Summary of Momentum Medical Scheme changes: 2027

• Certain annual sub-limits for in-hospital benefits will increase in line with inflation.

• Your Ingwe Primary Care Network or Ingwe Active Network providers will continue to provide chronic and day-to-day benefits. View the list of these network providers on the Momentum App or momentummedicalscheme.co.za, send us a WhatsApp message or call us on 0860 11 78 59. If you are on the Ingwe Connect Option, your chronic benefits continue to be available from State facilities. 

• You have two specialist visits per family for the year. The limit has increased to R1 500 per visit and R3 000 per family for the year. The visits are covered at 100% of the Momentum Medical Scheme Rate and your network GP needs to refer you.

• The free early detection and preventative care benefits on the health platform continue in 2027.
• The preventative dental care limit increased to R520 per beneficiary.

Contribution income bands

Your monthly income determines the contribution that you pay. The income bands that will apply from 1 January 2027 are:

• Less than or equal to R1 600 per month
• From R1 601 to R9 800 per month
• From R9 801 to R13 100 per month
• From R13 101 to R18 850 per month
• From R18 851 to R24 500 per month
• R24 501 and above per month

If you earn less than R24 501 per month, you have to submit proof of current income to be considered for the relevant contribution in 2027, in line with the Scheme Rules.

• Certain annual sub-limits for in-hospital benefits will increase.
• Co-payments for hospital authorisations, specialised procedures/treatment and specialised scans will increase.

•  Your chronic benefits remain available at State providers. 

• Virtual doctor’s visits have been increased from two to four
• The sports injury treatment benefit that covers two visits to a physiotherapist or biokineticist will increase to R1 250 per beneficiary per year. You need to request pre-authorisation before using the benefit.

• The free early detection and preventative care benefits on the health platform continue in 2027. 
• The dental benefit will be enhanced to cover preventative dental care up to R520 per beneficiary.
• For international emergency benefits, the co-payment per out-patient claim payable by the Scheme will increase to R2 380. 

• Certain annual sub-limits for in-hospital benefits will increase. 
• Co-payments for hospital authorisations, specialised procedures/treatment, specialised scans and extraction of wisdom teeth, in and out of hospital will increase. 

• You have to register and get authorisation from us for chronic benefits. If you are currently registered for a chronic condition, scripts are valid for six months and you have to submit a new script to your pharmacy once your script expires. You will need to send a renewal script to the Scheme and your pharmacy for certain conditions that do not have an ongoing authorisation.
• You have to get your chronic benefit from your chosen chronic benefit provider.

• The free early detection and preventative care benefits on the health platform continue in 2027. 
• The dental benefit will be enhanced to cover preventative dental care up to R520 per beneficiary.
• For international emergency benefits, the co-payment per out-patient claim payable by the Scheme will increase to R2 380. 

• Certain annual sub-limits for in-hospital benefits will increase.
• The co-payments for specialised procedures/treatment, specialised scans and extraction of wisdom teeth, in and out of hospital will increase.

• You have to register and get authorisation from us for chronic benefits. 
  If you are currently registered for a chronic condition, scripts are valid for six months and you have to submit a new script to your pharmacy once your script expires. You will need to send a renewal script to the Scheme and your pharmacy for certain conditions that do not have an ongoing authorisation.
• You have to get your chronic benefits from your chosen chronic benefit provider.
• You have cover for 32 conditions, which include the 26 Chronic Disease List (CDL) conditions, as contained in the Prescribed Minimum Benefits. No annual rand limit applies to the 26 CDL conditions. The limit for the additional 6 chronic conditions will increase to R14 300 per family for the year.

• The free early detection and preventative care benefits on the health platform continue in 2027. 
• The dental benefit will be enhanced to cover preventative dental care up to R520 per beneficiary.
• For international emergency benefits, the co-payment per out-patient claim payable by the Scheme will increase to R2 380.

• Certain annual sub-limits for in-hospital benefits will increase.
• The co-payments for specialised procedures/treatment, specialised scans and extraction of wisdom teeth, in and out of hospital will increase. 

• You have to register and get authorisation from us for chronic benefits. If you are currently registered for a chronic condition, scripts are valid for six months and you have to submit a new script to your pharmacy once your script expires. You will need to send a renewal script to the Scheme and your pharmacy for certain conditions that do not have an ongoing authorisation.
• You have to get your chronic benefit from your chosen chronic benefit provider.
• You have cover for 62 conditions, which include the 26 Chronic Disease List (CDL) conditions, as contained in the Prescribed Minimum Benefits. No annual rand limit applies to the 26 CDL conditions. The limit for the additional 36 chronic conditions will increase to R14 300 per family for the year.

• Annual out-of-hospital sub-limits for benefits, such as dentistry and optometry, will increase.
• The annual Threshold level, which is a fixed rand amount determined by your family size, will increase to:
  • Principal member                R40 000 
  • Per adult dependant           R34 700
  • Per child dependant            R11 500 (applies up to a maximum of three children)

• The free early detection and preventative care benefits on the health platform continue in 2027. 
• The dental benefit will be enhanced to cover preventative dental care up to R520 per beneficiary.
• For international emergency benefits, the co-payment per out-patient claim payable by the Scheme will increase to R2 380. 

• Certain annual sub-limits for in-hospital benefits will increase. 
• The co-payments for specialised scans in and out of hospital will increase. 

• You have to register and get authorisation from us for chronic benefits. 
  If you are currently registered for a chronic condition, scripts are valid for six months and you have to submit a new script to your pharmacy once your script expires. You will need to send a renewal script to the Scheme and your pharmacy for certain conditions that do not have an ongoing authorisation.
• You may get your chronic script and medication from any provider, subject to a comprehensive list of medicine, referred to as a formulary.
• You have cover for 62 conditions, which include the 26 Chronic Disease (CDL) List conditions as contained in the Prescribed Minimum Benefits. No annual rand limit applies to these 26 CDL conditions. The 36 additional chronic conditions accumulate to the overall annual day-to-day limit of R36 100 per beneficiary (this is a combined limit incorporating both day-to-day cover and cover for the 36 additional chronic conditions).

• The overall annual day-to-day limit will increase to R36 100 per beneficiary.
• Annual day-to-day sub-limits for benefits such as dentistry and optometry, which accumulate to the overall day-to-day limit of R36 100, will increase.

• The free early detection and preventative care benefits on the health platform continue in 2027. 
• The dental benefit will be enhanced to cover preventative dental care up to R520 per beneficiary.
• For international emergency benefits, the co-payment per out-patient claim payable by the Scheme will increase to R2 380.