Day-to-day Benefit
For everyday medical expenses. The Day-to-day Benefit covers routine medical costs like doctor's visits and prescribed medication.
What does it cover?
This benefit pays for day-to-day medical expenses, such as out-of-hospital doctor’s 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 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.
Impact Option
On the Impact Option, you get your day-to-day services from Impact Primary Care Network providers. You have 10 GP visits per beneficiary (from the 11th visit onwards, you need to obtain pre-authorisation and pay a co-payment), basic eye care and dentistry, prescribed medicine, specialist visits, and much more.
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.
+ This extra feature is a complementary product available from Momentum, a division of Momentum Metropolitan Life Limited. Momentum is not a medical scheme, and is a separate entity to Momentum Health. You can be a member of Momentum Health without taking any of the complementary products that Momentum offers.
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 into Above Threshold.
Once the Threshold has been reached, claims will be paid from Extended Cover at the Momentum Health Rate, subject to certain sub-limits.
The annual Threshold levels for 2019 are:
Principal Member
R20 800
Per adult dependant
R18 000
Per child dependant
R6 200
(up to a maximum of 3 children)
(up to a maximum of 3 children)
