Focus on the Ingwe Option - 2025

Introduction

The Ingwe Option provides affordable access to entry-level cover. For your hospitalisation cover, you can choose to use the Connect Network of private hospitals, the Ingwe Network of private hospitals, or Any hospital.

For chronic treatment and day-to-day benefits, such as GP visits or prescribed medicine, if you choose Connect Network hospitals, you need to use State facilities, if you choose Ingwe Network hospitals, you need to use Ingwe Primary Care Network providers, or if you choose Any hospital, you need to use Ingwe Active Network providers. View a list of network providers on momentummedicalscheme.co.za, or WhatsApp or call us on 0860 11 78 59.

You are also covered for three virtual GP consultations per year from the GP Virtual Consultation Network, which includes Hello Doctor. This means that you can have a virtual consultation with a qualified doctor, from the comfort of your home, or wherever you may find yourself at the time. If you need more day-to-day benefits, 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 preventative care benefits. If you choose Ingwe Network hospitals or Any hospital, Health Platform Benefits are only available from your chosen Primary Care Network provider, except for health assessments, maternity programme benefits and baby immunisations, which are available at any healthcare provider. If you choose Connect Network hospitals, you may use any healthcare provider.

Momentum Medical Scheme’s 2025 benefit and contribution amendments have been submitted to the Council for Medical Schemes and are subject to approval by the Regulator.

This focus page summarises the 2025 benefits available on the Ingwe Option. Scheme Rules always take precedence and are available on request. 


Major Medical Benefit

Provider Connect Network hospitals, Ingwe Network hospitals or Any hospital
Limit No overall annual limit applies
Rate Up to 100% of the Momentum Medical Scheme Rate
Specialised procedures/treatment Certain procedures covered (refer to the Member brochure for a list of procedures and treatment covered)

There is no overall annual limit for hospitalisation. This benefit provides cover for hospitalisation and certain specialised procedures/treatment at either the Connect Network of private hospitals,  the Ingwe Network of private hospitals or Any hospital, depending on the provider you have chosen. Claims are paid up to 100% of the Momentum Medical Scheme Rate. Under the hospitalisation benefit, hospital accounts and related costs incurred in hospital (from admission to discharge) are covered – provided that treatment has been authorised. 

The specialised procedures/treatment that are covered 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 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 admission. 

If you have chosen Connect Network hospitals or  Ingwe Network hospitals and do not use this provider, a 30% co-payment will apply on the hospital account.


Chronic Benefit

Chronic provider and formulary Ingwe Primary Care Network, Ingwe Active Network or State facilities. Subject to a list of medicine, referred to as a formulary. 
Chronic conditions covered 26 conditions, according to the Chronic Disease List in the Prescribed Minimum Benefits

The Chronic Benefit covers certain life-threatening conditions that need ongoing treatment. On the Ingwe Option, chronic benefits are available from the Ingwe Primary Care Network, Ingwe Active Network or State facilities. Chronic cover is provided for 26 conditions according to the Chronic Disease List, which forms part of the Prescribed Minimum Benefits. Chronic benefits are subject to registration and approval.


Day-to-day Benefit

Day-to-day providerIngwe Primary Care Network, Ingwe Active Network or State facilities
Day-to-day benefit
If you choose Connect Network hospitals, benefits are available from State facilities, unless otherwise indicated. If you choose Ingwe Network hospitals, benefits are only available from Ingwe Primary Care Network or if you choose Any hospital, benefits are only available at Ingwe Active Network. Benefits are subject to the rules and provisions set by the network, commonly referred to as protocols, and to the network’s list of applicable tariff codes

This benefit provides for day-to-day medical expenses, such as GP visits and prescribed medicine. On the Ingwe Option, day-to-day benefits are available from the Ingwe Primary Care Network, Ingwe Active Network or State facilities, unless otherwise indicated. You also have cover for three virtual consultations per year from the GP Virtual Consultation Network, which includes Hello Doctor.


