Benefits, in-hospital, Momentum Plan, out-hospital, Scheme Plans

Momentum Incentive Network (for hospitals) Any (for chronic): in-and-out of hospital benefits (2025)

October 15, 2023

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Momentum Incentive Network (and any provider for chronic). Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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Terminology:

PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
DSPs: Designated Service Providers. Where stipulated, you must use specific providers to get full benefit.
Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product.
All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2026)

Momentum:Incentive Network hospital (and any provider for chronic) (2026)
	Main member:	Adult member:	Child member:
Total Cost pm:	R5,333	R4,292	R1,993
Savings:	R6,396	R5,148	R2,388
Children Rates:	Under 21yrs Only pay for 3 children

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In-hospital Procedures (2025):

Momentum: Incentive Network hospital (and any provider for chronic)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	GPs: paid in full network Specialists: paid in full non-network Specialists: 200% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Associate hospitals Full list of the Associate Hospitals
Penalty for using other hospital:	30% of hospital account	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	Specialised radiology: R2,900 co-payment Dental admissions: R3,300 and R6,500 co-payment Also, additional R1,920 co-payment if in day hospital or an additional R3,840 co-payment if done in an overnight (acute) hospital for the foolowing : Arthroscopies Back and neck surgery Carpal Tunnel release Functional nasal and sinus procedures Joint replacements Laparoscopies Gastroscopies, Nail surgery, Cystoscopies, colonoscopies, sigmoidoscopies, Removing of extensive skin lesions If the following are of low severity: no benefit If high severity: R3,840 additional co-payment for in-hospital treatment: Conservative back and neck treatment Treatment of diseases of conjunctival Treatment of headaches Removing of minor skin lesions Treatment of adult influenza Treatment of adult respiratory tract infections Note: If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments, especially if you don't use a DSP for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI and CT scans, (MRCP), whole body radioisotope and PET scans: R2,900 co-payment, in and out of hospital	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	100% scheme rate
Transplants:	Recipient: Unlimited Donor: R27,500 cadaver costs and R56,000 for live donor costs. Only covered if recipient is a member of the scheme
Dialysis:	Covered
Exclusions:	If low severity, these are excluded: Conservative back and neck treatment Treatment of diseases of conjunctival Treatment of headaches Removing of minor skin lesions Treatment of adult influenza Treatment of adult respiratory tract infections NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Medical rehabilitation, private nursing, hospice and step-down facilities: R67,000 per family
Casualty/ER:	From day-to-day benefit	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	HIV related admissions: R92,600 per family, unless PMB
PMBs = Prescribed Minimum Benefits (more info) \| DSP = Designated Service Provider

Out-of-hospital Procedures (2025):

Momentum: Incentive Network hospital (and any provider for chronic)

Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated

	Main Member:	Adult:	Child:
Savings:	R5,796	R4,656	R2,160
Other Day-to-Day Funds:

All schemes must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
This can include consults with specialists, blood or other tests, radiology and medicine.
PMB benefits must never be paid from your savings account.
Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
See our Guide to PMBs for more information.

1 GP consult per person, paid by scheme, every 1-5 years (frequency depends on age)
Otherwise, from day-to-day benefit

Paediatrician: 2 consults, 0-12 months
Immunisations: Covered

Gap Cover:
Can pay for child ER visits
(Plans coming soon)

From day-to-day benefit

From day-to-day benefit

From day-to-day benefit .

MRI and CT scans, (MRCP), whole body radioisotope and PET scans: R2,900 co-payment, in and out of hospital

Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)

From day-to-day benefit

In-hospital: R8,400 per family
Out-of-hospital: Day-to-day benefit

From day-to-day benefit

From day-to-day benefit

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Medication Benefit (2025):