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 Health 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

Impact Option

Cover

26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*.

No annual limit applies.

Chronic Provider

Impact Active Primary Care Network

Custom Option

Cover

26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*.

No annual limit applies.

Chronic Provider

Any or Associated hospitals.

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 R9 800 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 R9 800 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 R24 700 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 and Impact Options

You need to get your chronic prescription from your Ingwe, Ingwe Active or Impact 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.

Requests for treatment related to the additional 270 Diagnosis and Treatment pairs will be considered if treatment is obtained from a State facility.

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.

Medicine from the non-preferred section on the formulary will attract both a generic reference price co-payment, plus a fixed percentage of the reference price, based on your option; the co-payment is 15% on the Custom Option, 10% on the Incentive Option and 5% on the Extender Option.

A dispensing fee co-payment may also be payable when using pharmacies not contracted to Momentum Health.

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, you will need to pay a co-payment of the cost difference between the selected item and the formulary price.

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 Health 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 Health, 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.