Custom
About this plan
🥇 Best suited for healthy individuals seeking strong chronic cover & affordable hospital cover with provider flexibility.
Principal Member
From
R2,585
per month
Adult Dependant
From
R1,956
per month
Child Dependant
From
R916
per month
What's covered
Hospital cover
Savings account
Day-to-day
Chronic cover
Dental
Optical
Maternity
Mental health
Waiting periods
- General
- 3 months
- Pre-existing conditions
- 12 months
Custom
Momentum Custom Medical Aid Plan (🇿🇦 2026*)
Overall, the Momentum Custom Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance for its Family Members. The Momentum Custom Medical Aid Plan starts from R2,585.| 👤 Main Member Contribution | R2,585 ZAR - R4,472 |
| 👤 Main Member with👥 Adult Dependent Contribution | R4,541 ZAR - R8,061 |
| 💙 Adult Dependent and 1 Child Dependent Contribution | R3,501 ZAR - R6,068 |
| 🔁 Gap Cover | ☑️ Yes - optional extra |
| 🌎 International Cover | Up to R7 660 million |
| ➡️ Prescribed Minimum Benefits (PMB) | ☑️ Yes |
| ⚕️ Screening and Prevention | ☑️ Yes |
| 💳 Medical Savings Account | None. Healthsaver optional extra |
| 🍼 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 R2,585 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 Summit
- 🥇 Momentum Ingwe
- 🥇 Momentum Incentive
- 🥇 Momentum Extender
- 🥇 Momentum Evolve
- 🥇 Momentum Custom
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 | R3,749 | R6,707 | R5,071 | R8,029 | R9,351 | R10,673 |
| 📌 Associated | Associated | R3,334 | R5,920 | R4,512 | R7,098 | R8,276 | R9,454 |
| 📌 Associated | State | R2,585 | R4,541 | R3,501 | R5,457 | R6,373 | R7,289 |
| 📍 Any | Any | R4,472 | R8,061 | R6,068 | R9,657 | R11,253 | R12,849 |
| 📍 Any | Associated | R3,953 | R7,042 | R5,390 | R8,479 | R9,916 | R11,353 |
| 📍 Any | State | R3,295 | R5,782 | R4,502 | R6,989 | R8,196 | R9,403 |
You might like the 5 Best Medical Aids under R300
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.POLL: 5 Best Medical Aids under R3000
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).
- ☑️ Any Hospitals
- ☑️ Associated Hospitals
- ☑️ However, certain procedures can only be done in a day hospital, which can be viewed on the Momentum App.
- ☑️ R2,000 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 R2,000.
- ☑️ If the procedure is done in a regular or a day hospital, you will also have to pay an additional R5,500 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) | No annual limit applies |
| 🩸 Organ Transplants (Doner) will only be covered if the recipient is an existing member of Momentum Health. | Cadaver costs are covered up to R26,000. Live donor costs are covered up to R53,000, 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 R2,000 co-payment per authorization. If available, Momentum HealthSaver+ pays dental and maxillo-facial surgeon bills. |
| 🦷 Impacted Wisdom Teeth | Major Medical Benefit pays day hospitals R3,600 and acute hospitals R6,800 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 R3,200 per scan. |
| ✅ Medical and Surgical Appliances, for instance, support stockings, back braces, etc. | Covers up to R8,400 per family per year. |
| 🦵 Internal Prostheses | R7,200 per beneficiary per event, with a maximum of two events per year. Other internal prostheses – up to R62,000 per beneficiary per event, with a cap of two events per year. |
| 📌 External Prostheses | There is up to R29,300 available per family. |
| 💙 Mental Health, including psychiatry, psychology, drug, and alcohol rehabilitation | Covers up to R47,300 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 R67,000 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 R89,500 per family. |
READ more: 5 Best Hospital Plans for Babies
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 R1,920 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 |
Discover more: Best Medical Aids in South Africa that Cover Cosmetic Surgery
Early Detection Testing:| 🔍 Benefit | ☑️ Eligibility | ➡️ Frequency |
| 🦷 Dental Consultations | All | Once yearly |
| ✅ Pap Smear and GP consult | Women 15> | Once yearly - based on type of pap smear |
| ✔️ Mammogram | Women 38> | Once every 2 years |
| 🦵 DEXA Bone Density Scan | Beneficiaries 50> | Once every 3 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.POLL: 5 Best Medical Aids for Fertility Treatment
| 🔎 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 and two weeks later |
| ✅ 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) |
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
- ☑️ R7 660 000 per beneficiary per 90 day journey (consisting of R15,500 for emergency optometry, R15,500 for emergency dentistry, and R765,000 for terrorism cover) and R765 000 terrorism cover.
- ☑️ An R2,280 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:- ☑️ Cost 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 (2026) | 🥈 Discovery Essential Core (2026) | 🥉 Bestmed Beat 2 (2026) |
| 👤 Main Member Contribution | R2,585 ZAR – R4,472 | R3,138 ZAR | R3,084 ZAR |
| 👥 Adult Dependent Contribution | R1,956 ZAR – R3,589 | R2,354 ZAR | R2,395 ZAR |
| 💙 Child Dependent Contribution | R1,040 ZAR – R1,993 | R1,260 ZAR | R1,229 ZAR |
| 🌎 International Cover | No,Emergency cover 7.660 000 ZAR | R5 million ZAR | R5 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.
You might also like the Momentum Summit
You might also like the Momentum Ingwe
You might also like the Momentum Incentive
You might also like the Momentum Extender
You might also like the Momentum Evolve
You might also like the Multiply Rewards
