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Momentum Custom Medical Aid Plan

Overall, the Momentum Custom Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance to up to 5 Family Members. The Momentum Custom Medical Aid Plan starts from R2,149.

👤 Main Member Contribution	R2,149 ZAR
👥 Adult Dependent Contribution	R1,626 ZAR
💙 Child Dependent Contribution	R762 ZAR
🔁 Gap Cover	☑️ Yes
🌎 International Cover	Up to R9.01 million
➡️ Prescribed Minimum Benefits (PMB)	☑️ Yes
⚕️ Screening and Prevention	☑️ Yes
💳 Medical Savings Account	None
🍼 Maternity Benefits	☑️ Yes
💊 Chronic Conditions	☑️ Yes

Momentum Custom Review – 8 Key Point Quick Overview

☑️ Momentum Custom Plan Overview
☑️ Momentum Custom Plan Contributions
☑️ Custom Plan Benefits and Cover Comprehensive Breakdown
☑️ Momentum Custom Plan Major Medical Benefits
☑️ Custom Plan Exclusions and Waiting Periods
☑️ Momentum Custom Plan vs. Similar Plans from other Medical Schemes
☑️ Our Verdict on the Momentum Custom Plan
☑️ Momentum Custom Plan Frequently Asked Questions

Momentum Custom Plan Overview

The Momentum Custom medical aid plan is one of 6, starting from R1,960, and includes cover for chronic conditions, dentistry, optometry, in and out-of-hospital consultations, procedures, and much more. Gap Cover is available on the Momentum Custom Plan, along with 24/7 medical emergency assistance. According to the Trust Index, Momentum has a trust rating of 4.3.

Momentum Medical Scheme has a Momentum Multiply Rewards Program and also the following medical aid plans:

Momentum Custom Plan Contributions

🔎 Hospital	➡️ Chronic	👤 Main Member	👥 2 Adults	2️⃣ Main Member 1 Child	3️⃣ 2 x Adults 1 Child	4️⃣ 2 x Adults 2 x Children	5️⃣ 2 x Adults 3 x Children
📌 Associated	Any	R3,089	R5,526	R4,178	R6,615	R7,704	R8,793
📌 Associated	Associated	R2,770	R4,918	R3,749	R5,897	R6,876	R7,855
📌 Associated	State	R2,149	R3,775	R2,911	R4,537	R5,299	R6,061
📍 Any	Any	R3,685	R6,642	R5,000	R7,957	R9,272	R10,587
📍 Any	Associated	R3,284	R5,850	R4,478	R7,044	R8,238	R9,432
📍 Any	State	R2,737	R4,803	R3,740	R5,806	R6,809	R7,812

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Custom Plan Benefits and Cover Comprehensive Breakdown

The Momentum Custom Plan offers access to major medical benefits and specialized procedures/treatments.

Momentum Custom Plan Major Medical Benefits

This benefit includes hospitalization and certain specialized procedures/treatment coverage. There is no annual maximum for hospitalizations. Other specialists are covered up to 100% of the Momentum Medical Scheme Rate, while associated specialists are covered in full. Accounts with hospitals are paid in full at the rate negotiated with the hospital group. Under the hospitalization benefit, hospital accounts and related costs incurred (from admission to discharge) are covered, assuming treatment has been pre-approved. The Major Medical Benefit covers specialized procedures/treatments if the treatment is clinically appropriate and reauthorized. If pre-approval is not obtained, a 30% co-payment will be applied to all accounts associated with the event. The Scheme will be responsible for 70% of the negotiated tariff, assuming authorization would have been granted according to the Scheme’s Rules.

You or your dependents must obtain authorization within 72 hours of admission in the event of an emergency. If you select Associated hospitals but do not use this provider, you will be responsible for a 30% co-payment on your hospital bill.

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Major Medical Benefits and Co-payments

Before utilizing your Major Medical Benefits, you must contact Momentum to obtain pre-authorization.
You will be required to enroll in a health management program for certain conditions, such as cancer.
Momentum Medical Scheme will pay benefits according to the Scheme Rules and the Benefits Schedule.
The Scheme has established clinical protocols for the treatment of each condition.
The annual sub-limits specified below apply.
If you do not join in January, your sub-limits will be adjusted proportionally (i.e., according to the number of months remaining in the year).

