Momentum Medical Scheme provides medical aid plans with monthly fees ranging from R495.00 to R12,345.00 for the primary member.
The primary member of a Momentum medical aid can earn up to R3,000.00 per month in rewards.
There are six medical plans available through the Momentum Medical Scheme.
Depending on your needs, affordability, and personal preferences, the scheme offers a variety of options from which to choose. Momentum medical aid plans include the following plans:
- Ingwe Plan,
- Evolve Plan,
- Custom Plan,
- Incentive Plan,
- Extender Plan, and
- Summit Plan.
The medical plans offered by the Momentum Medical Scheme are discussed in detail below.
Momentum Medical Scheme Plans
1. Ingwe Plan
The Ingwe Option provides an entry level medical aid for a monthly premium of R495.00. Ingwe medical aid is aimed at low income earners who need a hospital plan.
Ingwe covers 26 chronic conditions, and thus at par with the Chronic Disease List in Prescribed Minimum Benefits.
For treatment of the chronic conditions, you can consult either Ingwe Primary Care Network providers or Ingwe Active Primary Care Network providers, depending on your provider of choice.
There is an option to use the Ingwe Healthsaver to provide additional day-to-day coverage. Momentum HealthSaver is a supplemental product that allows you to save for medical expenses not covered by your plan.
Hospital accounts and related costs are covered under the hospitalisation benefit, provided that treatment has been authorized.
If authorization is not obtained, a 30% co-payment will be applied to all accounts associated with the event, and Momentum will be liable for only 70% of the negotiated tariff.
In an emergency, the main member or a dependent can obtain authorization within 72 hours of hospitalization.
2. Evolve Plan
Momentum Evolve medical aid provides private hospitalisation for a monthly fee of R1,539.00. The medical aid is an ideal option for an individual or family that is comfortable with receiving their chronic benefits from a state hospital while assured that hospitalization is covered in a private hospital.
Hospital accounts and related costs incurred in the hospital are covered as long as authorization is obtained, from admission to discharge. Evolve pays claims at 100% of the Momentum Medical Scheme rate and has no overall annual limits.
According to the Chronic Disease List in Prescribed Minimum Benefits, the plan covers 26 chronic conditions in a state hospital. Chronic treatment benefits include services such as doctor visits, prescriptions, and medication.
While the evolve option provides peace of mind in terms of hospitalization, it does not address your day-to-day medical needs. Members pay their daily medical expenses out of pocket.
3. Custom Plan
Momentum custom medical aid plan is a mid tier medical plan that charges a monthly premium of R1,960.00. Momentum’s custom option gives you comprehensive hospital cover in a private hospital of your choice without any annual limits.
Likewise, custom members are liable to pay co-payments for Major Medical Benefits, except in the case of motor vehicle accidents, maternity confinements and emergency treatments.
Should you wish to get discounts on your contribution, then you might consider using a network of private hospitals listed in the Custom plan.
That goes with the Chronic treatment as we, you can choose an associated hospital so as to get discounts on the monthly contributions. Furthermore, you can push your contributions even lower by opting to use state facilities to receive your chronic benefits.
The scheme will not cover the daily medical expenses you might incur, however you can add the HealthSaver to cover your day-to-day healthcare expenses.
4. Incentive Plan
Momentum Incentive medical aid plan provide an extensive hospital and chronic cover for a minimum monthly premium of R2,549.00.
10% of the contributions to the plan goes to the medical savings account for day to day expenses.
5. Extender Plan
The Momentum Extender option is an excellent value for individuals or families who require comprehensive healthcare coverage. The plan offers numerous advantages in terms of preventative, hospital, chronic condition, and daily healthcare needs.
In the event of a hospitalization, the scheme fully covers all associated specialists, while other specialists are covered up to 200% of the Momentum Medical Scheme rate. When it comes to hospital groups’ accounts, the scheme fully covers the accounts at the agreed-upon rate.