Health Platform Benefit

Provider Ingwe Primary Care Network, Ingwe Active Network or Any provider

The Health Platform Benefit  is available from the Ingwe Primary Care Network, Ingwe Active Network or Any provider. This 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

All children are charged for


Benefit schedule

Major Medical Benefit

Major Medical Benefit 
General rule applicable to the Major Medical Benefit: You need to contact us for pre-authorisation before making use of your Major Medical Benefits. For some conditions, like diabetes, you will need to register on a health management programme. The 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  Connect Network hospitals, Ingwe Network hospitals or Any hospital
Overall annual limit  None 
Hospitalisation 
Benefit  Specialists covered up to 100% 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  10 days per admission 
Renal dialysis Limited to Prescribed Minimum Benefits at State facilities 
Oncology If you choose Connect Network hospitals, you need to obtain your oncology treatment from an oncologist authorised by the Scheme, and benefits are limited to Prescribed Minimum Benefits at Connect Network hospitals. If you choose Ingwe Network hospitals or Any hospital, benefits are limited to Prescribed Minimum Benefits at State facilities
Organ transplants  If you choose Connect Network hospitals, benefits are limited to Prescribed Minimum Benefits at Connect Network hospitals. If you choose Ingwe Network hospitals or Any hospital, benefits are limited to Prescribed Minimum Benefits at State facilities
In-hospital dental and oral benefits  Not covered. Dentistry related to trauma covered at State facilities, limited to Prescribed Minimum Benefits 
Maternity confinements  
Caesarean sections: Only emergency caesareans are covered 
No annual limit applies 
Neonatal intensive care  No annual limit applies 
Medical and surgical appliances in hospital (such as support stockings, knee and back braces, etc.)  R6 700 per family 
Prosthesis – internal (incl. knee and hip replacements, permanent pacemakers, etc.) Limited to Prescribed Minimum Benefits at State facilities 
Prosthesis – external (such as artificial arms or legs)Limited to Prescribed Minimum Benefits at State facilities 
MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scansIf you choose Connect Network hospitals, MRI and CT scans are limited to Prescribed Minimum Benefits at Connect Network hospitals and other specialised scans are subject to Prescribed Minimum Benefits at State facilities. If you choose Ingwe Network hospitals or Any hospital, all scans are limited to Prescribed Minimum Benefits at State facilities
Mental health  
  • incl. psychiatry and psychology 
  • drug and alcohol rehabilitation

Limited to Prescribed Minimum Benefits at State facilities
Take-home medicine 7 days’ supply
Medical rehabilitation and step-down facilities  R16 700 per beneficiary (combined limit), subject to case management 
Private nursing and Hospice  Not covered 
Health management programmes for conditions such as HIV/Aids  Your doctor needs to register you on the appropriate health management programme 
Immune deficiency related to HIV 
Anti-retroviral treatment  
HIV related admissions 

R40 500 per family at preferred provider
R41 000 per family at your chosen hospital provider 
Emergency medical transport in South Africa by Netcare 911  No annual limit applies 
Specialised procedures/treatment 
Certain specialised procedures/treatment covered (refer to the Member brochure for a list of procedures and treatment covered) 

Chronic Benefit

Chronic Benefit  
General rule applicable to the Chronic Benefit: Benefits are only available at your chosen Network provider, and are subject to a list of medicine, referred to as a Network entry-level formulary 
Provider  

Ingwe Primary Care Network, Ingwe Active Network or Sate facilities

Cover  26 conditions covered, according to the Chronic Disease List in the Prescribed Minimum Benefits 

