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We’ve partnered with Momentum to offer our members affordable medical aid solutions for the South African market. There are three medical aid cover plans available and each plan provides a wide range of in-and-out of hospital benefits.
| Ingwe option | Evolve Option | Custom Option | |
|---|---|---|---|
| In-hospital Benefit | |||
| Hospitalisation | Hospital accounts are covered in full at the rate agreed upon with the hospital group. No overall annual limit applies. Specialists who treat you in hospital are covered up to 100% of the Momentum Medical Scheme Rate. | Associated specialists are covered in full. Other specialists are covered up to 100% of the Momentum Medical Scheme Rate. Hospital accounts are covered in full at the rate agreed upon with the hospital group. Certain procedures are covered in day facilitiesopen_in_new only. A co-payment of R1 740 applies and co-payments may also apply for certain specialised procedures and treatment. | Associated specialists are covered in full. Other specialists are covered up to 100% of the Momentum Medical Scheme Rate. Hospital accounts are covered in full at the rate agreed upon with the hospital group. No overall annual limit applies. A co-payment of R1 740 applies per admission and co-payments may also apply for certain specialised procedures and treatment. |
| Hospital provider | Any, Ingwe Network, or State | Evolve Network | Any, or Associated |
| Health Platform Benefit | |||
| Emergency Cover | Emergency evacuation in South Africa by Netcare 911. International emergency cover is not available on this option. | Emergency evacuation in South Africa by Netcare 911. International emergency cover by ISOS, covered up to R5 million per 90-day journey. | Emergency evacuation in South Africa by Netcare 911. International emergency cover by ISOS, covered up to R7.66 million per 90-day journey. |
| Preventative and early detection tests | We cover certain tests and vaccines and a free health assessment once a year. | We cover certain tests and vaccines and a free health assessment once a year. | We cover certain tests and vaccines and a free health assessment once a year. |
| Maternity programme detection tests | Women registered on our maternity programme get 7 antenatal visits which include a urine test and 2 pregnancy scans, and 1 visit to the paediatrician during the baby's first year, as well as a home visit from a nurse on the day after child-birth. | Women registered on our maternity programme get 2 doula visits, 12 antenatal visits which include a urine test, 2 pregnancy scans, certain pathology tests, and 2 visits to the paediatrician during the baby's first year. You also get a home visit from a nurse on the day after childbirth, and again after 2 weeks. | Women registered on our maternity programme get 2 doula visits, 12 antenatal visits which include a urine test, two pregnancy scans, certain pathology tests, and two visits to the paediatrician during the baby's first year. You also get a home visit from a nurse on the day after childbirth, and again after two weeks. |
| Day-to-day Benefit | |||
| Savings | There is no savings built into this option, but you can add HealthSaver+ | There is no savings built into this option, but you can add HealthSaver+ | There is no savings built into this option, but you can add HealthSaver+ |
| General practitioners | You have unlimited GP visits. From the 11th visit onwards, you need pre-authorisation from the Scheme for it to be covered. You also get 3 virtual consultations with a doctor on the GP Virtual Consultation Network, which includes Hello Doctor. | 2 Virtual consultations from a doctor on the GP Virtual Consultation Network, which includes Hello Doctoropen_in_new. If you need more GP visits, you can use HealthSaver+ if available. Sports injury treatment: 2 Physiotherapist or Biokineticist consultations per beneficiary, up to a limit of R1 000 per year, subject to authorisation. | GP visits are not covered. You will pay out of your pocket or you can use HealthSaver+ funds, if available. |
| Eye care | You get 1 eye test, 1 pair of clear standard or bi-focal lenses with standard frame, per beneficiary every 2 years. Spectacles will only be granted if your refraction measurement is more than 0.5. | Not covered. You will pay out-of-pocket or use HealthSaver+ funds, if available. | Not covered. You will pay out of your pocket or you can use HealthSaver+ funds, if available. |
| Dentistry | You get 1 basic dentistry consultation per beneficiary every year, plus extractions, fillings, and x-rays. Specialised dentistry, such as braces, is not covered by the Scheme. | Not covered. You will pay out-of-pocket or use HealthSaver+ funds, if available. | Basic dentistry: You can use HealthSaver+open_in_new funds, if available. Dental specialist accounts for extraction of impacted wisdom teeth in doctors’ rooms: Covered from Major Medical Benefit at 100% of the Momentum Medical Scheme Rate, subject to HealthSaver+ funds, if available.. |
| Medicine | Any prescribed medication from the list of medicine, referred to as the prescribed formulary. | Prescribed and over-the-counter medication not covered. You will pay out of your pocket or you can use HealthSaver+ funds, if available. | GP visits are not covered. You will pay out of your pocket or you can use HealthSaver+ funds, if available. |
| Mental health | Limited to Prescribed Minimum Benefits* at State facilities. | Not covered. You will pay out of your pocket or can use HealthSaver+, if available. | Not covered. You will pay out of your pocket or you can use HealthSaver+ funds, if available. |
| Specialist visits | 2 visits per family per year, limited to R1 220 per visit and up to a maximum of R2 440 per family per year. Covered at 100% of the Momentum Medical Scheme Rate. Subject to referral by your Ingwe Primary Care Network or Ingwe Active Network provider and pre-authorisation. Psychologists and psychiatrists are limited to Prescribed Minimum Benefits* at State facilities | Not covered. You will pay out of your pocket or can use HealthSaver+, if available. | Not covered. You will pay out of your pocket or can use HealthSaver+ funds, if available. |
| Day-to-day provider | Ingwe Primary Care Network or Ingwe Active Network | Any provider, subject to HealthSaver+ funds, if available. | Any provider, subject to HealthSaver+ funds, if available. |
| Chronic Benefit | |||
| Chronic cover | We cover 26 chronic conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies. | We cover 26 chronic conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies. | We cover 26 chronic conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies. |
| Chronic provider | Ingwe Primary Care Network or Ingwe Active Network | State | Any associated or state |
| Hello Doctor | |||
| Expert advice from real doctors | We give you a free subscription to Hello Doctor, where you can seek advice from a doctor, anytime, anywhere. Available 365/24/7. | We give you a free subscription to Hello Doctor, where you can seek advice from a doctor, anytime, anywhere. Available 365/24/7. | We give you a free subscription to Hello Doctor, where you can seek advice from a doctor, anytime, anywhere. Available 365/24/7. |