The extender has R500 000 oncology cover per beneficiary every year, then a 20% co-payment applies should the limit be exceeded. Besides cancer related benefits, members are also covered for transplants, rehabilitation, trauma benefits and seven days’ supply of take home medication among other hospital benefits.
Of your monthly contributions, 25% is allocated to your Medical Savings Account. The savings account is credited with the all year allocation in advance to allow you to start using the funds even before contribution.
Funds in your savings account are meant to cover your day-to-day medical needs like GP visits and prescribed medicines. Should you not deplete the credit in your savings account, then the balance therein will be carried for use in the following year.
However, in an event that your savings account is depleted while you still have some day-to-day medical expenses, then you will have to pay from your own pocket or use the HealthSaver.
6. Summit Plan
The Summit option is ideal for a family that requires extensive hospital coverage from a preferred hospital or service provider. This is Momentum’s premium package, and you must be willing and ready to pay appropriate contributions for such a service.
Any specialists you choose to use are covered at 300% of the Momentum Scheme rate, while hospital accounts are fully covered. There are no applicable overall annual limits in hospitalisation, regardless of the service provider you choose.
The plan doesn’t have annual limits on:
- high and intensive care
- maternity confinement and neonatal intensive care
- oncology and renal dialysis
- organ transplant recipients and other medical events
The chronic conditions benefits in the summit option are similar to those of the extender. However the summit subscribers have a slightly extended limit of R29 700 per family every year, which is more than double of the extender limit.
The R29 700 is a combined limit incorporating both the 36 additional conditions and the day-to-day medical cover. The summit does not have a medical savings account, hence you can use the HealthSaver to increase your daily medical cover.
Complimentary products
HealthSaver
The Momentum HealthSaver is a complementary product accessible to all Momentum members who wish to save more for their daily healthcare needs. Your HealthSaver account earns you a 10% interest on available positive balance.
Positive HealthSaver balances can be used to cover other medical events that are not included in your medical scheme plan. Funds can be used to pay for:
- Hospital co-payments when scheme’s limits are reached
- Day-to-day medical expenses such as pharmacies, vitamins and fitness programs
- Affiliated gym fees and purchasing fitness devices
- Your Momentum monthly contribution among other various uses
HealthReturns
HealthReturns is a stimulus program that rewards members for living a healthy lifestyle and following up on their health status by doing regular check ups. Momentum pays families upto R3000 returns per month for healthy living.
To earn the HealthReturns, members need to:
- Go for annual health assessments, this helps identify medical needs at an early stage and get appropriate help earlier. Health assessments help reduce the costs of treatments as the condition would be treated while it is still on its early stages.
- Comply with chronic protocols; members need to claim for chronic medication for all of the CDL conditions in which they are registered, this includes managing a lifestyle recommended for the respective chronic conditions. To earn more HealthReturns, Momentum encourages members to get more pathology tests if need be, this will help detect any health challenges earlier.
- Be active; the Momentum Medical Scheme contribution and Healthy Heart Score determine how much you can earn. The scheme looks at the number of your active days in a month combined with your fitness assessment routine to determine your returns.
Competitive Advantages of Momentum Medical Scheme
- There are different medical aid plans to choose from.
- Main members can get up to R3,000.00 each month.
- Free access to health advice via hello doctor face to face consultation.
- Free annual health assessment.
- Competitive monthly contributions.
- The main member can add dependents.
Disadvantages of the Momentum Medical Scheme
- The KidsReturns is not available for the Ingwe members, of which they probably need it the most to cover their daily healthcare needs since the scheme does not cover them.
- Momentum’s day-to-day healthcare cover benefits are not as sufficient especially for members who have daily health complications that need to be monitored.
Conclusion
Momentum has quite broad plan options to choose from, making it easy for both low and high income earners to find their appropriate plan within the scheme. The scheme seems to emphasize preventative activities making it a convenient scheme that will help you keep track of your health status.