Providers:

Any Hospitals
Associated Hospitals
However, certain procedures can only be done in a day hospital, which can be viewed on the Momentum App.

Overall Annual Limit on Custom: Unlimited

Co-Payments:

R1,740 per authorization, excluding motor vehicle accidents, pregnancy, and emergency treatment. An additional co-payment may be required for the following specialized procedures:
On the Custom Option, your co-pay for these services, wherever they are rendered, will be R1,740.
If the procedure is done in a regular or a day hospital, you will also have to pay an additional R3,480 per authorization for “Specialized Procedures.”

📌 Arthroscopies, Back and neck surgery, Carpal tunnel release, Functional nasal and sinus procedures, Joint replacements, Laparoscopies	The co-payments above apply if the procedure is done in a day or acute hospital.
📌 Gastroscopies, Colonoscopies, Cystoscopies, Sigmoidoscopies, Nail surgery, Removing of extensive skin lesions	Done outside of a hospital, in a day hospital, or a hospital if the appropriate co-payment is paid.
📌 Conservative back and neck treatment, Removal of minor skin lesions, Treatment of diseases of the conjunctiva, Treatment of headache, Treatment of adult influenza, Treatment of adult respiratory tract infections	The Scheme does not cover low-severity cases, but Momentum HealthSaver+ can pay for them if available. The Scheme pays for high-risk cases in an acute hospital with the abovementioned co-payments.

Hospitalization

All related specialists are covered under this benefit.
Up to 100% of the Momentum Medical Scheme Rate is paid for other specialists.
The hospital bill will be paid at the group’s agreed-upon rate.

💙 High and Intensive Care	There is no annual limit on this benefit.
⚕️ After-hour casualty visits	Subject to the Momentum HealthSaver if funds are available.
➡️ Renal Dialysis	Only PMBs are covered at State Hospitals. If you choose State as your chronic provider, you must undergo renal dialysis at State facilities.
🩺 Oncology	R300,000 per recipient per year and a 20% co-payment after that. Reference pricing from Momentum Medical Scheme is used for chemotherapy and other medications. The Custom Network of Oncologists is where you should get your oncology care and medicines. If you select State or Associated as your chronic provider, you must acquire your oncology medication through Medipost.
❤️ Organ Transplants (Recipient)	Only PMBs are covered at State Hospitals.
🩸 Organ Transplants (Doner) will only be covered if the recipient is an existing member of Momentum Health.	Cadaver costs are covered up to R22,400. Live donor costs are covered up to R45,400, including organ transportation.
✳️ Maxillo-facial surgery and general anesthesia for children under 7 (this excludes implants).	Major Medical Benefit pays hospital and anesthetist bills with R1,740 co-payment per authorization. If available, Momentum HealthSaver+ pays dental and maxillo-facial surgeon bills.
🦷 Impacted Wisdom Teeth	Major Medical Benefit pays day hospitals R3,150 and acute hospitals R5,850 per authorization for hospital and anesthetist accounts. Major Medical Benefit pays 100% of Momentum Medical Scheme Rate for dental, dental specialist, and maxillofacial surgeon accounts.
🚼 Maternity confinements	No annual limit.
🍼 Neonatal Intensive Care	No annual limit.
☑️ MRI, PET, and CT scans	There is no annual limit, but this benefit is subject to a co-payment of R2,900 per scan.
✅ Medical and Surgical Appliances, for instance, support stockings, back braces, etc.	Covers up to R7,230 per family per year.
🦵 Internal Prostheses	R6,250 per beneficiary per event, with a maximum of two events per year. Other internal prostheses – up to R53,000 per beneficiary per event, with a cap of two events per year.
📌 External Prostheses	There is up to R25,200 available per family.
💙 Mental Health, including psychiatry, psychology, drug, and alcohol rehabilitation	Covers up to R40,800 per beneficiary yearly. There is a 21-day sub-limit that applies to drug and alcohol rehabilitation.
💊 Take-Home Medication	The patient receives a 7-day supply upon discharge.
🚑 Alternatives to Hospitalization, such as step-down facilities	There is a limit of R58,000 per family.
🔎 Immune Deficiency – HIV	This can be done at any network provider of the member’s choosing.
📌 Anti-retroviral Treatments	There is no annual limit on this benefit.
📍 HIV-related hospital admissions	There is a limit of R77,100 per family.

