Overall, the Momentum Incentive Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and International Cover for its Family Members. The Momentum Incentive Medical Aid Plan starts from R3,060 ZAR.
| 👤 Main Member Contribution | R3,060 – R5,457 |
| 👥 Adult Dependent Contribution | R2,414 – R4,434 |
| 🍼 Child Dependent Contribution | R1,174 – R2,128 |
| 🔁 Gap Cover | ☑️ Yes |
| 🚑 Hospital Cover | Unlimited |
| 🏠 Home Care | ☑️ Yes |
| 💶 Prescribed Minimum Benefits (PMB) | ☑️ Yes |
| 📉 Screening and Prevention | ☑️ Yes |
| 💳 Medical Savings Account | ☑️ Yes |
| 💙 Maternity Benefits | ☑️ Yes |
💙 The Momentum Incentive medical aid plan is one of 6, starting from R3,060 and includes cover for chronic conditions, dentistry, optometry, in and out-of-hospital consultations, procedures, and much more.
💙The Incentive Option includes cover for hospitalization in private hospitals. There is no overall annual limit for hospitalization. You can choose to have access to any hospital, or you can choose to save on your monthly contribution by selecting to use a specific list of private hospitals (referred to as Associated hospitals).
💙For chronic treatment, you can choose to have access to any doctor for your chronic scripts and any pharmacy for your chronic medication.
💙 Or you can choose to save on your monthly contribution by selecting to use a list of Associated doctors for your chronic script and Medipost courier pharmacy for your chronic medication. Alternatively, you can choose to use State facilities for your chronic script and chronic medication to obtain the maximum contribution saving.
💙 10% of your contribution goes to a dedicated Personal Medical Savings Account (Savings) to cover your day-to-day expenses.
💙 If you need more day-to-day cover, you can make use of Momentum HealthSaver+. HealthSaver is a complementary product offered by Momentum that lets you save for medical expenses not covered on your option.
💙 Gap Cover is available on the Momentum Incentive 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 |
| 📌 Associated | Any | R4,827 | R8,711 | R6,630 | R10,541 | R12,317 | R14,120 |
| 📌 Associated | Associated | R4,306 | R7,730 | R5,942 | R9,336 | R11,002 | R12,638 |
| 📌 Associated | State | R3,060 | R5,474 | R4,234 | R6,648 | R7,822 | R8,996 |
| 📍 Any | Any | R5,457 | R9,891 | R7,585 | R12,019 | R14,147 | R16,275 |
| 📍 Any | Associated | R4,686 | R8,443 | R6,527 | R10,284 | R12,125 | R13,966 |
| 📍 Any | State | R3,801 | R6,795 | R5,304 | R8,298 | R9,801 | R11,304 |
💙 Hospitalization and some specialized procedures and treatments are paid for under this benefit. A yearly cap on hospital stays is not in place, and the cover is unlimited for affiliated specialists and up to 200% of the Momentum Medical Plan Rate for all other specialists.
💙 Furthermore, all hospital bills are paid at a predetermined rate. If your treatment has been approved in advance, the hospitalization benefit will pay for your hospital bill and any other fees paid during your stay in the hospital.
💙 The Major Medical Benefit covers specialized procedures/treatment if they are deemed medically necessary and have been pre-authorized, even if they do not necessitate hospitalization. If pre-authorization is not acquired, the Scheme will only pay 70% of the negotiated price (assuming authorization would have been given according to the regulations of the Scheme).
💙 Furthermore, the participant will be responsible for the remaining 30%.
💙 The main member, a member of their immediate family, or a close friend must get permission to stay longer than 72 hours if admitted due to an emergency. In addition, a 30% co-payment will be added to the hospital bill if they select Affiliated hospitals but do not end up using one of them.
