cadaver costs
R59 000 live donor costs (including transportation)
In-hospital dental and oral benefits
Maxillo-facial surgery (excluding implants)
and general anaesthesia for children under 7
The hospital account is paid at the negotiated rate and the anaesthetist account is covered up to 300% of the Momentum Medical Scheme Rate.
The dentist, dental specialist and maxillo-facial surgeon accounts are paid from available day-to-day benefits, subject to the day-to-day limits
Dentistry related to trauma The hospital account is paid at the negotiated rate.
The anaesthetist, dentist, dental specialist and maxillo-facial surgeon accounts are covered up to 300% of the Momentum Medical Scheme Rate 
Extraction of impacted wisdom teeth The hospital account is paid at the negotiated rate and the anaesthetist account is covered up to 300% of the Momentum Medical Scheme Rate.
The dentist, dental specialist and maxillo-facial surgeon accounts are paid up to 100% of the Momentum Medical Scheme Rate
Implants and all other in-hospital dental treatment The cost of implants, as well as the hospital, anaesthetist, dentist, dental specialist and maxillo-facial surgeon accounts are paid from available day-to-day benefits, subject to the day-to-day limits
Other in-hospital procedure
Maternity confinements No annual limit applies
Neonatal intensive care No annual limit applies
MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans (in- and out of hospital) No annual limit applies, subject to co-payment of R3 500 per scan and pre-authorisation
Medical and surgical appliances in-hospital (such as support stockings, knee and back braces, etc) R9 230 per family, subject to pre-authorisation
Prosthesis – internal (including knee and hip replacements, permanent pacemakers, etc) Cochlear implants: R245 000 per beneficiary, maximum 1 event per year
 Intraocular lenses: R9 540 per beneficiary per event, maximum 2 events per year.
Other internal prostheses: R92 200 per beneficiary per event, maximum 2 events per year
Prosthesis – external (such as artificial arms or legs,etc) R32 000 per family
Mental health 
  •  incl. psychiatry and psychology
  •  drug and alcohol rehabilitation
R50 600 per beneficiary
Take-home medicine 7 days’ supply
Trauma benefit Covers certain day-to-day benefits that form part of the recovery following specific traumatic events, such as near drowning, poisoning, severe allergic reaction and external and internal head injuries. Appropriate treatment related to the event is covered as per authorisation
Medical rehabilitation, private nursing, Hospice and step-down facilities R75 000 per family (combined limit), subject to case management
Health management programmes for conditions such as chronic renal disease, organ transplants, mental health, HIV/Aids and oncology Your doctor needs to register you on the appropriate health management programme
Immune deficiency related to HIV
  • Anti-retroviral treatment
  •  HIV related admissions
No annual limit applies at any provider
R96 800 per family at any hospital
Emergency medical transport in South Africa by Netcare 911 No annual limit applies
International emergency medical transport by preferred provider R9 010 000 per beneficiary per 90-day journey. This benefit includes R15 500 for emergency optometry, R15 500 for emergency dentistry and R765 000 terrorism cover.
A R2 280 co-payment applies per emergency out-patient claim
Specialised procedures or treatment
Certain specialised procedures/treatment covered (when clinically appropriate) in- and out-of-hospital (refer to the Member brochure for a list of procedures and treatment covered)

Chronic Benefit

Chronic Benefit 
General rule applicable to Chronic Benefits: Benefits are subject to registration on the Chronic Management Programme and approval by the Scheme.
Provider You can use any provider of your choice
Cover Cover for 62 conditions: 26 conditions according to Chronic Disease List in Prescribed Minimum Benefits - no annual limit applies
Cover for 36 additional conditions, subject to overall day-to-day limit of R34 500 per beneficiary  (this is a combined limit incorporating both day-to-day cover and cover for the 36 additional conditions)

Day-to-day Benefit

Day-to-day Benefit
General rule applicable to the Day-to-day Benefit: Benefits are paid at 100% of the Momentum Medical Scheme Rate, subject to the annual sub-limits specified below and an overall day-to-day limit of R34 500 per beneficiary. This is a combined limit incorporating both day-to-day cover and cover for 36 additional chronic conditions. The sub-limits specified apply per year unless stated otherwise. Should you not join in January, your sub-limits will be adjusted pro-rata (this means it will be adjusted in line with the number of months left in the year).
Provider You can use any provider of your choice
Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody, Physiotherapy and Podiatry R9 840 per family.
Subject to overall day-to-day limit of R34 500 per beneficiary
Mental health (incl. psychiatry and psychology) R29 600 per family.
Subject to overall annual day-to-day limit of R34 500 per beneficiary
Dentistry – basic (such as extractions or fillings) Subject to overall annual day-to-day limit of R34 500 per beneficiary
Dentistry – specialised (such as bridges or crowns) R20 700 per beneficiary, R49 800 per family.
Subject to overall annual day-to-day limit of R34 500 per beneficiary. Both in- and out of hospital dental specialist accounts accumulate towards the limit. Dental specialist accounts for extraction of impacted wisdom teeth in doctors’ rooms:  Covered from Major Medical Benefit at 100% of the Momentum Medical Scheme Rate, subject to pre-authorisation
External medical and surgical appliances (incl. hearing aids, glucometers, blood pressure monitors, wheelchairs etc) R40 100 per family. R23 200 sub-limit for hearing aids. Subject to overall annual day-to-day limit of R34 500 per beneficiary
General practitioners Subject to overall annual day-to-day limit of R34 500 per beneficiary
Specialists Subject to overall annual day-to-day limit of R34 500 per beneficiary
Optical and optometry (incl. contact lenses and refractive eye surgery Overall limit of R6 100 per beneficiary. Frame sub-limit of R3 080 Subject to overall annual day-to-day limit of R34 500 per beneficiary
Pathology (such as cholesterol tests) Subject to overall annual day-to-day limit of R34 500 per beneficiary
Radiology (such as x-rays) Subject to overall annual day-to-day limit of R34 500 per beneficiary
MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans Covered from Major Medical Benefit, subject to a
R3 500 co-payment per scan and pre-authorisation
Prescribed medication  R26 900 per beneficiary, R44 200 per family. 
Subject to overall annual day-to-day limit of R34 500 per beneficiary
Over-the-counter medication (including prescribed vitamins and homeopathic medicine) Not covered

