Overall, the Momentum Evolve Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and High and Intensive Care for its Family Members. The Momentum Evolve Medical Aid Plan starts from R1,847 ZAR.
| 👤 Main Member Contribution | R1,847 |
| 👥 Adult Dependent Contribution | R1,847 |
| 💙 Child Dependent Contribution | R1,847 |
| 🔁 Gap Cover | ☑️ Yes |
| 🏠 Home Care | ☑️ Yes |
| 💶 Prescribed Minimum Benefits (PMB) | ☑️ Yes |
| ⚕️ Screening and Prevention | ☑️ Yes |
| ➡️ Hospital Cover | Unlimited |
| 🌎 International Cover | Up to R5 million |
| 📉 Annual Limit | None |
💙The Momentum Evolve medical aid plan is one of 6, starting from R1,847, 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 Evolve 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 1 Child | 3️⃣ 2 x Adults 1 Child | 4️⃣ 2 x Adults 2 x Children | 5️⃣ 2 x Adults 3 x Children |
| ➡️ Evolve Network | 📌 State | R1,847 ZAR | R3,694 ZAR | R3,694 ZAR | R5,541 ZAR | R7,388 ZAR | R9,235 ZAR |
You might like 5 Best Medical Aids under R1000
💙 Depending on your chosen provider, this benefit provides coverage for hospitalization and certain specialized procedures/treatments.
💙 Furthermore, you can receive this benefit at any hospital, private hospitals in the Evolve Network, or State hospitals, and up to 100% of the Momentum Medical Scheme Rate will be covered.
💙 The hospitalization benefit covers hospital accounts and related costs incurred during the hospital stay, from admission to discharge, if the treatment has been approved. The benefit for specialized procedures/treatments is included in the Major Medical Benefit and may not require hospitalization.
💙However, it is covered, assuming it is clinically appropriate and authorized. If authorization is not obtained, a 30% co-payment will be applied to all accounts associated with the event. The Scheme will cover 70% of the negotiated tariff, assuming the authorization would have been granted according to the Scheme’s Rules.
💙 In an emergency, you, a family member, or a friend must obtain authorization within 72 hours of admission. However, members must note that certain procedures can only be performed (and will be covered) in day hospitals, including sinus procedures, cataract surgery, and others, as indicated in the relevant tables below.
Discover the 3 Best Hospital Plans Under R1000
Providers:
Overall Annual Limit on Evolve: Unlimited
Co-Payments:
| 📌 Arthroscopies, Back and neck surgery, Carpal tunnel release, Functional nasal and sinus procedures, Joint replacements, Laparoscopies | If the procedure is done in a day or acute hospital, the co-payments above apply. Members should note that Back and Neck Surgery and Joint replacements are only covered in a State facility. |
| 📌 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. Members should note that Conservative Back and Neck treatment is only covered in a state facility. |
You might consider the 5 Best Medical Aids under R1500
| 🩺 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. |
| 🧪 Oncology | R200,000 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 Evolve Network of Oncologists is where you should get your oncology care and medicines. |
| ❤️ Organ Transplants | Only PMBs are covered at State Hospitals. |
| 🍼 Maternity confinements | No annual limit. |
| 👶 Neonatal Intensive Care | No annual limit. |
| 👩⚕️ Medical and Surgical Appliances, for instance, support stockings, back braces, etc. | Covers up to R7,530 per family per year. |
| 👨⚕️ Internal Prostheses | R6,300 per beneficiary per event, with a maximum of two events per year. Other internal prostheses – up to R42,000 per beneficiary per event, with a cap of two events per year. |
| ➡️ External Prostheses | There is up to R27,000 available per family. |
| 📌 MRI and CT scans | There is no annual limit, but this benefit is subject to a co-payment of R3,200 per scan. |
| 💙 Mental Health, including psychiatry, psychology, drug, and alcohol rehabilitation | Only PMBs are covered at State Hospitals. 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. |
| ⚕️ Trauma | Covers day-to-day benefits for recovering from near-drowning, poisoning, severe allergic reactions, and external and internal head injuries. The authorization covers event-related treatment. |
| 📈 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 R48,300 per family. |
💙 Specific specialized procedures/treatments are covered in and out-of-hospital (when clinically appropriate).
