How to read your claims statement

Summary claims statement

Understanding your Momentum Medical Scheme claims statement

Please follow the numbering shown in the image above.

Notes to understanding the Summary claims statement 

  1. The details of your chosen benefit option
  2. The amount the Scheme paid from the Major Medical Benefit this month.
  3. The amount the Scheme paid from the Chronic Benefit this month.
  4. The amount the Scheme paid from the Major Medical Benefit this calendar year.
  5. The amount the Scheme paid from the Chronic Benefit this calendar year.
  6. The Personal Medical Savings Account (PMSA) balance brought forward from the previous benefit year.
  7. The Savings (PMSA) contributions received in this calendar year.
  8. Savings (PMSA) is advanced for the number of months remaining in the calendar year – this is the amount that has been advanced for the remainder of the year. 
  9. Interest earned by you on your Savings (PMSA) balance.
  10. The total claims paid from Savings (PMSA) during this month. (The same amount will be reflected on your Detailed claims statement, in the Medical Savings column).
  11. The total claims paid from Savings (PMSA) for this calendar year.
  12. This amount reflects either the amount due by you to the Scheme, or the amount payable by the Scheme to you. If there is an amount due to you by the Scheme, the payment date and bank details for the payment will be shown below this line in a message field.

Detailed claims statement


Please follow the numbering shown in the image above.

Notes to understanding the Detailed claims statement  

1. The Payment Information columns reflect any payments made per claim transaction to the supplier or to you, as well as any amounts due by you to the Scheme.

2. The Benefit Information columns show which benefit the claim transaction was paid from, as follows:

2.1 The Major Medical Benefit, which covers in-hospital and certain procedures claims, subject to authorisation.

 2.2 The Medical Savings Account (PMSA) covers day-to-day claims from your available Savings. 

2.3 HealthSaver account – this is a voluntary account that you can use to pay for medical expenses which are not covered by your option. All transactions in this column will also reflect on your separate HealthSaver statement, which is compiled on the 1st of every month (see 2.3.1). 

2.4 Chronic Medicine Benefit – this benefit covers registered and approved chronic medication and treatment.

3. The Pay Code column reflects the specific pay code applicable to the claims transaction, and an explanation of the pay code is provided in 3.1.

4. The relevant healthcare provider’s practice name and number for the claims transactions listed beneath the line.

5. The total amount paid from your Medical Savings account (PMSA) for the claims transactions listed (this amount will also be reflected under Note 10 on the Summary claims statement).

6. This HealthSaver total will be the same as the total in Note 7 on the HealthSaver statement. 

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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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