Incentive 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.

Major Medical Benefits are available at Any or Associatedget_app hospitals.

Hospitalisation

• Associated specialists are covered in full, while other specialists are covered up to 200% of the Momentum Medical Scheme Rate. Hospital accounts are covered in full at the rate agreed upon with the hospital group.
• No annual limit on high and intensive care.
• No annual limit on maternity confinement and neonatal intensive care.
• R400 000 oncology cover per beneficiary every year, thereafter a 20% co-payment applies. Momentum Medical Scheme 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 480 per scan and obtain pre-authorisation.
• R55 000 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.

Specialised procedures/treatment

• 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, Associatedget_app, or State providers.

It covers 26 conditions under Prescribed Minimum Benefits* according to the Chronic Disease List with no annual limit. The 6 additional conditions are subject to a limit of R10 700 per family every year.

*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 covers your everyday medical expenses, such as doctors' visits and prescribed medication.

Day-to-day Benefits are available at any provider.

Savings
10% of your contribution goes to a dedicated Medical Savings account, to cover your day-to-day expenses, such as GP visits and prescribed medicine. If you need more day-to-day cover, you can choose to make use of HealthSaver.

General practitioners
Subject to Savings. If no savings available, paid out-of-pocket or from HealthSaver if applicable.

Eye care
Subject to Savings. If no savings available, paid out-of-pocket or from HealthSaver if applicable.

Dentistry
Subject to Savings. If no savings available, paid out-of-pocket or from HealthSaver if applicable.

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 Medical Scheme Rate. Hospital accounts are paid in full at the negotiated rate, and the dentist, dental specialist and maxillo-facial surgeon accounts are payable from Savings or HealthSaver, if available.

In the case of maxillo-facial trauma, the in-hospital dentist, dental specialist or maxillo-facial surgeon accounts will be payable from the Major Medical Benefit.

Dental implants, including the cost of implants, and the anaesthetist and hospital accounts, are payable from Savings or HealthSaver, if available.

In-hospital dentistry is subject to pre-authorisation and a co-payment of R1 500 applies per authorisation.

Medicine
Subject to Savings. If no savings available, paid out-of-pocket or from HealthSaver if applicable.

Mental health
Subject to Savings. If no savings available, paid out-of-pocket or from HealthSaver if applicable.

Specialist visits
Subject to Savings. If no savings available, paid out-of-pocket or from HealthSaver if applicable.

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, various pathology tests, as well as online antenatal and postnatal classes, online video consultations with a lactation specialist, three nurse home visits after returning home from the hospital, and 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 R8 million per 90-day journey.