• Benefits, in-hospital, Momentum Plan, out-hospital, Scheme Plans

Momentum Summit:
in-and-out of hospital benefits (2025)

Contents:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Momentum Summit. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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)

Momentum:Summit (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R16,469
  • R13,075
  • R3,756
Savings:
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R34,500
  • R34,500
  • R34,500
Children Rates:
  • Under 21yrs
  • Only pay for 3 children
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In-hospital Procedures (2025):

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

Momentum: Summit
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: 300% 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
Note:
  • 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, especially if you don't use a DSP 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:
  • Unlimited
Exclusions:
  • 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: R72,000 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: Summit
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
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.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R31,300
  • R31,300
  • R31,300
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)
Specialist 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)
  • R9,420 per family, from day-to-day benefit
General Appliances:
  • In-hospital: R8,830 per family
  • Out-of-hospital:
  • R38,400 per family, from day-to-day benefit
1.1. Hearing Aids:
  • R22,200, from above limit
1.2. Wheelchairs:
  • See above
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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 (2025):

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

Momentum: Summit
Assume scheme pays all these costs, unless otherwise stated
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.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • R31,300
  • R31,300
  • R31,300
Other Day-to-Day Funds:
Chronic:
  • Otherwise, from day-to-day benefit
  • Use State facilities for your chronic script, medication and treatment
Acute (prescribed) medication:
  • R25,700 per person and R42,300 per family. Paid from day-to-day benefit
Over-the-counter:
  • No benefit
Birth Control:
  • See Acute Benefit
On Discharge:
  • 7 days supply
Biological: .
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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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How to choose the right Medical Aid plan
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