Specialized Procedures and Treatment

Specific specialized procedures/treatments are covered in and out-of-hospital (when clinically appropriate).

Chronic Benefit

The Chronic Benefit covers certain life-threatening conditions requiring ongoing treatment. Any, Associated, or State hospitals can serve as your Chronic Benefit provider. The Chronic Disease List, part of the Prescribed Minimum Benefits, specifies cover for 26 chronic conditions. Chronic benefits are contingent upon enrollment in the Chronic Management Programme and Scheme approval.

Day-to-day Benefit

Momentum HealthSaver+ can be utilized if you wish to add cover for routine medical expenses, such as doctor’s visits and prescription drugs.

Specialized Dentistry:

Dentists remove impacted wisdom teeth in doctors’ offices:
Major Medical Benefit at 100% of Momentum Medical Scheme Rate, with R1,740 co-payment and pre-authorization.
Other Dentistry: Momentum HealthSaver+ if available.

Health Platform Benefit

Health Platform benefits are covered by the Scheme up to a maximum Rand amount per benefit, provided you inform us before using the benefits.

Preventative Care:

🔎 Benefit	☑️ Eligibility	📉 Frequency
🍼 Baby immunizations	Children up to 6	According to the Department of Health (DOH).
💉 Flu Vaccines	Children 6 months – 5 Years Beneficiaries 60 and older High-risk beneficiaries	Once yearly
📌 Tetanus diphtheria Injection	All beneficiaries	As required
📍 Pneumococcal Vaccine	Beneficiaries 60 and older High-risk beneficiaries	Once yearly

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Early Detection Testing:

🔍 Benefit	☑️ Eligibility	➡️ Frequency
🦷 Dental Consultations	All	Once yearly
✅ Pap Smear and GP consult	Women 15>	Once yearly
✔️ Mammogram	Women 38>	Once yearly
🦵 DEXA Bone Density Scan	Beneficiaries 50>	Once every 2 years
🩺 GP Consultation for General Physical Exams	Beneficiaries 21 – 29 Beneficiaries 30 – 59 Beneficiaries 60 – 69 Beneficiaries 70>	Once every 5 years Once every 3 years Once every 2 years Once yearly
📌 Prostate Specific Antigen	Male Beneficiaries 40 – 49 Male Beneficiaries 50 – 59 Male Beneficiaries 60 – 69 Male Beneficiaries 70>	Once every 5 years Once every 3 years Once every 2 years Once yearly
✳️ Health Assessment, including blood pressure testing, cholesterol, blood sugar, height, weight, and waist circumference measurements	Principal members and their adult dependents	Once yearly
⚕️ Cholesterol Testing, only if the health assessment shows a level of 6mmol/L>	Principal members and their adult dependents	Once yearly
📈 Blood Sugar Tests, only if the health assessment shows a level of 11 mmol/L>	Principal members and their adult dependents	Once yearly
📉 Glaucoma test	Beneficiaries 40 – 49 Beneficiaries 50>	Once every 2 years Once yearly
📊 HIV Testing	Beneficiaries 15>	Once every 5 years

Maternity Program

Take Note: Only women who are registered on the program and who are not subject to waiting periods are eligible for the program.

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🔎 Benefit	☑️ Frequency
🍼 Doula Benefit	2 Visits per pregnancy
📌 Antenatal visits with a GP, Midwife, or gynecologist	12 Visits
📍 Nurse visits to the home of the pregnant member	2 Visits after discharge from the hospital following childbirth
✅ Urine Testing using a dipstick	Included in the Antenatal visits
🩸 Blood Group, full blood count, hemoglobin estimation, and Rhesus Factor	1 Test
🧪 Urinalysis	12 Tests
🩺 Urine tests, including microscopic exams, etc.	As needed
👶 Scans and Ultrasounds	2 scans (3D and 4D are covered up to the same rate as 2D scans)

Pediatrician Visitations: Babies up to 1 year who are registered on the Maternity Programme2 visits within the baby’s first year

