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 | ||
|
There is no overall annual limit for hospitalisation. For your hospitalisation |
The Evolve Option provides cover for hospitalisation at the Evolve Network of private hospitals. There is no overall annual limit for hospitalisation. A co-payment of R2 000 per authorisation applies to Major Medical Benefits including for non-emergency Prescribed Minimum Benefits, except for motor vehicle accidents, maternity confinements, emergency treatment and when you involuntarily use a non-designated Service Provider. An additional co-payment may apply for certain specialised procedures |
The Custom Option provides cover for hospitalisation at private hospitals. There is no overall annual limit for hospitalisation. You can choose to have access to any hospital or you can choose to save on your monthly contribution by selecting to use a specific list of private hospitals (referred to as Associated hospitals, A co-payment of R2 000 per authorisation applies to Major Medical Benefits including for nonemergency Prescribed Minimum Benefits, except for motor vehicle accidents, maternity confinements, emergency treatment and when you involuntarily use a non-designated Service Provider. |
| Hospital provider | ||
|
There is no overall annual limit for hospitalisation. For your hospitalisation cover, you can choose to use either the Connect Network of private hospitals, the Ingwe Network of private hospitals, or Any hospital. |
The Evolve Option provides cover for hospitalisation at the Evolve Network of private hospitals (see page 40 for this list). There is no overall annual limit for hospitalisation. A co-payment of R2 000 per authorisation applies to Major Medical Benefits including for non-emergency Prescribed Minimum Benefits, except for motor vehicle accidents, maternity confinements, emergency treatment and when you involuntarily use a non-designated Service Provider. An additional co-payment may apply for certain specialised procedures |
The Custom Option provides cover for hospitalisation at private hospitals. There is no overall annual limit for hospitalisation. You can choose to have access to any hospital or you can choose to save on your monthly contribution by selecting to use a specific list of private hospitals (referred to as Associated hospitals. A co-payment of R2 000 per authorisation applies to Major Medical Benefits including for nonemergency Prescribed Minimum Benefits, except for motor vehicle accidents, maternity confinements, emergency treatment and when you involuntarily use a non-designated Service Provider.a |
| Health Platform Benefit | ||
| Emergency Cover | ||
| Emergency medical transport in South Africa by Netcare 911. No annual limit applies |
R5 000 000 per beneficiary per 90-day journey. This benefit includes R15 500 for emergency optometry, R15 500 for emergency dentistry and R765 000 terrorism cover. A R2 280 co-payment applies per emergency out-patient claim |
R7 660 000 per beneficiary per 90-day journey. This benefit includes R15 500 for emergency optometry, R15 500 for emergency dentistry and R765 000 terrorism cover A R2 280 co-payment applies per emergency out-patient claim |
| Preventative and early detection tests | ||
|
Preventative care includes:
Flu vaccines Early detection tests Health assessment: Blood pressure test, Cholesterol and Blood sugar (finger prick tests), height, weight and waist circumference All principal members and adult beneficiaries Once a year Preventative dental care covered up to R500 per beneficiary at any dental provider Pap smear (pathologist) Pap smear (pathologist) – Standard or LBC (Liquid based cytology) or – HPV PCR screening test (If result indicates high risk, then a follow-up LBC is also covered) General physical examination (GP* consultation) Prostate specific antigen (pathologist) Cholesterol test (pathologist)** Blood sugar test (pathologist)*** HIV test (pathologist)
Health line |
Preventative care includes: Baby immunisations (On Ingwe Option, baby immunisations are covered in private facilities for baby’s first year, limited to R3 100. Once the limit is reached, immunisations are available at the Department of Health baby clinics Flu vaccines Tetanus diphtheria injection Pneumococcal vaccine
Early detection tests include: Health assessment: Blood pressure test, Cholesterol and Blood sugar (finger prick tests), height, weight and waist circumference All principal members and adult beneficiaries Once a year Preventative dental care covered up to R500 per beneficiary at any dental provider Pap smear consultation (nurse, GP* or gynaecologist) Pap smear (pathologist) Pap smear (pathologist) – Standard or LBC (Liquid based cytology) or – HPV PCR screening test (If result indicates high risk, then a follow-up LBC is also covered) Mammogram FIT (Faecal immunochemical testing) test DEXA bone density scan (radiologist, GP* or specialist) General physical examination (GP* consultation) Prostate specific antigen (pathologist) Cholesterol test (pathologist)** Blood sugar test (pathologist)*** Glaucoma test HIV test (pathologist) |
Preventative care includes: Baby immunisations (On Ingwe Option, baby immunisations are covered in private facilities for baby’s first year, limited to R3 100. Once the limit is reached, immunisations are available at the Department of Health baby clinics Flu vaccines Tetanus diphtheria injection Pneumococcal vaccine
