Incentive Option

In-hospital Benefit

You can choose to have access to any hospital in South Africa or choose to save on your contribution (Provider Choice) by electing to use a specific list of private hospitals for any planned hospital admissions.

Chronic illness cover

To save on your contribution you have the option to choose between:

Day-to-day Benefit

Free health screening cover

PROVIDER CHOICE

See how much you can save

Calculate how much you can save as a single member.

1. Select hospital provider

Your choice for planned procedures. In the event of an emergency, you can go to any hospital, regardless of your hospital choice.

2. Select chronic provider

Chronic medication is the treatment for certain life-threatening conditions that need ongoing treatment.

Savings

Monthly contribution

R3 060

You can save

R2 397

The actual amount you save depends on your medical aid option, the number of dependants on Momentum Medical Scheme, as well as your choice of providers.

What does the Incentive Option cover?

In-hospital Benefit

This benefit covers hospitalisation as well as some out-of-hospital procedures or treatments that can be safely performed in a doctor's room or day hospital.

Hospital choice

Provider

Available at Any or Associated hospitals.

Hospitalisation

Benefit

Associated specialists are covered in full. Other specialists are covered up to 200% 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.

Specialised dentistry

Certain in-hospital dental and oral benefits are covered from the In-hospital Benefit.
Co-payments may apply, depending on the procedure.

Maternity

No annual limit on maternity confinement and neonatal intensive care.

Oncology

Covered up to R400 000 per beneficiary per year, thereafter a 20% co-payment applies. Momentum Medical Scheme reference pricing applies to chemotherapy and adjuvant medication.

Organ transplant

No annual limit.

MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans.

No annual limit.
You need to pay a co-payment of R2 900 per scan.

Medical rehabilitation, private nursing, Hospice, and step-down facilities

R67 000 per family.

Trauma benefit

Certain day-to-day claims that form part of your recovery following specific traumatic events.

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 preferred provider R92 600 per family at your chosen hospital provider.

Emergency medical transport in South Africa by Netcare 911

No annual limit applies.

International emergency medical transport by preferred provider

R8 000 000 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 180 co-payment applies per emergency out-patient claim.

Take-home medication

7 days’ supply.

Specialised procedures/treatment

Certain specialised procedures or treatments covered

Certain specialised procedures/treatments are covered, when clinically appropriate, in-and out-of-hospital.

*Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide members with continuous care to improve their health and well-being and to make healthcare more affordable.

Chronic Benefit

This benefit takes care of certain life-threatening conditions, such as diabetes and heart disease, that need ongoing treatment.

Network provider

Available from:

Any, Associated or State providers.

Benefit

Cover

26 conditions under Prescribed Minimum Benefits* according to the Chronic Disease List.
6 additional conditions – limited to R13 100 per family per year.

*Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide members with continuous care to improve their health and well-being and to make healthcare more affordable.

Day-to-day Benefit

This benefit covers your everyday medical expenses, such as doctors' visits and prescribed medication.

Network provider

Available from:

Benefits are available at any provider.
You can add HealthSaver⁺ to supplement your day-to-day benefits.

Savings

Medical Savings Account

10% of your contribution goes to a built-in Savings account, to cover your day-to-day expenses.
Your Savings account is credited in advance for the year and any unused Savings balance at the end of the year will be carried forward to the following benefit year.
You can add HealthSaver⁺ to save even more for day-to-day medical expenses.