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Health Management Programs

These benefits are limited to PMBs and are covered at State Facilities

🔍 Benefit	☑️ Eligibility	📉 Frequency
🧪 Cholesterol	All beneficiaries who are registered in the program.	As Required
✅ Chronic Renal Failure	All beneficiaries who are registered in the program.	As Required
🍬 Diabetes	All beneficiaries who are registered in the program.	As Required
💊 Drug and Alcohol Rehabilitation	All beneficiaries who are registered in the program.	As Required
😷 HIV/AIDS	All beneficiaries who are registered in the program.	As Required
🚩 Hypertension (Cardio Care)	All beneficiaries who are registered in the program.	As Required
💙 Mental Health	All beneficiaries who are registered in the program.	As Required
✔️ Oncology	All beneficiaries who are registered in the program.	As Required
❤️ Organ Transplants	All beneficiaries who are registered in the program.	As Required

Momentum Health Line

A 24-hour emergency health advice line is open to all beneficiaries as required.

Momentum Emergency Evacuation

All emergency evacuation in South Africa is done through Netcare 911. While all beneficiaries have access to this, members must note that this is only for emergencies.

Momentum International Emergency cover by ISOS

66 million (consisting of R15,500 for emergency optometry, R15,500 for emergency dentistry, and R765,000 for terrorism cover).
An R1,960 co-payment is applicable per the Scheme-payable out-patient claim.

Custom Plan Exclusions and Waiting Periods

Exclusions

Members of Momentum must note that while there are limitations and exclusions, they are still entitled to Prescribed Minimum Benefits (PMBs). Furthermore, the following items are not covered by Momentum but could be claimed from a positive Medical Savings Account:

Costs during waiting periods or for conditions not disclosed at the time of application.
Costs exceeding the annual maximum for the specific category as set out in Annexure B of the Scheme Rules.
Injuries sustained during participation in a riot, civil commotion, war, invasion, terrorist activity, or rebellion.
Professional speed contests or trials.
Treatment by a health care provider not registered with a recognized professional body constituted in terms of an Act of Parliament.
Holidays for recuperative purposes, including headache and stress relief clinics.
Treatment for which efficacy and safety cannot be proved.
Operations, medicine, treatments, and procedures for cosmetic purposes unrelated to illness, accident, or disease.
Obesity
Costs for attempted suicide that exceed Prescribed Minimum Benefits limits.
Certain cosmetic surgeries, such as breast reduction, breast augmentation, gynecomastia, otoplasty, and blepharoplasty.
Medication not registered by the Medicine Control Council.
Services rendered by institutions not registered in terms of any law (except for State facilities/hospitals).
Gum guards and gold are used in dentures.
Frail care
All traveling expenses except the benefits covered by Emergency rescue and international cover.
Costs deemed medically unnecessary or inappropriate by the Medical Assessor.
Missed appointments.
Circumcision unless clinically indicated, and any contraceptive measures or devices.
Reversal of vasectomies or tubal ligation (sterilization).
Injuries resulting from narcotism or alcohol abuse (except for the Prescribed Minimum Benefits).
Infertility treatment covered by Prescribed Minimum Benefits will be covered in State facilities subject to paragraph 4 of Annexure D of the Scheme Rules.
Cost of injury and related costs resulting from scuba diving to depths below 40 meters and cave diving.

Waiting Periods

Depending on pre-existing or existing conditions, the following might apply when you register for medical cover with the Momentum Custom Plan:

A 3-month general waiting period in respect of all benefits.
A 12-month exclusion in respect of a pre-existing condition.
A late-joiner contribution penalty.

