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

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Momentum Incentive (Network 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 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
• 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.

In-hospital Procedures (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Momentum: Incentive (Network provider for chronic)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	GPs: 100% scheme rate 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:	Any hospital
Penalty for using other hospital:	n/a	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: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). 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 if you don't use a DSP, especially if you are being treated 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):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Momentum: Incentive (Network provider for chronic)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings: R5,628 R4,512 R2,208 Other Day-to-Day Funds:
PMBs out of hospital:	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.
GP consultations:	1 GP consult per person, paid by scheme, every 1-5 years (frequency depends on age) Otherwise, from day-to-day benefit
Childcare:	Paediatrician: 2 consults, 0-12 months Immunisations: Covered	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	From day-to-day benefit
Pathology:	From day-to-day benefit
General radiology:	From day-to-day benefit .
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 pay co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	From day-to-day benefit
General Appliances:	In-hospital: R8,400 per family Out-of-hospital: Day-to-day benefit
1.1. Hearing Aids:	From day-to-day benefit
1.2. Wheelchairs:	From day-to-day benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Momentum: Incentive (Network provider for chronic)
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings: R5,628 R4,512 R2,208 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. 6 additional conditions, R13,100 per family Choose any GP and pharmacy
Acute (prescribed) medication:	From day-to-day benefit
Over-the-counter:	From day-to-day benefit
Birth Control:	From day-to-day benefit
On Discharge:	7 days supply
Biological:	PMBs only
View 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.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider