Momentum Incentive Medical Aid Plan ( 🇿🇦 2026*)

  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 R3,362 ZAR.      

Momentum Incentive Plan Review - 8 Key Point Quick Overview

1. ☑️ Momentum Incentive Plan Review – 8 Key Point Quick Overview
2. ☑️ Momentum Incentive Plan Overview
3. ☑️ Momentum Incentive Plan Contributions
4. ☑️ Incentive Plan Benefits and Cover Comprehensive Breakdown
5. ☑️ Momentum Incentive Health Platform Benefit
6. ☑️ Incentive Plan Exclusions and Waiting Periods
7. ☑️ Momentum Incentive Plan vs. Similar Plans from other Medical Schemes
8. ☑️ Our Verdict on The Incentive Plan
9. ☑️ Momentum Incentive Plan Frequently Asked Questions

Momentum Incentive Plan Overview

  💙 The Momentum Incentive medical aid plan is one of 6, starting from R3,362 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:  

• ✅ Momentum Summit
• ✅ Momentum Ingwe
• ✅ Momentum Incentive
• ✅ Momentum Extender
• ✅ Momentum Evolve
• ✅ Momentum Custom

Momentum Incentive Plan Contributions

   

Incentive Plan Benefits and Cover Comprehensive Breakdown

Major Medical Benefit

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.    

Major Medical Benefits and Co-payments

• ☑️ Before utilizing your Major Medical Benefits, you must contact Momentum for pre-authorization.
• ☑️ You must 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.
• ☑️ Cover for 32 conditions: 26 conditions, according to the Chronic Disease List in  the Prescribed Minimum Benefits: no annual limit applies
• ☑️ 6 additional conditions: limited to R13 700 per family per year
• ☑️ 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).

Discover the 10 Best Hospital Plans in South Africa 

Providers:

• ☑️ Any Hospitals
• ☑️ Associated Hospitals

Overall Annual Limit on Custom:  Unlimited   Co-Payments: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.
• ☑️ Or a co-payment of R5 500 per authorisation applies to these procedures/treatment if performed in an acute hospital.

   

Read more about 5 Best Medical Aid Co-Payment Cover in South Africa

Hospitalization

• ☑️ All related specialists are covered under this benefit.
• ☑️ Up to 200% of the Momentum Medical Scheme Rate is paid for other specialists.
• ☑️ The hospital bill will be paid at the group’s agreed-upon rate.

     

Chronic Benefit

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  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.     💙 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.    

Day-to-day Benefit

  💙 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.    

Momentum Incentive Health Platform Benefit

  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.  

Preventative Care

   

Early Detection Testing

   

You might like to read more about 5 Best Hospital Plans for Pensioners and Receivers of SASSA

Health Management Programs

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

Incentive Plan Exclusions and Waiting Periods

Exclusions

  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:  

• ☑️ Costs during waiting periods or for conditions not disclosed during 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 Incentive 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.

Medical Aid Comparisons : Momentum Incentive Plan vs. Similar Plans from other Medical Schemes

   

Our Verdict on The Incentive Plan

💙 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.     You might also like the Momentum Summit You might also like the Momentum Ingwe You might also like the Momentum Extender You might also like the Momentum Evolve You might also like the Momentum Custom You might also like the Multiply Rewards

Momentum Incentive Plan Frequently Asked Questions

What dental benefits are included in the Momentum Incentive Plan?

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.  

What hospital benefits are included in the Momentum Incentive 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.  

Does the Momentum Incentive Plan offer coverage for chronic conditions?

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.  

Is there a maternity program included in the Momentum Incentive Plan?

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.  

Can I choose my own healthcare provider under the Momentum Incentive Plan?

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.  

Are there waiting periods for benefits under the Momentum Incentive Plan?

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.  

How do I join the Momentum Incentive Plan?

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.