Learn more about Health Insurance
💙 If funds are available, these benefits are subject to the Momentum HealthSaver balance.
| 📌 General Practitioners (GPs) | 2 GP Virtual Consultation Network (Hello Doctor) consultations. Medication is prescribed during consultations. Momentum HealthSaver+ may apply to medication. |
| 📌 Sports Injury Benefit | 2 annual sports injury physiotherapist or biokinetics visits per beneficiary. Covered up to 100% of the Momentum Medical Scheme Rate and up to R1,120 per beneficiary per year. Subject to pre-approval. |
💙 The Evolve Primary Care Network and the Evolve Active Network offer the Health Platform Benefit. Through a variety of programs, this benefit promotes health awareness, improves the quality of life, and provides peace of mind.
| 🔍 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 |
You might want to know How to Report a Medical Aid Scheme for Wrongdoing
| 🔎 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 |
💙 Only women who are registered on the program and who are not subject to waiting periods
| 🔎 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 Programme – 2 visits within the baby’s first year
💙 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.
READ: What is Road and Transport Cover?
💙 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 Evolve Plan:
| 🔎 Medical Aid | 🥇 Momentum Evolve Plan (2025) | 🥈 Bonitas BonStart Plus (2025) | 🥉 KeyHealth Essence (2025) |
| 👤 Main Member Contribution | R1,847 | R1,907 | R2,187 |
| 👥 Adult Dependent Contribution | R1,847 | R1,813 | R1,753 |
| 🍼 Child Dependent Contribution | R1,847 | R840 | R788 |
| 🌎 International Cover | ✅ Yes | ✅ Yes | ✅ Yes |
| 💶 Prescribed Minimum Benefits (PMB) | ✅ Yes | ✅ Yes | ✅ Yes |
| 📉 Screening and Prevention | ✅ Yes | ✅ Yes | ✅ Yes |
| 🏥 Hospital Cover | Unlimited | Unlimited | Unlimited |
| 🏠 Home Care | ✅ Yes | ✅ Yes | None |
| 💙 Maternity Benefits | ✅ Yes | ✅ Yes | ✅ Yes |
💙 The Momentum Evolve Medical Aid Option is a comprehensive health insurance plan that offers extensive coverage for both in-hospital and out-of-hospital medical expenses, including chronic medication, dentistry, optometry, and maternity benefits.
💙 The plan provides unlimited hospitalization coverage at any private hospital within the Momentum Health Network, and there is no overall annual limit for hospitalization.
💙 One of the significant benefits of the Momentum Evolves Medical Aid Option is that it provides access to a wide network of healthcare providers, including doctors, specialists, and hospitals, which offer discounted rates to policyholders.
💙 The plan also offers cover for emergency medical treatment while traveling outside South Africa. However, one potential drawback of the plan is that policyholders may be subject to co-payments or higher costs if they choose to use medical providers outside the network.
💙 Overall, the Momentum Evolve Medical Aid Option appears to be a good choice for those who want extensive health coverage and access to a wide network of healthcare providers. However, individuals should carefully consider the costs and benefits of the plan and compare it to other options available before deciding.
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 Custom
You might also like the Multiply Rewards
The Momentum Evolve Plan is a comprehensive health insurance plan offered by Momentum Health that provides coverage for a wide range of medical expenses.
The plan covers in-hospital and out-of-hospital medical expenses, including chronic medication, dentistry, optometry, and maternity benefits.
Yes, you can choose to use any medical provider you wish. However, you could be subject to co-payments or higher costs if you use medical providers outside the network. Furthermore, some treatments are only covered at certain facilities.
No, there is no overall annual limit for hospitalization covered with the Momentum Evolve Plan.
Yes, the plan offers emergency medical treatment coverage while traveling outside South Africa.
You can sign up for the Momentum Evolve Plan by contacting Momentum Health directly or through an independent financial adviser.
Yes, you can cancel your Momentum Evolve Plan at any time by providing written notice to Momentum Health. However, you may be subject to cancellation fees depending on the terms of your policy. Therefore, before canceling, ensure you read and understand the cancellation policy.
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.
You might also like
Free Medical Aid Quote
MEDICAL AID FROM R1870 P/M
We work with leading medical aid companies in South Africa.
🔎 Report a bug or outdated data to be updated to [email protected]
© Medicalaid.com | All rights Reserved |
Copyright 2024
Top 5 Medical Aids
Top 5 Gap Cover Plans
In the Media
Your compare list
Back
