Evolve Option

This benefit covers hospitalisation as well as some out-of-hospital procedures or treatments that can be safely performed in a doctor's room, registered day clinic, or out-patient facility. A co-payment of R1 640 applies per authorisation, except for motor vehicle accidents, maternity confinements, and emergency treatment.

Major Medical Benefits are available at Evolve Network hospitals. Certain proceduresget_app are only covered in day facilities.

Our Health Platform Benefit provides cover for a range of benefits such as preventative screening tests, certain check-ups and more.

Hospitalisation

• Associated specialists are covered in full. Other specialists are covered up to 100% of the Momentum Medical Scheme Rate. Hospital accounts are covered in full at the rate agreed upon with the hospital group.
• Oncology is covered at R200 000 per beneficiary per year, thereafter a 20% co-payment applies. Momentum Medical Scheme reference pricing applies to chemotherapy and adjuvant medication. You need to get your oncology treatment and medication from the Evolve Network of Oncologists.
• Organ transplant and renal dialysis, limited to Prescribed Minimum Benefits* at State facilities.
• No annual limit for MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans. You will need to pay R2 740 per scan and obtain pre-authorisation.
• Medical rehabilitation, private nursing, Hospice and step-down facilities limited to R47 700 per family per year.
• Trauma benefit for day-to-day claims that form part of your recovery following specific traumatic events.
• Seven days’ supply of take-home medication.

Specialised procedures/treatment

• Certain specialised procedures/treatments are covered, when clinically appropriate, in- and out-of-hospital.

*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 moreopen_in_new

This benefit takes care of certain life-threatening conditions, such as diabetes and heart disease, that need ongoing treatment.

It covers 26 conditions under Prescribed Minimum Benefits* according to the Chronic Disease List at State facilities.

*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 moreopen_in_new

Day-to-day needs such as GP visits, specialist visits, eye care, dentistry, prescribed medicine and mental health are paid by you or from HealthSaver⁺, if available.

*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.

A unique benefit that encourages health awareness, enhances quality of life and gives peace of mind through preventative care and early detection tests.

Preventative care
Includes baby immunisations, flu vaccines, as well as tetanus diphtheria injections.

Early detection tests
Includes pap smears, dental consultations, general physical examinations, prostate-specific antigens, health assessments, cholesterol tests, blood sugar tests and HIV tests.

Maternity programme
Women registered on our maternity programme get 12 antenatal visits which include a urine test, two pregnancy scans, two nurse home visits after returning home from the hospital, as well as two visits to the paediatrician during the baby's first year.

Health management programmes
For the management of diabetes, hypertension, HIV/Aids, oncology, drug and alcohol rehabilitation, chronic renal failure, organ transplants and cholesterol.

Health line
24-hour emergency health advice.

Emergency evacuation
Emergency evacuation in South Africa by Netcare 911.

International emergency cover by ISOS, covered up to R5 million per 90-day journey.