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Benefits and coverage offered by the Ingwe option 2025

CX Experts
Updated

This document details the Momentum Ingwe Option for 2025, optimized for AI readability.

I. Overview:

The Ingwe Option provides affordable entry-level health coverage. Members select a hospital network (Connect, Ingwe, or Any), influencing chronic care and day-to-day benefit access. Virtual GP consultations and a Health Platform Benefit are included. Momentum HealthSaver+ and Momentum Multiply are optional add-ons (offered by Momentum, a separate entity). Benefits and contributions are subject to regulatory approval. Scheme Rules prevail.

Overall day-to-day Benefits:

The overall day-to-day limit for the Ingwe Option is R31,300 per beneficiary for 2024.

II. Core Benefits:

A. Major Medical Benefit (Hospitalization):

There is no overall annual limit for hospitalisation. This benefit provides cover for hospitalisation and certain specialised procedures/treatment at either the Connect Network of private hospitals, the Ingwe Network of private hospitals or Any hospital, depending on the provider you have chosen. Claims are paid up to 100% of the Momentum Medical Scheme Rate. Under the hospitalisation benefit, hospital accounts and related costs incurred in hospital (from admission to discharge) are covered – provided that treatment has been authorised.

  • Network: Connect, Ingwe, or Any.
  • Limit: No overall annual limit.
  • Rate: Up to 100% of Momentum Medical Scheme Rate.
  • Pre-authorization: Required. Some conditions require health management program registration.
  • Sub-limits (Annual):
    • High/Intensive Care: 10 days per admission.
    • Renal Dialysis: PMBs at State facilities.
    • Oncology: PMBs, network-specific providers.
    • Organ Transplants: PMBs, network-specific providers.
    • Mental Health: PMBs at State facilities.
    • MRI, CT, Specialized Scans: PMBs, network-specific providers.
    • Take-Home Medicine: 7 days.
    • Rehabilitation: R16,700 per beneficiary.
    • HIV-related: R40,500 per family (preferred providers), R41,000 per family (chosen provider).
    • Emergency Transport (Netcare 911): No limit.
    • Specialized Procedures: See Member brochure.

B. Chronic Benefit:

  • Network: Ingwe Primary Care, Ingwe Active, or State.
  • Conditions: 26 (Chronic Disease List per PMBs).
  • Formulary: Network-specific.
  • Requirement: Registration and approval.

C. Day-to-Day Benefit (Outpatient):

  • Network:
    • Connect: State facilities.
    • Ingwe: Ingwe Primary Care.
    • Any: Ingwe Active.
  • Virtual GP Consultations: 3 per year.
  • Out-of-Network GP: 1 per beneficiary per year (max 2 per family per year), authorization & co-pay.
  • Specialists: 2 per family per year, limits apply, referral required.
  • Optical: 1 test & standard lenses/frame every 2 years (criteria apply).
  • Pathology, Radiology: Specific lists.
  • Medication: Formulary.
  • Other Therapies (Acupuncture, etc.): PMBs at State facilities.

You have unlimited GP visits from the Ingwe Primary Care Network or Ingwe Active Network or State, depending on your choice of provider. From the 11th visit onwards, you’ll need pre-authorisation from the Scheme for it to be covered. You also get 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.

D. Health Platform Benefit (Preventative Care):

  • Network: Varies per service, generally Primary Care Network (Ingwe/Any) or any provider (Connect).
  • Benefits:
    • Baby Immunizations: First year.
    • Flu Vaccine: Eligible beneficiaries.
    • Dental: R380 per year.
    • Pap Smear: Women 15+.
    • Physical Exam: Age-based frequency.
    • Prostate Exam: Men 40+.
    • Health Assessment: Annually.
    • Cholesterol, Blood Sugar Tests: Criteria apply.
    • HIV Test: Every 5 years (15+).
  • Maternity Program (Registration required 8-20 weeks):
    • Antenatal Visits: 7.
    • Nurse Home Visit: 1.
    • Urine Tests: Included in antenatal.
    • Pathology Tests: Specific tests.
    • Scans: 2.
    • Pediatrician Visit: 1 (baby's first year).
  • Health Line: 24/7 advice.

III. Network Information:

  • Provider Lists: momentummedicalscheme.co.za
  • Contact: WhatsApp or Phone 0860 11 78 59

IV. Momentum (Separate Entity):

Momentum offers additional products (HealthSaver+, Multiply) but is distinct from the medical scheme. These are not medical scheme benefits.

V. Disclaimer:

Benefits and contributions subject to change. Scheme Rules prevail.

Ingwe Option: Income Definition and Contribution Calculation

Contribution Calculation Based on Income

For members enrolled in the Ingwe Option, contribution calculations are determined by the higher gross income between you and your spouse or partner, provided they are included in your membership. If both you and your spouse/partner are covered under the same membership, the greater of the two incomes will be used to establish the required contribution amount.

To process applications for membership or any changes to benefit options, it is mandatory to complete the Declaration of Income form. This form requires details on your income sources and your income tax reference number. Failure to provide this information will result in the inability to proceed with your application.

Definition of Income

For contribution calculations, income is defined as any amount received by or due to you, your spouse, or your partner (if they are included in your membership). This definition ensures a comprehensive evaluation of your financial situation and includes various sources of income:

  1. Employment Income

    • Average salary, commission, or bonuses earned over the past 12 months from employment or self-employment.

    • Income from formal and informal sector employment.

