Momentum Incentive State (for chronic):
cancer, maternity and mental health (2025)

This page has information on: Costs, Maternity, Oncology, Mental Health for Momentum Incentive (State provider for chronic)

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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)

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

Cancer/ Oncology benefits (2025):

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

Momentum: Incentive (State provider for chronic)
Assume scheme pays all these costs, unless otherwise stated
Overall cancer coverage (in and out of hospital):	R400,000 per person, then a 20% co-payment Note: Most cancers are PMBs, and treatment is paid in full by scheme. More info here Most schemes require use of specific providers (DSPs) for oncology treatment.	Gap Cover: Can cover the penalty in full (Plans coming soon)

Maternity benefits (2025):

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

Momentum: Incentive (State provider for chronic)
Assume scheme pays all these costs, unless otherwise stated
Hospital stay:	Contracted Specialists: Covered in full, otherwise 200% scheme rate Usually covered for 2 nights for natural birth, and 3 nights for C-sections. All newborns receive immediate full medical aid cover at birth, even if parents are on a waiting period.	Gap Cover: Can cover most shortfalls (Plans coming soon)
Consultations:	Paid by scheme Consults: 12 consults Lactation consult: 1 consult 1 consult from nurse home visit, day after return from hospital 1 consult from nurse home visit, 2 weeks after above visit Antenatal classes: R410
Scans:	2 x 2D scans
Note:	If you are pregnant and don't have medical aid, your pregnancy will most likely be excluded for new cover, but your baby will be covered from birth. Read more about pregnancy cover if you don't have medical aid.

Mental Health benefits (2025):

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

Momentum: Incentive (State provider for chronic)
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:	Main Member: Adult: Child: Savings: R5,016 R3,948 R1,980 Other Day-to-Day Funds:
FYI:	Mental Health PMB conditions are covered for in and out of hospital treatment, even on "hospital" plans. For a full list see here. Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts. Scheme will pay this in full, if you use a DSP.
In-hospital:	PMBs: Covered in full at DSP, up to 21 days admission, from below limit first Alcoholism/Drug Addiction: 21 days admission, from below limit first Otherwise, R48,400 per person	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Out-of-hospital:	PMBs: 10+ consults, paid by scheme Otherwise, paid from day-to-day benefit
Other:	Traumatic event claims: 6 counselling sessions per person per year, for the year in which the trauma event occurred and the year after

Important!
• Unless specified, assume that all benefits are paid at 100% scheme rate.
• No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
• "Unlimited" benefits are still subject to authorisation, protocols and sublimits.
• Assume that all benefits need to be pre-authorised.