Overall, the Momentum Summit Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance for its Family Members. The Momentum Summit Medical Aid Plan starts from R14,903 ZAR.
| 👤 Main Member Contribution | R14,903 ZAR |
| 👥 Adult Dependent Contribution | R11,919 ZAR |
| 💙 Child Dependent Contribution | R3,424 ZAR |
| 🌎 International Cover | R9, 010 000 ZAR |
| 🏥 Hospital Cover | Unlimited |
| 🍼 Maternity Benefits | ☑️ Yes |
| 👶 Pre and Post Natal Care | ☑️ Yes |
| 📉 Prescribed Minimum Benefits (PMB) | ☑️ Yes |
| ✔️ Screening and Prevention | ☑️ Yes |
| 💶 Medical Savings Account | None |
💙 The Momentum Summit medical aid plan is one of 6, starting from R14,903 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 Summit 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 / Day-to-Day | 👤 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 |
| 📌 Any | Freedom-of-Choice | R14,903 | R26,822 | R18,327 | R30,246 | R33,670 | R37,094 |
💙 The benefit offers coverage for hospitalization and specialized procedures/treatments. Hospitalization has no overall annual limit, and associated specialists are covered fully.
💙 In contrast, other specialists are covered by up to 300% of the Momentum Medical Scheme Rate. Hospital accounts are covered at an agreed-upon rate with the hospital group if treatment has been pre-authorized.
💙 Specialized procedures/treatments included in the Major Medical Benefit do not necessarily require hospital admission, provided they are clinically appropriate and authorized. Failure to obtain pre-authorization will result in a 30% co-payment for all related accounts.
💙 The scheme will cover 70% of the negotiated tariff, subject to the Rules of the Scheme. In an emergency, authorization must be obtained within 72 hours of admission by the patient, a family member, or a friend.
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Providers: Any Hospitals
Overall Annual Limit on Custom: Unlimited
| 🔍 High and Intensive Care | There is no annual limit on this benefit. |
| ⏰ After-hour casualty visits | Subject to the day-to-day benefit. |
| 📌 Renal Dialysis | There is no annual limit. |
| 📍 Oncology | No annual limit applies. Price will apply to both chemotherapy and adjuvant drugs. Specialized oncology benefits are offered for specific biologicals and immunologicals depending on criteria. |
| ❤️ 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. | Cadaver costs are covered up to R27,500. Live donor costs are covered up to R56,000, including organ transportation. |
| 😊 Maxillo-facial surgery and general anesthesia for children under 7 (this excludes implants). | The hospital account is paid at the negotiated rate and the anaesthetist account is covered up to 300% of the Momentum Medical Scheme Rate. The dentist, dental specialist and maxillo-facial surgeon accounts are paid from available day-to-day benefits, subject to the day-to-day limits |
| 🦷 Impacted Wisdom Teeth | Hospital account (covered in full at the rate negotiated with the hospital group) and anesthetist account (covered up to 300% of Momentum Medical Plan Rate) are covered by the Major Medical Benefit. Major Medical Benefit payments for dentistry, dental specialist, and maxillofacial surgeon services up to 100% of the Momentum Medical Scheme Rate |
| 🍼 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 R8,830 per family per year. |
| 🦵 Internal Prostheses | Cochlear implants: R234,00 per recipient, maximum of 1 procedure per year Intraocular lenses: R9,130 per recipient per event, maximum 2 events per year Other internal prostheses: R88,200 per recipient per event, with a maximum of two yearly events. |
| 🦾 External Prostheses | There is up to R30,600 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 R72,000 per family. |
| 🩺 Immune Deficiency – HIV | Members can use a network provider of their choosing. |
| 👩⚕️ Anti-retroviral Treatments | There is no annual limit on this benefit. |
| 👨⚕️ HIV-related hospital admissions | There is a limit of R92,600 per family. |
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💙 The Chronic Benefit provides coverage for life-threatening conditions that require ongoing treatment. Patients can choose any provider for chronic prescriptions and medication, provided they are on the comprehensive formulary.
💙 A co-payment for the cost difference is required if the medication is outside the formulary. In addition, the Chronic Benefit has no annual limit for the 26 conditions listed in the Chronic Disease List as part of the Prescribed Minimum Benefits.
💙 Additionally, 36 other conditions are covered within an overall day-to-day limit of R33,000 per beneficiary, combining day-to-day cover and coverage for the 36 additional chronic conditions. However, registration in the Chronic Management Program and Scheme approval is necessary to avail of these benefits.
| 📌 Provider | Any Provider |
| 📍 Cover | Coverage for 62 diseases: 26 conditions according to the Specified Minimum Benefits Chronic Disease List – no annual limit Cover for 36 additional ailments, with a daily maximum of R33,000 per beneficiary. This limit includes both day-to-day coverage and coverage for the 36 additional conditions. |
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💙 The benefit covers day-to-day medical expenses, including GP visits and prescribed medicine, and is paid from the risk-benefit. There is an overall day-to-day limit of R33,000 per beneficiary, and specific sub-limits apply.
