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A doctor and patient sit across a desk in consultation while the doctor writes down notes.

Chronic Benefit

Ensures you're covered for certain life-threatening conditions, such as diabetes and heart disease, that need ongoing treatment.

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 affordable access to certain prescribed 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.

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 300 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 300 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 R25 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 Health 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.

Any Provider


You may get your chronic prescription and medication from any provider, subject to your option specific formulary.

If you choose to get your medication from the preferred list of medicines, you will not pay a co-payment. If you choose to get your medication from outside the formulary (i.e. non-preferred items), a co-payment is payable.

A dispensing fee co-payment may also be payable when using pharmacies not contracted to Momentum Medical Scheme.
Associated Provider


You need to get your chronic prescription from an Associated GP and your chronic medication from Medipost, subject to an entry-level formulary.

If you choose to get your medication from outside the formulary, a co-payment will apply. On the Custom Option, the co-payment will be the cost difference between the selected item and the formulary price. On the Incentive Option, the co-payment will be 20% and on the Extender Option, the co-payment will be 15%.

If you choose to get your chronic prescription from a non-Associated GP, the Scheme will only pay 50% of the Momentum Health Rate for the consultation.

If you choose to get your chronic medication from a pharmacy other than Medipost, Momentum Medical Scheme will only pay 50% of the formulary price for the medicine.
State Provider


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 the 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 Health Reference Price, and a co-payment will be applied. The co-payment is 15% on the Custom Option, 10% on the Incentive Option and 5% on the Extender Option.

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.

A young nurse with a stethoscope around her neck and shelves of medicine in the background, writes down a note on her notepad.

How to register for chronic medication

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.


Want a quote?

You'll get a quote reflecting the medical aid contribution at the end of the process.

Need advice?

An accredited healthcare consultant will call you to discuss our medical aid options and benefits.

Other benefits

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Benefit

Day-to-day
Benefit

Health Platform
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Doctor

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