Note: We are updating 2024 benefits as they are released. Some plans show old benefits until schemes release new plans.

Momentum Summit:
in-and-out of hospital benefits (2024)


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Monthly Costs:

Summit 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R13,573
  • R10,855
  • R3,118
  • Only pay for 3 children
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
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:♦️
Inhospital | 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
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In-hospital Procedures for 2024:

Momentum: Summit
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • 300% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 300% scheme rate
Hospital Choice:
  • Any hospital
Day Hospitals:
Penalty for using other hospital:
  • n/a
Other Co-payments:
  • n/a
Specialised Radiology:
  • MRI and CT scans, (MRCP), whole body radioisotope and PET scans: R2,770 co-payment, in and out of hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
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:
  • Unlimited
Exclusions:
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:♦️
Inhospital | 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
.
.
.

Out-of-hospital Procedures for 2024:

Momentum: Summit
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
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
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
Childcare:
  • Paediatrician: 2 consults, 0-12 months
  • Immunisations: Covered
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: R2,770 co-payment, in and out of hospital
Supplementary Services: (Physio, etc)
  • From day-to-day benefit
General Appliances:
  • In-hospital: R8,390 per family
  • Out-of-hospital:
  • R36,500 per family, from day-to-day benefit
1.1. Hearing Aids:
  • R21,100, 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:♦️
Inhospital | 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
.

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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Medication Benefit for 2024:

Momentum: Summit
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
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
Chronic:
  • Otherwise, from day-to-day benefit
  • Use State facilities for your chronic script, medication and treatment
Acute (presrcibed) medication:
  • R24,400 per person and R40,200 per family. Paid from day-to-day benefit
Over-the-counter:
  • No benefit
Birth Control:
  • See Acute Benefit
On Discharge:
  • 7 days supply
Biological: .
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:♦️
Inhospital | 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
.

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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