💙 Furthermore, the overall day-to-day limit of R33,000 includes both day-to-day cover and coverage for the 36 additional chronic conditions.
| 🔎 Provider | Any provider |
| 📌 Healthcare Alternatives: Acupuncture, Homeopathy, Naturopathy, Herbology, Audiology, Occupational and Speech therapy, Chiropractors, Dieticians, Biokinetics, Orthoptists, Osteopathy, Audiometry, Chiropody, Physiotherapy, and Podiatry | R9 420 per family. Subject to overall annual day-to-day limit of R33 000 per beneficia |
| 🧠 Mental Health (Psychology and Psychiatry) | R28 300 per family. Subject to overall annual day-to-day limit of R33 000 per beneficiary |
| 🪥 Basic Dentistry | Subject to an annual per-beneficiary daily limit of R33,000. |
| 🦷 Specialized Dentistry | R19,800 for each recipient and R47,700 per household Both in-hospital and out-of-hospital accounts for dental specialists accrue towards the limit. Subject to overall annual day-to-day limit of R33 000 per beneficiary. Both in- and out-of-hospital dental specialist accounts accumulate towards the limit |
| 🩺 External Medical Devices: (Including hearing aids, glucometers, blood pressure monitors, wheelchairs, etc.) | R38,400 per household. Sub-limit of R22,200 per family for hearing aids. Subject to an overall annual day-to-day limit of R33,000 per beneficiary. |
| 👩⚕️ General Practitioner consultations | Subject to an annual per-beneficiary daily limit of R33,000. |
| 👨⚕️ Specialist consultations | Subject to an annual per-beneficiary daily limit of R33,300. |
| 🤓 Optical and Optometry | There is an overall limit of R5,800 per beneficiary. There is a sub-limit of R2,950 for frames. Subject to an annual per-beneficiary daily limit of R33,000. |
| 📉 Pathology | Subject to an annual per-beneficiary daily limit of R29,700. |
| 📈 Radiology | Subject to an annual per-beneficiary daily limit of R33,000. |
| 📊 MRI, PET, and CT scans | Covered by Major Medical Coverage, subject to a co-payment of R2,900 per scan and prior authorization. |
| 💊 Prescribed medication | There is a limit of R25,700 per beneficiary. There is a limit of R42,300 per family Subject to an annual per-beneficiary daily limit of R33,000. |
💙 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 Summit Plan:
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| 🔎 Medical Aid Plan | 🥇 Momentum Summit Plan | 🥈 Keyhealth Platinum | 🥉 Medihelp MedPlus |
| 🌎 International Cover | R9,010 000 | R6,000 000 | – |
| 👤 Main Member Contribution | R14,903 ZAR | R12,779 | R14,184 |
| 👥 Adult Dependent Contribution | R11,919 ZAR | R8,960 | R14 184 |
| 💙 Child Dependent Contribution | R3,424 ZAR | R2,699 | R3,540 |
| 🔁 Gap Cover | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 📉 Annual Limit | Unlimited | Unlimited | Unlimited |
| 🍼 Maternity Benefits | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 💶 Prescribed Minimum Benefits (PMB) | ☑️ Yes | ☑️ Yes | ☑️ Yes |
| 🔎 Screening and Prevention | ☑️ Yes | ☑️ Yes | ☑️ Yes |
💙 The Momentum Summit Option is a comprehensive medical aid plan that offers a range of benefits to its members. One of its key advantages is the flexibility it provides in terms of healthcare providers, giving patients the freedom to choose their preferred doctors, hospitals, and pharmacies.
💙 Additionally, the plan offers unlimited hospitalization coverage in private hospitals, which can benefit patients requiring specialized medical treatment. The plan also covers chronic conditions with no annual limit for the 26 conditions listed in the Chronic Disease List.
💙 An additional 36 conditions are subject to an overall day-to-day limit of R33,000 per beneficiary. The Health Platform Benefit covers preventative screening tests and certain check-ups. Furthermore, it can benefit patients who want to stay proactive with their health.
However, the Momentum Summit Option also has some drawbacks. For instance, patients who choose to get their medication outside the comprehensive formulary may be subject to a co-payment for the cost difference between the selected item and the formulary price.
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Yes, the Momentum Summit Plan covers back and neck surgery, including spinal fusion, discectomy, and laminectomy. However, the scheme only covers these procedures if they are deemed medically necessary and have been pre-authorized.
The Momentum Summit Plan is a comprehensive medical aid plan offered by Momentum Health. It is designed to provide members access to quality private healthcare services, including hospitalization, chronic medication, and day-to-day benefits.
Yes, the Momentum Summit Plan covers pregnancy and childbirth, including antenatal care, delivery, and postnatal care.
Yes, the Momentum Summit Plan covers the treatment of diabetes, including medication, doctor consultations, and blood tests.
The Momentum Summit Plan includes hospitalization coverage, chronic medication benefits, and day-to-day benefits.
No, the Momentum Summit Plan does not cover cosmetic surgery, as it is not medically necessary.
One potential disadvantage of the Momentum Summit Plan is that it may be more expensive than other medical aid plans, particularly for those who do not require regular medical care. Additionally, some members may be subject to co-payments for certain benefits or may be required to use healthcare providers within the network to avoid additional costs.
Yes, the Momentum Summit Plan covers the treatment of HIV, including medication and doctor consultations.
To join the Momentum Summit Plan, complete an application form and provide the necessary documentation. Membership is subject to certain eligibility criteria, including a medical underwriting process. Once your application is approved, you will be able to access the benefits of the plan.
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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