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Providers:
Overall Annual Limit on Custom: Unlimited
Co-Payments:
💙 R1,920 per authorization, excluding motor vehicle accidents, pregnancy, and emergency treatment. An additional co-payment may be required for the following 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 a hospital, 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. |
Read more about 5 Best Medical Aid Co-Payment Cover in South Africa
| 🔍 High and Intensive Care | There is no annual limit on this benefit. |
| ⏰ After-hour casualty visits | Subject to Medical Savings Account. |
| ☑️ Renal Dialysis | There is no annual limit. If you choose State as your chronic provider, you must undergo renal dialysis at State facilities. |
| ✅ Oncology | R400,000 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) | There is no annual limit. |
| 💙 Organ Transplants (Doner) will only be covered if the recipient is an existing member of Momentum Health. | R27 500 cadaver costs R56 000 live donor costs (including transportation) |
| 😊 Maxillo-facial surgery and general anesthesia for children under 7 (this excludes implants). | Hospital account (covered in full at the rate negotiated with the hospital group) and anesthetist account (covered up to 200% of Momentum Medical Plan Rate) paid from Major Medical Benefit The hospital account is paid at the negotiated rate, subject to a R1 750 co-payment per authorization. |
| 🦷 Impacted Wisdom Teeth | Hospital account (covered in full at the rate negotiated with the hospital group) and anesthetist account (covered up to 200% of Momentum Medical Plan Rate) paid from Major Medical Benefit. Subject to R3,450 co-payment for day hospitals and R6,500 co-payment for acute hospitals per authorization. Major Medical Benefit pays up to 100% of Momentum Medical Scheme Rate for dentistry, dental specialist, and maxillofacial surgeon bills. |
| 🍼 Maternity confinements | No annual limit. |
| 👶 Neonatal Intensive Care | No annual limit. |
| 📌 MRI, PET, and CT scans | No annual limit exists, 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 R8,400 per family per year. |
| 🦻 Internal Prostheses | Cochlear implants: R214 200 per beneficiary, maximum 1 event per year. Intraocular lenses: R8 540 per beneficiary per event, maximum 2 events per year. Other internal prostheses: R64 000 per beneficiary per event, maximum 2 events per year |
| 🦾 External Prostheses | There is up to R29,400 available per family. |
| 🧠 Mental Health, including psychiatry, psychology, drug, and alcohol rehabilitation | Covers up to R48,400 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. |
| 💶 Trauma Benefit | Covers certain day-to-day expenses incurred because of specified traumatic incidents, including near-drowning, poisoning, severe allergic reactions, and external and internal brain traumas. According to the authorization, treatment relating to the event is covered. |
| 🚑 Alternatives to Hospitalization, such as step-down facilities | There is a limit of R67,000 per family. |
| 🚩 Immune Deficiency – HIV | No annual limit applies at preferred provider R92 600 per family at your chosen hospital provider |
| 🛺 International emergency medical transport by preferred provider | R8 000 000 per beneficiary per 90-day journey. This benefit includes R15 500 for emergency optometry, R15 500 for emergency dentistry and R765 000 terrorism cover. A R2 180 co-payment applies per emergency out-patient claim |
💙 The Chronic Benefit covers some life-threatening diseases requiring continued care. Any Affiliated or State may serve as your Chronic Benefit provider.
💙 There is no annual cap on chronic coverage for the 26 conditions listed on the Chronic Disease List, which is part of the Prescribed Minimum Benefits.
💙 In addition, an extra six conditions are subject to a yearly maximum of R13,100 per family (refer to the brochure for a list of these conditions). Chronic benefits are contingent upon enrollment in the Chronic Management Program and Scheme approval.
| 🔎 Provider | Any, Associated or State |
| ➡️ Cover | 32 Conditions |
| 📉 Limit | 26 Conditions according to the CDL in PMB benefits – no annual limit Six additional conditions up to R11,800 per family yearly. |
💙 Note: If the State cannot provide you with the necessary chronic medication, you may acquire it through Ingwe Primary Care Network providers, subject to a Network formulary and Scheme approval.
💙 10% of your contribution is allocated to a Personal Medical Savings Account to cover day-to-day expenses like doctor’s visits and prescription medication.
💙 Momentum HealthSaver+ can be utilized if you require additional coverage daily. Benefits are contingent on the availability of Savings, and claims are paid at cost with no sub-limits.
