What does it cover?
The Chronic Benefit covers a variety of life-threatening conditions that require ongoing treatment. These include the 26 conditions on the Chronic Disease List, according to the Medical Schemes Act’s Prescribed Minimum Benefits*, which ensure access to certain medical treatments for all medical scheme members, regardless of their level of cover.
Momentum Medical Scheme offers a unique structure that empowers you to choose chronic cover that works for you, your family and your pocket.
Ingwe Option
Cover
26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*.
No annual limit applies.
Chronic Provider
Ingwe Primary Care Network or
Ingwe Active Primary Care Network
Evolve Option
Cover
26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*.
No annual limit applies.
Chronic Provider
State
Custom Option
Cover
26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*.
No annual limit applies.
Chronic Provider
Any, Associated or State.
Incentive Option
Cover
32 conditions; 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies.
6 additional conditions: limited to
R10 700 per family per year.
Chronic Provider
Any, Associated or State.
Extender Option
Cover
62 conditions; 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies.
36 additional conditions: limited to
R10 700 per family per year.
Chronic Provider
Any, Associated or State.
Summit Option
Cover
62 conditions; 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies.
36 additional conditions: subject to an overall day-to- day limit of R26 900 per beneficiary per year.
Chronic Provider
Any.
*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. Learn more
How does it work?
Members on the Ingwe Option
You need to get your chronic prescription from your Ingweor Ingwe Active Primary Care Network doctor, and your chronic medication from Medipost pharmacy. Ensure that your prescription is sent to Medipost, they will arrange delivery of the medication to you.
Benefits are subject to the Network entry-level formulary. If your treating doctor prescribes medicine that is not on the formulary (for the 26 Prescribed Minimum Benefit conditions), and the medicine is clinically appropriate, then you will need to pay a 30% co-payment.
Members on the Evolve Option
You need to choose one of the designated State facilities to get your chronic prescription and medication, subject to the State formulary and medical management (including doctor, pharmacy, blood tests, x-rays etc.).
If you voluntarily choose to get your chronic medication outside the State formulary, the Scheme will pay up to the Momentum Medical Scheme Reference Price, and a 15% co-payment will be applied.
Members on the Custom, Incentive and Extender Options
The chronic provider that you have chosen determines how you get your chronic prescription and medication.
Members on the Summit Option
You have the freedom of choice to get your chronic prescription and medication from any provider, subject to a comprehensive formulary.
To activate your Chronic Benefit from Momentum Medical Scheme, simply ask your treating doctor to call us on 0860 117 859. Once approved, you can start receiving your medication from your chosen pharmacy.
Learn more about Chronic Registration
Clinical Criteria.