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

What's on this page:

  1. Monthly Costs (2025)
  2. In-hospital Procedures (2024):
  3. Out-of-hospital Procedures (2024):
  4. Medication Benefit (2024):
This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Momentum Extender (State provider for chronic).

Monthly Costs (2025)

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

Extender (State provider for chronic) 2025 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R8,196
  • R6,727
  • R2,405
  • Only pay for 3 children
Savings:
  • R24,588
  • R20,181
  • R7,215
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R8,812
  • R8,819
  • R2,385
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Unlimited
  • Unlimited
  • Unlimited
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:
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.
.

In-hospital Procedures (2024):

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

Momentum: Extender (State provider for chronic)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
non-Network Specialists:
  • 200% scheme rate
Scheme rate is set by Momentum
network Specialists:
  • Covered in full
non-Network GPs:
  • Covered in full
network GPs:
  • Covered in full
Hospital Choice:
  • Any hospital
Day Hospitals:
  • See co-payments, below to see which procedures are covered in a Day Hospital
Penalty for using other hospital:
  • n/a
 You don't pay a penalty if admission was unavoidable due an emergency
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
 * There might be other co-payments if you don't use scheme-chosen provider for some services.

* Treatment required for PMB level care is always paid by scheme, with no co-payment, if you follow the protocols.
That means that these co-payments might not apply in your case! More info here
Specialised Radiology:
  • MRI and CT scans, (MRCP), whole body radioisotope and PET scans: R2,770 co-payment, in and out of hospital
 No limits or co-payments for PMB level care and/or for emergency
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • 200% scheme rate
 No limits or co-payments for PMB level care and/or for emergency
Transplants:
  • Recipient: Unlimited
  • Donor: R26,100 cadaver costs and R53,000 for live donor costs. Only covered if recipient is a member of the scheme
Dialysis:
  • Covered
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.
 * Treatment required for PMB level of care is always paid by scheme, if you follow the protocols. It cannot be excluded. More info here.

Alternatives to hospitals:
  • Medical rehabilitation, private nursing, hospice and step-down facilities: R68,000 per family
Casualty:
  • From day-to-day benefit
Other:
  • HIV related admissions: R87,900 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:
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.
.

Out-of-hospital Procedures (2024):

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

Momentum: Extender (State provider for chronic)
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R24,588
  • R20,181
  • R7,215
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R8,812
  • R8,819
  • R2,385
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Unlimited
  • Unlimited
  • Unlimited
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, from day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Childcare:
  • Paediatrician: 2 consults, 0-12 months
  • Immunisations: Covered
Specialists consultations:
  • From day-to-day benefit
 Treatment required for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here
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: R2,770 co-payment, in and out of hospital
 Scans required for PMB level care are paid paid by scheme, with no co-payment, if you follow the protocols. More info here
Scopes: No limits or co-payments for PMB level care and/or for emergency
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
General Appliances:
  • In-hospital: R8,390 per family
  • Out-of-hospital:
  • R29,600 per family, from day-to-day benefit
1.1. Hearing Aids:
  • R8,950, from above limit
1.2. Wheelchairs:
  • See above
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:
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.

Medication Benefit (2024):

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

Momentum: Extender (State provider for chronic)
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings:
  • R24,588
  • R20,181
  • R7,215
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R8,812
  • R8,819
  • R2,385
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • Unlimited
  • Unlimited
  • Unlimited
Chronic:
  • 36 additional conditions, R12,400 per family
  • Use State facilities for your chronic script, medication and treatment
 You might be required to use specific pharmacies and be limited to specific medicines
Acute (presrcibed) medication:
  • R21,100 per person and R40,000 per family. Paid from day-to-day benefit
Over-the-counter:
  • From day-to-day benefit. Does not accumulate to threshold
Birth Control:
  • From day-to-day benefit
On Discharge:
  • 7 days supply
Biological:
    .
 Treatment that is required (by law) for PMB conditions is always paid paid by scheme, with no co-payment, if you follow the protocols. More info here.)
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:
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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