Day-to-day Benefit 

Day-to-day Benefit 
General rule applicable to the Day-to-day Benefit: If you choose Connect Network hospitals, benefits are available from State facilities, unless otherwise indicated. If you choose Ingwe Network hospitals, benefits are only available from Ingwe Primary Care Network or if you choose Any hospital, benefits are only available at Ingwe Active Network. Benefits are subject to the rules and provisions set by the network, commonly referred to as protocols, and to the network’s list of applicable tariff codes
Provider   Ingwe Primary Care Network, Ingwe Active Network or State facilities 
Acupuncture, Homeopathy, Naturopathy, 
Herbology, Audiology, Occupational and 
Speech therapy, Chiropractors, Dieticians, 
Biokinetics, Orthoptists, Osteopathy, 
Audiometry, Chiropody, and Podiatry  
Limited to Prescribed Minimum Benefits at State facilities 
Mental health (incl. psychiatry and psychology)  Limited to Prescribed Minimum Benefits at State facilities 
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 contact us for pre-authorisation if you have more than 4 fillings or 4 extractions 
Dentistry – specialised (such as bridges or crowns)  Not covered 
External medical and surgical appliances (incl. 
hearing aids, wheelchairs, etc.) 
Not covered 
General practitioners  There is no limit to the number of times you may visit your network GP. However, please note all visits from the 11th visit onwards must be pre-authorised  
GP virtual consultations3 virtual consultations per year from the GP Virtual Consultation Network, which includes Hello Doctor. Consultations include scripting of medication where required
Out-of-network GP, casualty or after-hours visits  1 visit per beneficiary per year, subject to authorisation (you need to authorise within 72 hours of the consultation, otherwise a 30% co-payment will apply and Momentum Medical Scheme will be responsible for 70% of the negotiated tariff). Maximum of 2 visits per family per year, R110 co-payment per visit applies
Specialists  2 visits per family per year, limited to R1 350 per visit and up to a maximum of R2 700 per family per year. Covered at 100% of the Momentum Medical Scheme Rate. Subject to referral by your chosen Primary Care Network provider and pre-authorisation. Psychologists and psychiatrists are limited to Prescribed Minimum Benefits at State facilities 
Physiotherapy   Included in the specialist limit 
Optical and optometry (excl. contact lenses and refractive eye surgery)  1 eye test and 1 pair of clear standard or bi-focal lenses with standard frame as per formulary per beneficiary every 2 years. Spectacles will only be granted if your refraction measurement is more than 0.5 
Pathology – basic (such as cholesterol tests)  Specific list of pathology tests covered 
Radiology – basic (such as x-rays)  Specific list of black and white x-rays covered 
MRI and CT scans, magnetic resonance cholangiopancreatography (MRCP), whole body radioisotope and PET scans  If you choose Connect Network hospitals, MRI and CT scans are limited to Prescribed Minimum Benefits at Connect Network hospitals and other specialised scans are subject to Prescribed Minimum Benefits at State facilities. If you choose Ingwe Network hospitals or Any hospital, all scans are limited to Prescribed Minimum Benefits at State facilities
Prescribed medication  Subject to a list of medicine, referred to as a prescribed formulary 
Over-the-counter medication  Not covered 

Health Platform Benefit

Health Platform Benefit 
General rule applicable to the Health Platform Benefit: If you choose Ingwe Network hospitals or Any hospital,Health Platform Benefits are only available from your chosen Primary Care Network provider, except for healthassessments, maternity programme benefits and baby immunisations, which are available at any healthcareprovider. If you choose Connect Network hospitals, you may use any healthcare provider.
What is the benefit?  Who is eligible?  How often?
Preventative care 
Baby immunisations: Covered in private facilities for baby’s first year, limited to  R2 950 per year. Once the limit is reached, immunisations are available at the Department of Health baby clinics  Children up to age 6   As required by the 
Department of Health 
Flu vaccines  Children between 6 months and 5 years 
Beneficiaries 60 years and older 
High-risk beneficiaries 
Once a year 
Tetanus diphtheria injection  All beneficiaries  As needed 
Early detection tests 
Preventative dental care covered up to R380per beneficiary at any dental provider
All beneficiaries  Once a year 
Pap smear consultation (nurse or GP)  Women 15 and older  Once a year 
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 
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 
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) 
Antenatal visits (Midwives, GP or gynaecologist)      Women registered on the programme  7 visits 
Nurse home visit  1 visit on the day after returning from hospital following childbirth 
Urine tests (dipstick)  Included in antenatal visits 
Pathology tests Blood group, full blood count, haemoglobin estimation and Rhesus factor  1 test 
Urinalysis  7 tests 
Urine tests (microscopic exams, antibiotic susceptibility and culture)  As indicated 
Scans  2 pregnancy scans  
Paediatrician visits  Babies up to 12 months registered on the programme  1 visit 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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