This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Momentum Evolve.
In-hospital Procedures (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
non-Network Specialists: |
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network Specialists: |
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non-Network GPs: |
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network GPs: |
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Hospital Choice: |
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Day Hospitals: |
- See co-payments, below to see which procedures are covered in a Day Hospital
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Penalty for using other hospital: |
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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 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*
- * You still pay the R1,830 co-payment if done in doctor's rooms, or
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
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Specialised Radiology: |
- MRI and CT scans, (MRCP), whole body radioisotope and PET scans: R3,050 co-payment, in and out of hospital
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Scopes: |
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Supplementary Services: (Physio, etc) |
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Transplants: |
- PMBs only , at State facilities
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Dialysis: |
- PMBs only and only in State facilities
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Exclusions: |
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
- Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
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Alternatives to hospitals: |
- Medical rehabilitation, private nursing, hospice and step-down facilities: R55,000 per family
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Casualty: |
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Other: |
- Back and neck surgery, conservative back and neck treatment and joint replacements: State facilities
- HIV related admissions: R45,900 per family, unless PMB
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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
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View all the other benefits for this plan:
In-hospital |
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.
Find all other open medical aid plans here.
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Out-of-hospital Procedures (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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- 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.
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- 1 GP consult per person, paid by scheme, every 1-5 years (frequency depends on age)
- 2 virtual consults with Hello Doctor or Evolve Network GPs.
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- Paediatrician: 2 consults, 0-12 months
- Immunisations: Covered
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- MRI and CT scans, (MRCP), whole body radioisotope and PET scans: R3,050 co-payment, in and out of hospital
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Scopes: |
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- Sport injury: 2 Physio or biokineticist consults, up to R1,060 per year
- Otherwise, PMBs only
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- In-hospital: R7,150 per family
- Out-of-hospital: No benefit
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- 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
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View all the other benefits for this plan:
In-hospital |
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.
Find all other open medical aid plans here.
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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 (2024):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
- No savings account option on this plan
- The scheme might still cover some or all day-to-day claims. See below, and see benefits.
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Chronic: |
- Use State facilities for your chronic script, medication and treatment
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- 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:
In-hospital |
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.
Find all other open medical aid plans here.
|
. |
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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