| 🔎 Provider | Members can use any provider |
| 📌 Healthcare Alternatives: Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody, Physiotherapy, and Podiatry | Subject to medical savings if funds are available. |
| 🧠 Mental Health (Psychology and Psychiatry) | Subject to medical savings if funds are available. |
| 🪥 Basic Dentistry | Subject to medical savings if funds are available. |
| 🦷 Specialized Dentistry | When dental specialist extracts impacted wisdom teeth in doctors’ offices, the Major Medical Benefits will cover up to 100% of the Momentum Medical Scheme Rate. Subject to an R1,590 co-payment and pre-authorization. Additional dental specialties: Subject to available Savings, if any |
| 👩🏻🦼 External Medical Devices: (Including hearing aids, glucometers, blood pressure monitors, wheelchairs, etc.) | Subject to medical savings if funds are available. |
| 👩⚕️ General Practitioner consultations | Subject to medical savings if funds are available |
| 👨⚕️ Specialist consultations | Subject to medical savings if funds are available |
| 👓 Optical and Optometry | Subject to medical savings if funds are available |
| 📈 Pathology | Subject to medical savings if funds are available |
| 📉 Radiology | Subject to medical savings if funds are available |
| 📊 MRI, PET, and CT scans | Covered by Major Medical Coverage, subject to a co-payment of R2,630 per scan and prior authorization. |
| 💊 Prescribed medication | Subject to medical savings if funds are available |
| ⚕️ Over-the-Counter Medication | Subject to medical savings if funds are available |
💙 Health Platform benefits are covered by the Scheme up to a maximum Rand amount per benefit, provided you inform the scheme 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 High-risk beneficiaries | Once yearly |
| 😷 Tetanus diphtheria Injection | All beneficiaries | As required |
| ⚕️ Pneumococcal Vaccine | Beneficiaries 60 and older High-risk beneficiaries | Once yearly |
| 🔎 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 |
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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 |
💙 Momentum members must note that while limitations and exclusions exist, 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 Incentive Plan:
| 🔎 Medical Plan | 🥇 Momentum Incentive Plan (2025) | 🥈 Discovery Priority Series (2025) | 🥉 KeyHealth Equilibrium (2024) |
| 🌎 International Cover | Up to R8 million | Up to R5 million | Up to R6 million |
| 👤 Main Member Contribution | R3,060 – R5,457 | R4,981 – R5,796 | R2,778 |
| 👥 Adult Dependent Contribution | R2,414 – R4,434 | R3,917 – R4571 | R1,716 |
| 💙 Child Dependent Contribution | R1,174 – R2,128 | R1,989 – R2,318 | R854 |
| 🏥 Hospital Cover | Unlimited | Unlimited | Unlimited |
| 💶 Prescribed Minimum Benefits (PMB) | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 📉 Screening and Prevention | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 💳 Medical Savings Account | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| ☑️ Disease Prevention Program | ☑️ Yes | ☑️ Yes | ☑️ Yes |
💙 Momentum Incentive is a comprehensive medical aid plan offering members a range of benefits and options. The plan is designed to provide quality healthcare services to individuals and families, with coverage for hospitalization, day-to-day medical expenses, chronic medication, and emergency medical services.
💙 Momentum Incentive offers a range of benefit options, allowing members to choose a plan that best suits their needs and budget. Furthermore, the plan covers various healthcare services, including hospitalization, day-to-day medical expenses, chronic medication, and emergency medical services.
💙 However, like most medical aid plans, Momentum Incentive can be expensive, and the cost may be a barrier to access for some individuals and families.
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The Momentum Incentive Plan offers dental benefits as part of its day-to-day benefits. This includes preventative and basic dentistry cover, such as dental check-ups, fillings, and extractions. However, more advanced dental procedures may not be covered by the plan.
The Momentum Incentive Plan offers hospital benefits, including cover for in-hospital treatment, accommodation, and medication. The plan also covers certain surgical procedures, subject to specific clinical protocols.
Yes, the Momentum Incentive Plan covers certain chronic conditions, including diabetes, hypertension, and asthma. Members must register for chronic medication benefits and provide medical information to qualify for this coverage.
Yes, the Momentum Incentive Plan offers a maternity program, which includes cover for antenatal care, childbirth, and postnatal care. The plan also provides cover for certain complications related to pregnancy and childbirth.
The Momentum Incentive Plan has a network of healthcare providers, including hospitals, doctors, and specialists, that members can choose from. Members can also choose to use providers outside the network but may need to pay additional costs.
Yes, there are waiting periods for certain benefits under the Momentum Incentive Plan. These waiting periods may vary depending on the benefit and the plan option chosen by the member.
To join the Momentum Incentive Plan, visit the Momentum website or contact their customer service center. You must provide personal and medical information and choose a plan that best suits your needs and budget.
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.
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