Note: We are updating 2024 benefits as they are released. Some plans show old benefits until schemes release new plans.

Momentum Custom Network (for hospitals) State (for chronic):
in-and-out of hospital benefits (2024)


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Monthly Costs:

Custom Associate (and State provider for chronic) 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R2,149
  • R1,626
  • R762
  • Only pay for 3 children
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Children Rates:
  • Under 21yrs
  • Only pay for 3 children
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Momentum plans, with costs and brief summary
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In-hospital Procedures for 2024:

Momentum: Custom Associate (and State provider for chronic)
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • Covered in full
non-Network GPs:
  • 100% scheme rate
network GPs:
  • Covered in full
Hospital Choice:
Day Hospitals:
  • See co-payments, below to see which procedures are covered in a Day Hospital
Penalty for using other hospital:
  • 30% of hospital account
Other Co-payments:
  • R1,830 per authorisation, except for vehicle accidents, maternity and emergency treatment
  • R1,830 per authorisation for most out of hospital procedures.
  • Specialised radiology: R3,050 co-payment
  • Dental admissions: R3,300 and R6,150 co-payment
Also, additional R1,830 co-payment if in day hospital or an additional R3,660 co-payment if done in an overnight (acute) hospital for the following :
  • 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*
  • * You still pay the R1,830 co-payment if done in doctor's rooms
If the following are of low severity: no benefit
If high severity: R3,660 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
Specialised Radiology:
  • MRI and CT scans, (MRCP), whole body radioisotope and PET scans: R3,050 co-payment, in and out of hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • Recipient: Unlimited
  • Donor: R23,600 cadaver costs and R47,900 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
Alternatives to hospitals:
  • Medical rehabilitation, private nursing, hospice and step-down facilities: R61,000 per family
Casualty:
  • PMBs only
Other:
  • HIV related admissions: R81,300 per family, unless PMB
Note:
  • 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 Provders. Where stipulated, you must use specific 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
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Momentum plans, with costs and brief summary
.
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.

Out-of-hospital Procedures for 2024:

Momentum: Custom Associate (and State provider for chronic)
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
PMBs out of hospital:
  • All medical aids 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
  • The benefit is paid by the scheme, and not out of your savings account
  • If you have no day-to-day funds, you still have cover for PMBs
  • 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.
General info:
GP consultations:
  • 1 GP consult per person, paid by scheme, every 1-5 years (frequency depends on age)
  • Otherwise, no benefit unless PMB
Childcare:
  • Paediatrician: 2 consults, 0-12 months
  • Immunisations: Covered
Specialists consultations:
  • PMBs only
Pathology:
  • PMBs only
General radiology:
  • PMBs only
Specialised radiology:
  • MRI and CT scans, (MRCP), whole body radioisotope and PET scans: R3,050 co-payment, in and out of hospital
Supplementary Services: (Physio, etc)
  • PMBs only
General Appliances:
  • In-hospital: R7,630 per family
  • Out-of-hospital: No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Note:
  • PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
  • DSPs: Designated Service Provders. Where stipulated, you must use specific 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
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Momentum plans, with costs and brief summary
.

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.

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Medication Benefit for 2024:

Momentum: Custom Associate (and State provider for chronic)
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Chronic:
  • Use State facilities for your chronic script, medication and treatment
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
  • No benefit
On Discharge:
  • 7 days supply
Biological:
  • PMBs only
Note:
  • Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
  • Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
  • PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
  • DSPs: Designated Service Provders. Where stipulated, you must use specific 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
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Momentum plans, with costs and brief summary
.

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.


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