Early detection tests include: Health assessment: Blood pressure test, Cholesterol and Blood sugar (finger prick tests), height, weight and waist circumference All principal members and adult beneficiaries Once a year Preventative dental care covered up to R500 per beneficiary at any dental provider Pap smear consultation (nurse, GP* or gynaecologist) Pap smear (pathologist) Pap smear (pathologist) – Standard or LBC (Liquid based cytology) or – HPV PCR screening test (If result indicates high risk, then a follow-up LBC is also covered) Mammogram FIT (Faecal immunochemical testing) test DEXA bone density scan (radiologist, GP* or specialist) General physical examination (GP* consultation) Prostate specific antigen (pathologist) Cholesterol test (pathologist)** Blood sugar test (pathologist)*** Glaucoma test HIV test (pathologist) |
| Maternity programme detection tests | ||
|
Maternity programme Nurse home visit Urine tests (dipstick) Pathology tests: Paediatrician visits |
Maternity programme Doula benefit Antenatal visits (Midwives, GP* or gynaecologist) Nurse home visit Urine tests (dipstick) Pathology tests – Blood group, full blood count and Rhesus factor, Creatinine, Glucose strip, Haemoglobin estimation, Urinalysis, Urine tests (microscopic exams, antibiotic susceptibility and culture) Scans Paediatrician visits |
Maternity programme Doula benefit Antenatal visits (Midwives, GP* or gynaecologist) Nurse home visit Urine tests (dipstick) Pathology tests – Blood group, full blood count and Rhesus factor, Creatinine, Glucose strip, Haemoglobin estimation, Urinalysis, Urine tests (microscopic exams, antibiotic susceptibility and culture) Scans Paediatrician visits |
| Day-to-day Benefit | ||
| Savings | ||
| Not applicable. You can choose to add the HealthSaver | Not applicable. You can choose to add the HealthSaver+ |
Not applicable. You can choose to add the HealthSaver+ |
| General practitioners | ||
|
There is no limit to the number of times you visit your network GP. However, please note all visits from the 11th visit onwards must be pre-authorised 3 virtual doctor consultations per beneficiary per year from the GP Virtual Consultation Network, which includes Hello Doctor. Consultations include scripting of medication where required |
You have cover for 2 virtual doctor consultations per beneficiary per year from the GP Virtual Consultation Network, which includes Hello Doctor. |
Subject to HealthSaver+ if available |
| Eye care | ||
|
1 eye test and 1 pair of clear standard or bi-focal lenses with standard frame as per formulary per beneficiary every 2 years. Spectacles will only be granted if your refraction measurement is more than 0.5 |
Subject to HealthSaver+ if available |
Subject to HealthSaver+ if available |
| Dentistry | ||
|
Examinations, fillings and x-rays as per the list of tariff codes. One dental consultation is covered per year per beneficiary. You need to call us for pre-authorisation if you have more than 4 fillings or 4 extractions |
Subject to HealthSaver+ if available |
Anaesthetist and 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 R2 000 co-payment and pre-authorisation Other specialised dentistry: Subject to HealthSaver+ if available |
| Medicine | ||
| Subject to a list of medicine, referred to as a prescribed formulary |
Subject to HealthSaver+ if available |
Subject to HealthSaver+ if available |
| Mental health | ||
| Limited to Prescribed Minimum Benefits at State facilities |
Limited to Prescribed Minimum Benefits at Evolve Network hospitals |
R47 300 per beneficiary |
| Specialist visits | ||
|
2 visits per family per year, limited to R1 425 per visit and up to a maximum of R2 850 per family per year. Covered at 100% of Momentum Medical Scheme Rate. Subject to referral and pre-authorisation. Psychologists and psychiatrists are limited to Prescribed Minimum Benefits at State facilities |
Subject to HealthSaver+ if available |
Subject to HealthSaver+ if available |
| Day-to-day provider | ||
| Ingwe Primary Care Network providers**, Ingwe Active Network providers** or State facilities |
Any provider |
Any provider |
| Chronic Benefit | ||
| Chronic cover | ||
| 26 conditions – no annual limit applies |
26 conditions – no annual limit applies |
26 conditions – no annual limit applies |
| Chronic provider | ||
|
Medical management including doctor, pharmacy, blood tests, x-rays, etc Ingwe Primary Care Network providers**, Ingwe Active Network providers** or State facilities |
Medical management including doctor, pharmacy, blood tests, x-rays, etc State facilities | Medical management including doctor, pharmacy, blood tests, x-rays, etc Any (Any GP and any pharmacy), Associated** (Selected preferred GPs and Medipost Courier pharmacy for chronic medication), or State facilities |
| Hello Doctor | ||
| Expert advice from real doctors | ||
| 3 virtual doctor consultations per beneficiary per year from the GP Virtual Consultation Network, which includes Hello Doctor. Consultations include scripting of medication where required | You have cover for 2 virtual doctor consultations per beneficiary per year from the GP Virtual Consultation Network, which includes Hello Doctor. | Subject to HealthSaver+ if available |
See Our Medical Aid Options
Ingwe Option
From R589 P/M
It’s an affordable, entry-level medical aid plan, but you can still enjoy hospital cover, day-to-day and chronic illness benefits when you use the network providers.
Terms and Conditions Apply
Evolve Option
From R1847 P/M
For digitally savvy individuals who are looking for affordable hospital cover and virtual GP visits, with the ability to manage their membership from their device in the comfort of their own home.
Terms and Conditions Apply
Custom Option
From R2353 P/M
The Custom Option is the medical aid plan to choose if you are looking for
an affordable hospital plan with customisable savings through HealthSaver+ and free preventative screening benefits.
Terms and Conditions Apply
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Momentum is a division of Momentum Metropolitan Life Limited, an authorised financial services provider (FSP 6406) and a wholly owned subsidiary of Momentum Metropolitan Holdings Limited.
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