Health Platform Benefit

Health Platform Benefit
General rule applicable to the Health Platform Benefit: Health Platform Benefits are paid by the Scheme up to a maximum rand amount per benefit. You do not need to pre-notify before using Health Platform Benefits, except for preventative dental care, pap smears, general physical examinations and HIV tests. Where pre-notification is required, you can pre-notify quickly and easily on the Momentum App, via the web chat facility or by logging on to momentummedicalscheme.co.za. You may also send us a WhatsApp or call us on 0860 11 78 59.
What is the benefit? Who is eligible? How often?
Preventative care
Baby immunisations Children up to age 6 As required by the Department of Health
Flu vaccines Children between 6 months and 5 years
Beneficiaries 60 and older
All high-risk beneficiaries
Once a year
Tetanus diphtheria injection All beneficiaries As needed
Pneumococcal vaccine Beneficiaries 60 and older
High-risk beneficiaries
Once a year
Early detection tests
Preventative dental care covered up to R500 per beneficiary at any dental provider
All beneficiaries Once a year
Pap smear consultation (nurse, GP* or gynaecologist) Women 15 and older Based on type of pap smear (see below)
Pap smear (pathologist)
Standard or LBC (Liquid based cytology)
Or HPV PCR screening test (If result indicates high risk, then a follow-up LBC is also covered)
Women 15 and older 

Women 21 to 65
Once a year 

Once every 3 years
Mammogram  Women 38 and older Once every 2 years
FIT (Faecal immunochemical testing) test 
Beneficiaries 45 to 80
Once a year
DEXA bone density scan (radiologist, GP* or specialist) Beneficiaries 50 and older Once every 3 years
General physical examination (GP* consultation) Beneficiaries 21 to 29 Once every 5 years
Beneficiaries 30 to 59 Once every 3 years
Beneficiaries 60 to 69 Once every 2 years
Beneficiaries 70 and older Once a year
Prostate specific antigen (pathologist) Men 40 to 49 Once every 5 years
Men 50 to 59 Once every 3 years
Men 60 to 69 Once every 2 years
Men 70 and older Once  a year
Health assessment: Blood pressure test, cholesterol and blood sugar tests (finger prick tests), height, weight and waist circumference measurements All principal members and adult beneficiaries Once a year
Cholesterol test (pathologist): Only covered if health assessment results indicate a total cholesterol of 6 mmol/L and above Principal members and adult beneficiaries Once a year
Blood sugar test (pathologist): Only covered if health assessment results indicate blood sugar levels of 11 mmol/L and above Principal members and adult beneficiaries Once a year
Glaucoma test Beneficiaries 40 to 49  Once every 2 years
Beneficiaries 50 and older Once a year
HIV test (pathologist) Beneficiaries 15 and older Once every 5 years
Maternity programme (subject to registration on the Maternity programme between 8 and 20 weeks of pregnancy)
Doula benefit
Women registered on
the programme
2 visits per pregnancy
Antenatal visits (Midwives, GP* or gynaecologist) 12 visits
Online antenatal and postnatal classes 18-month subscription
Online video consultations with lactation specialist Initial consultation plus follow up
Nurse home visits 3 visits: Day after return from hospital following childbirth, then after 2 and 6 weeks
Urine tests (dipstick) Included in antenatal visits
Pathology tests Antiglobin, blood group, creatinine, full blood count, platelet count, Rhesus factor and Rubella antibody 1 test
Glucose strip and haemoglobin estimation 2 tests
Urinalysis 12 tests
Urine tests (microscopic exams, antibiotic susceptibility and culture) As indicated
Scans 2 pregnancy scans. We cover 3D and 4D growth scans up to the rate that we pay for 2D scans
Pediatrician visits Babies registered on the programme 2 visits in baby’s first year
Health line
24-hour emergency health advice All beneficiaries As needed

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.

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