What does it cover?
The Extender Option provides cover for hospitalisation in private hospitals with no overall annual limit. You can choose to have access to any hospital, or choose to receive a discount on your contribution by electing to use a specific list of private hospitals (referred to as Associated hospitals).
For chronic treatment you can choose to have access to any doctor for your prescriptions and any pharmacy for your chronic medication. Or, you can choose to receive a further discount on your contribution by electing to use a list of Associated doctors for your chronic prescription and Medipost courier pharmacy for your chronic medication. Alternatively, you can elect to use State facilities for your chronic prescription and chronic medication to obtain the maximum contribution discount.
25% of your contribution goes to a dedicated Medical Savings account to cover your day-to-day expenses. If you need more day-to-day cover, you can make use of the HealthSaver.
Our Health Platform Benefit provides cover for a range of benefits such as preventative screening tests, certain check-ups and more.
Major Medical Benefit
This benefit covers hospitalisation as well as some out-of-hospital procedures that can be safely performed in a doctor's room, registered day clinic, or out-patient facility.
Major Medical Benefits are available at Any or Associated hospitals.
- Associated specialists are covered in full, while other specialists are covered up to 200% of the Momentum Health Rate. Hospital accounts are covered in full at the rate agreed upon with the hospital group. No overall annual limit applies.
- No annual limit on high and intensive care.
- No annual limit on maternity confinement and neonatal intensive care.
- R500 000 oncology cover per beneficiary every year, thereafter a 20% co-payment applies. Momentum Health reference pricing applies to chemotherapy and adjuvant medication.
- No annual limit for organ transplant recipients.
- No annual limit for MRI and CT scans, magnetic resonance cholangiopancreatography, whole body radioisotope and PET scans (in- and out-of-hospital). You need to pay a co-payment of R2 250 per scan and obtain pre-authorisation.
- R52 700 per family for medical rehabilitation, private nursing, hospice and step-down facilities.
- Trauma benefit for day-to-day claims that form part of your recovery following specific traumatic events.
- Seven days’ supply of take home medication.
- Certain specialised procedures/treatments are covered, when clinically appropriate, in and out of hospital.
This benefit takes care of certain life-threatening conditions, such as diabetes and heart disease, that need ongoing treatment.
Chronic Benefits are available at Any, Associated, or State providers.
It covers 26 conditions under Prescribed Minimum Benefits* according to the Chronic Disease List with no annual limit. The 36 additional conditions are subject to a limit of R9 800 per family every year.
This benefit covers your everyday medical expenses, such as doctors' visits and prescribed medication.
Day-to-day Benefits are available at Any or Associated providers.
25% of your contribution goes to a dedicated Medical Savings account, to cover your day-to-day expenses.
Your Savings account is credited in advance for the remaining months of the year and any unused Savings balance at the end of the year will be carried forward to the following benefit year.
If the Savings are not enough to cover annual day-to-day expenses, you will have a self-funding gap to pay out-of-pocket, up to the Threshold of R20 800 (principal member), R18 000 (per adult dependant), R6 200 (per child dependant).
Although claims add up to the Threshold at 100% of the Momentum Health Rate, you may claim a higher amount from Savings if the provider charges more than the Momentum Health Rate. This will result in a bigger self-funding gap. You can use HealthSaver to fund your self-funding gap.
Once the Threshold has been reached, claims will be paid from Extended Cover at the Momentum Health Rate, subject to certain sub-limits. These day-to-day limits accumulate before and after the Threshold.
If you choose Any or State as your chronic provider, we cover 100% of the Momentum Health Rate. If you choose an Associated provider for your chronic needs, we cover 100% of the Momentum Health Rate for Associated GP's and 70% for non-Associated GP's.
You get R3 940 to use on eye care per beneficiary. The maximum amount you can spend on a frame is R2 150.
There is no limit for basic dentistry; covered at 100% of the Momentum Health Rate from your available Day-to-day Benefits. Specialised dentistry is paid from available day-to-day benefits, limited to R12 800 per beneficiary and R33 500 per family per year. Both in- and out-of-hospital dental specialist accounts accumulate towards the day-to-day limit.
General anaesthesia for children under 7, maxillo-facial surgery (excluding implants) and impacted wisdom teeth are covered in-hospital. The anaesthetist account is covered up to 200% of the Momentum Health Rate. Hospital accounts are paid in full at the negotiated rate, and the dentist, dental specialist and maxillo-facial surgeon accounts are paid from available day-to-day benefits, subject to day-to-day limits.
In the case of maxillo-facial trauma, the in-hospital dentist, dental specialist or maxillo-facial surgeon will be payable from the Major Medical Benefit.
Dental implants, including the cost of implants, and the anaesthetist and hospital accounts, are payable from available day-to-day benefits, subject to day-to-day limits.
In-hospital dentistry is subject to pre-authorisation and a co-payment of R1 700 applies per authorisation.
Prescribed medication is covered up to R16 700 per beneficiary and overall cover up to R31 500 per family every year. Over-the-counter medication is paid out-of-pocket or from HealthSaver if applicable.
We cover up to R18 900 per family every year.
There is no limit to specialists. We cover you at 100% of the Momentum Health Rate from your available Day-to-day Benefits.
Health Platform Benefit
A unique benefit that encourages health awareness, enhances quality of life and gives peace of mind through preventative care and early detection tests.
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.
Women registered on our maternity programme get 12 antenatal visits which include a urine test, two pregnancy scans, various pathology tests, as well as online antenatal and postnatal classes, online video consultations with a lactation specialist, and two visits to the paediatrician during the baby's first year.
Health management programme
For the management of diabetes, hypertension, HIV/Aids, oncology, drug and alcohol rehabilitation, chronic renal failure, organ transplants and cholesterol.
24-hour emergency health advice.
Emergency evacuation in South Africa by Netcare 911.
International emergency cover by ISOS, covered up to R8,82 million per 90-day journey.
Momentum Multiply rewards and discounts
Get rewarded for living a healthy lifestyle. Complete the Health and Fitness assessment to earn up to R3 000 per family, per month in HealthReturns.