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 R1960.
|👤 Main Member Contribution||R2,580 ZAR|
|👥 Adult Dependent Contribution||R3,176 ZAR|
|💙 Child Dependent Contribution||R2,449 – R6,573 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|
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:
|🔎 Hospital||➡️ Chronic||👤 Main Member||👥 2 Adults||2️⃣ Main Member|
|3️⃣ 2 x Adults|
|4️⃣ 2 x Adults|
2 x Children
|5️⃣ 2 x Adults
3 x Children
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The Momentum Custom Plan offers access to major medical benefits and specialized procedures/treatments.
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.
Overall Annual Limit on Custom: Unlimited
|📌 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.
|💙 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.|
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Specific specialized procedures/treatments are covered in and out-of-hospital (when clinically appropriate).
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.
Momentum HealthSaver+ can be utilized if you wish to add cover for routine medical expenses, such as doctor’s visits and prescription drugs.
Health Platform benefits are covered by the Scheme up to a maximum Rand amount per benefit, provided you inform us before using the benefits.
|🔎 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
|📌 Tetanus diphtheria Injection||All beneficiaries||As required|
|📍 Pneumococcal Vaccine||Beneficiaries 60 and older|
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
|Once every 5 years
Once every 3 years
Once every 2 years
|📌 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
|✳️ 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|
|Once every 2 years
|📊 HIV Testing||Beneficiaries 15>||Once every 5 years|
Take Note: Only women who are registered on the program and who are not subject to waiting periods are eligible for the program.
|🔎 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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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|
A 24-hour emergency health advice line is open to all beneficiaries as required.
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.
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:
Depending on pre-existing or existing conditions, the following might apply when you register for medical cover with the Momentum Custom Plan:
|🔎 Medical Aid Plan||🥇 Momentum Custom Plan||🥈 Discovery Essential Core||🥉 Bestmed Beat 2|
|👤 Main Member Contribution||R2,580 ZAR||R2,405 ZAR||R2,090 – R2,323 ZAR|
|👥 Adult Dependent Contribution||R3,176 ZAR||R1,804 ZAR||R1,624 – R1,804 ZAR|
|💙 Child Dependent Contribution||R2,449 – R6,573 ZAR||R967 ZAR||R879 – R978 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|
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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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.
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.
You can contact Momentum medical aidper call or WhatsApp on 0860 11 78 59
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.
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.
Optional benefits of the Custom Medical Aid plan include extended maternity benefits, additional specialist consultations, and preventative healthcare benefits.
Pre-existing conditions might be subject to a waiting period before they are covered under 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.
Members pay premiums monthly.
The Custom Medical Aid plan includes cover for specialized dentistry under the day-to-day benefit.
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.
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.
The Custom Medical Aid plan includes coverage for antenatal consultations, hospitalization for childbirth, nurse home visits, and postnatal consultations, among other benefits.
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