Momentum Custom Plan vs. Similar Plans from other Medical Schemes

🔎 Medical Aid Plan	🥇 Momentum Custom Plan	🥈 Discovery Essential Core	🥉 Bestmed Beat 2
👤 Main Member Contribution	R2,149 ZAR	R2,855 ZAR	R2,545 ZAR
👥 Adult Dependent Contribution	R1,626 ZAR	R2,141 ZAR	R1,976 ZAR
💙 Child Dependent Contribution	R762 ZAR	R1,146 ZAR	R1,071 ZAR
🌎 International Cover	Up to R9.01 million ZAR	R5 million ZAR	R10 million ZAR
🔁 Gap Cover	☑️ Yes	☑️ Yes	❎ No
💶 Prescribed Minimum Benefits (PMB)	☑️ Yes	☑️ Yes	☑️ Yes
🩺 Screening and Prevention	☑️ Yes	☑️ Yes	☑️ Yes
⚕️ Hospital Cover	Unlimited	Unlimited	Subject to scheme rules
☑️ Mental Healthcare Program	☑️ Yes	☑️ Yes	☑️ Yes

Our Verdict on the Momentum Custom Plan

The Momentum Custom Medical Aid is a comprehensive health insurance plan offered by Momentum Health that provides a high level of coverage for a wide range of medical expenses. The Momentum Custom plan is designed for individuals and families looking for a more comprehensive cover that caters to their needs. The plan includes in-hospital cover, chronic medication, dentistry, optometry, maternity benefits, and out-of-hospital benefits such as consultations with healthcare professionals, pathology, radiology, and day-to-day medicines. Members have access to private hospitals, clinics, and doctors and can choose to use any medical provider they wish. The plan also includes a network of healthcare providers; using these providers can result in lower costs and no co-payments. However, members of this plan might still face several limits and waiting periods, especially for pre-existing conditions. Furthermore, some benefits could have several annual or lifetime limits.

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Momentum Custom Plan Frequently Asked Questions

What is the Momentum Custom Medical Aid plan?

The Momentum Custom Medical Aid plan is a comprehensive health insurance plan offered by Momentum Health that provides a high level of coverage for a wide range of medical expenses.

What benefits are included in the Custom Medical Aid plan?

The Custom Medical Aid plan includes in-hospital cover, chronic medication, dentistry, optometry, maternity benefits, and out-of-hospital benefits such as consultations with healthcare professionals, pathology, radiology, and day-to-day medicines.

What are the contact details for Momentum Medical Aid Scheme ?

You can contact Momentum medical aidper call or WhatsApp on 0860 11 78 59

How does the Custom Medical Aid plan differ from other Momentum Health plans?

The Custom Medical Aid plan offers a higher level of coverage than more entry-level Momentum Health plans (such as Ingwe and Evolve). Custom is designed for individuals and families who require a more comprehensive cover that caters to their specific needs.

Can I choose my healthcare provider with the Custom Medical Aid plan?

Yes, members of the Custom Medical Aid plan can choose to use any medical provider they wish. The plan also includes a network of healthcare providers; using these providers could result in lower costs and no co-payments.

What are the optional benefits of the Custom Medical Aid plan?

Optional benefits of the Custom Medical Aid plan include extended maternity benefits, additional specialist consultations, and preventative healthcare benefits.

Are pre-existing conditions covered under the Custom Medical Aid plan?

Pre-existing conditions might be subject to a waiting period before they are covered under the Custom Medical Aid plan.

How do I join the Custom Medical Aid plan?

To join the Custom Medical Aid plan, applicants can complete the digital form on the official Momentum website and submit it to the Scheme online or via email.

How are premiums paid for the Custom Medical Aid plan?

Members pay premiums monthly.

What is the cover for dentistry under the Custom Medical Aid plan?

The Custom Medical Aid plan includes cover for specialized dentistry under the day-to-day benefit.

Does the Custom Medical Aid plan cover travel insurance?

No, travel insurance is not included in the Custom Medical Aid plan. However, Momentum offers international emergency cover via ISOS of up to R7.66 million, with a co-payment of R1,960 for out-patient claims, which are payable by Momentum.

What is the cover for chronic medication under the Custom Medical Aid plan?

The Custom Medical Aid plan covers a wide range of chronic medications, subject to benefit limits and enrollment in the appropriate health program offered by Momentum.

What is the cover for maternity benefits under the Custom Medical Aid plan?

The Custom Medical Aid plan includes coverage for antenatal consultations, hospitalization for childbirth, nurse home visits, and postnatal consultations, among other benefits.

Adriaan Schoeman

Adriaan holds an MBA and specializes in medical aid research. With his commitment to perfection, he ensures the accuracy of all data presented on medicalaid.com every three months. When he is not conducting research, Adriaan can be found indulging in his passion for trout fishing amidst nature.