What does the
Day-to-day Benefit cover?
This benefit pays for day-to-day medical expenses, such as out-of-hospital doctors' visits, eye care, dentistry, and prescribed medication.
For example, when you get the flu and go to your General Practitioner
(GP), the doctor is paid using your Day-to-day Benefits. The same applies when you go to your dentist and optician. This benefit also pays for prescribed medication and over-the-counter medication, x-rays, and so much more.
Why do I need it?
Even if you and your family are relatively healthy, consider what your out-of-pocket medical expenses might be in a year in which each member of the family gets secondary infections after the flu, one of you develops complications such as a lung infection and requires x-rays and visits to a specialist. Paying for these medical expenses out of your own pocket can be quite expensive.
How does it work?
Ingwe Option
On the Ingwe Option, you get your day-to-day services from Ingwe Primary Care Network or Ingwe Active Network providers. You have unlimited GP visits (from the 11th visit onwards, you need to obtain pre-authorisation), basic eye care and dentistry, prescribed medicine, specialist visits, and much more.
Evolve Option
On the Evolve Option, day-to-day healthcare expenses like GP visits, optometry, dentistry, and specialists can be funded from Momentum's voluntary HealthSaver+ account.
Custom Option
On the Custom Option, day-to-day healthcare expenses like GP visits, optometry, dentistry, and specialists can be funded from Momentum's voluntary HealthSaver+ account.
Incentive Option
On the Incentive Option, 10% of your total contribution goes to a Medical Savings account. This is advanced upfront for the year and any unused funds at the end of the year will be carried forward to the following year. Once your medical savings have been depleted, you will pay out-of-pocket for day-to-day expenses like GP visits and dentistry. Alternatively, you can use HealthSaver+ to pay for these expenses.
Extender Option
On the Extender Option, 25% of your total contribution goes to a Medical Savings account to cover day-to-day healthcare expenses like GP visits, dentistry, and specialists. This is advanced upfront for the year and any unused funds at the end of the year will be carried forward to the following year.
Once medical savings have been depleted, you will fall into the self-funding gap which means that you will have out-of-pocket expenses up until the Threshold, determined by your family size. Alternatively, you can add HealthSaver+ to cover your out-of-pocket expenses. You must still submit your claims in this period so that we know when you move when you reach the Threshold.
Once the Threshold has been reached, claims will be paid from Extended Cover at the Momentum Medical Scheme Rate, subject to certain sub-limits.
The annual Threshold levels for 2022 are:
Principal member
R23 600
Per adult dependant
R22 100
Per child dependant
R7 300
(up to a maximum of 3 children)
(up to a maximum of 3 children)
Summit Option
On the Summit Option, day-to-day claims are paid at 100% of the Momentum Medical Scheme Rate, subject to certain sub-limits. The overall day-to-day limit is R28 000 per beneficiary for 2022. Any expenses over this amount you will need to pay for. Alternatively, you can use HealthSaver+ to fund additional expenses.
+ You may choose to make use of additional products available from Momentum Metropolitan Holdings Limited (Momentum), to seamlessly enhance your medical aid. Momentum is not a medical scheme and is a separate entity to Momentum Medical Scheme. The complementary products are not medical scheme benefits. You may be a member of Momentum Medical Scheme without taking any of the complementary products.
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