Medical aid frequently asked questions

This is only applicable on our Extender Option. A self-funding gap is when you have used up all your medical savings and then need to fund your health expenses from your own pocket until you reach the Threshold.

For example, let’s say you have R3 000 to use on day-to-day medical expenses for the year. If you use up this amount, you move into the self-funding gap territory. This self-funding gap varies according to your family size. The more dependants you have, the bigger the self-funding gap.

Once you have reached the Threshold, you move into the Extended Cover benefits where the medical scheme pays for your everyday medical expenses.

Yes, the Scheme will still cover chronic medication and hospitalisation.

Yes, it is important to continue submitting your claims, otherwise we will not know that you have passed the self-funding gap and qualify for the Extended Cover benefits.

Yes, Momentum Medical Scheme will terminate your membership if you do not pay your contributions, or if there was fraudulent transactions or claims.

You can submit claims for medical treatment up until the day your medical scheme membership expires. If you gave written notice of your intention to end your membership on the 31^st of December, and you go to the doctor on that day, you can still submit a claim for that doctor's visit. Anything after midnight that date will not be processed.

No, as that is not legal. Claiming twice for the same medical expenses is seen as fraud. It is important to make sure when you are moving medical aids that you terminate your membership with the current medical scheme before you become a member of the new medical scheme.

You can either speak to a financial adviser or contact various schemes to get more information before you make your choice. Assess your needs first so that you can choose the option that will give you the best coverage for your needs. For example, if you have eye problems, you won't choose a scheme that only allocates R200 per year for glasses. If you're fairly healthy and don’t get sick very often, it would be beneficial to choose a scheme with low day-to-day benefits, but good hospital coverage. Make sure to read the fine print.

Some medical scheme options have a medical savings account. This is a percentage of your monthly contribution, up to a maximum of 25%. This is used to pay for day-to-day medical expenses. Certain sub-limits may still apply.

On the Incentive Option, 10% of your contribution is available in a savings account. When your Savings is depleted, you will need to pay for your day-to-day medical expenses out of your own pocket. On the Extender Option, 25% of your contribution is available in a savings account to cover day-to-day expenses. If this component is not enough to cover your annual day-to-day expenses, you will also have access to the Extended Cover benefit which provides further cover for day-to-day benefits once your day-to-day claims have reached the Threshold (a pre-determined amount that is based on your family size).

It is important to note that chronic and hospitalisation benefits are not paid from your savings. Funds in the savings account that are not utilised, are carried over to the next year. Should you resign from the scheme and you still have funds in your savings account, this will be paid out to you.

Download the Momentum App so that you can:

• Find a network hospital.
• Find an associated provider.
• Submit and track your claims.
• View your claims history and get your claim statements.
• Pre-notify for Health Platform Benefits and get pre-authorisation for hospital admissions.
• Check your balances for HealthSaver⁺, Personal Medical Savings Account, HealthReturns⁺, and Active Dayz^TM
• Calculate your HealthReturns⁺.
• Book a health or fitness assessment.
• • Download and share your health tax certificates.