    • Earnings from services or goods provided, including part-time jobs, contract work, freelancing, or temporary positions.

  2. Investment and Passive Income

    • Interest income and dividends received.

    • Rental income from leased properties or assets.

  3. Retirement and Social Assistance Income

    • Payments from pension funds, provident funds, retirement annuities, or any other annuities.

    • Distributions from discretionary or vested trusts.

    • Social assistance grants, including old-age pensions and disability grants.

  4. Other Sources

    • Any other income received by you, your spouse, or partner that contributes to your financial resources.

Proof of Income Requirements

To validate income declarations, specific documents must be submitted for both you and your spouse or partner if they are included in your membership:

  1. Employed Individuals

    • Most recent payslip or IRP5 certificate.

    • If income fluctuates, copies of the last three months’ payslips.

  2. Individuals Earning from Services or Goods

    • Last three months’ bank statements from all accounts.

    • Affidavit confirming employment status and that these are the only bank accounts.

  3. Self-Employed Individuals

    • Latest audited financial statements of the business.

    • Last three months’ bank statements for both personal and business accounts.

    • Affidavit confirming self-employment status and that these are the only bank accounts.

  4. Unemployed Individuals

    • Proof of UIF registration.

    • Last three months’ bank statements.

    • Affidavit stating unemployment status and that these are the only bank accounts.

  5. Students

    • Proof of full-time enrollment at a registered academic institution.

  6. Pensioners

    • Documentation proving annuity or pension income (e.g., a letter from SASSA).

    • Last three months’ bank statements.

    • Affidavit confirming pensioner status and that these are the only bank accounts.

One-Time Payments and Adjustments

If a one-time payment, such as a bonus, is included in the three months’ payslips submitted, it will not be factored into the income calculation. Additional payslips may be requested if this information is not sufficiently represented within the submitted documents.

 

Ingwe Option: Optometry Benefit Details

1. Eligibility & Frequency of Benefits

  • Every beneficiary under the Ingwe Option is entitled to:

    • One comprehensive eye examination (eye test) every two years to assess eye health and vision correction needs.

    • One pair of spectacles (frame + lenses) every two years to support vision correction.

2. Spectacles & Lenses Provided

  • Members can choose from a designated range of frames under this benefit.

  • If selecting a frame outside this range, members must pay the difference in cost.

  • Lenses provided:

    • Standard white CR39 lenses (single vision or bi-focal).

    • Lens type is determined based on the required vision correction.

3. Qualifying Criteria

  • The optometry benefits apply only if:

    • The member uses an Ingwe Primary Care Network Optometrist.

    • The member’s refraction measurement exceeds 0.5 (required for spectacle and lens benefits).

4. Exclusions & Additional Costs

  • Not covered under this benefit:

    • Sunglasses, tinted lenses, hard coatings, and contact lenses.

  • Any upgrades or additional services outside the stated benefits must be paid for by the member.

Ingwe Option - Individual Contributions for 2025

This health insurance plan includes comprehensive coverage with essential services such as Hospital Care, Chronic Care, and Day-to-Day Medical Needs. Contributions are categorized into Principal (P), Adult (A), and Child (C) segments.

Monthly Income Range: R0 - R1,500

Hospital

  • Connect Network: P - R985, A - R985, C - R275

  • Ingwe Network: P - R589, A - R589, C - R531

  • Any: P - R589, A - R589, C - R589

Chronic

  • State: P - R985, A - R985, C - R275

  • Ingwe Primary Care Network: P - R589, A - R589, C - R531

  • Ingwe Active Network: P - R589, A - R589, C - R589

Day-to-Day

  • State: P - R985, A - R985, C - R275

  • Ingwe Primary Care Network: P - R589, A - R589, C - R531

  • Ingwe Active Network: P - R589, A - R589, C - R589

 

Monthly Income Range: R1,501 - R9,000

Hospital

  • Connect Network: P - R1,143, A - R1,143, C - R299

  • Ingwe Network: P - R1,296, A - R1,296, C - R593

  • Any: P - R1,684, A - R1,684, C - R668

Chronic

  • State: P - R1,143, A - R1,143, C - R299

  • Ingwe Primary Care Network: P - R1,296, A - R1,296, C - R593

  • Ingwe Active Network: P - R1,684, A - R1,684, C - R668

Day-to-Day

  • State: P - R1,143, A - R1,143, C - R299

  • Ingwe Primary Care Network: P - R1,296, A - R1,296, C - R593

  • Ingwe Active Network: P - R1,684, A - R1,684, C - R668

 

Monthly Income Range: R9,001 - R11,950

Hospital

  • Connect Network: P - R1,492, A - R1,492, C - R372

  • Ingwe Network: P - R1,650, A - R1,650, C - R618

  • Any: P - R2,355, A - R2,355, C - R712

Chronic

  • State: P - R1,492, A - R1,492, C - R372

  • Ingwe Primary Care Network: P - R1,650, A - R1,650, C - R618

  • Ingwe Active Network: P - R2,355, A - R2,355, C - R712

Day-to-Day

  • State: P - R1,492, A - R1,492, C - R372

  • Ingwe Primary Care Network: P - R1,650, A - R1,650, C - R618

  • Ingwe Active Network: P - R2,355, A - R2,355, C - R712

 

Monthly Income Range: R11,951 - R17,000

Hospital

  • Connect Network: P - R1,609, A - R1,609, C - R400

  • Ingwe Network: P - R2,266, A - R2,266, C - R667

  • Any: P - R3,208, A - R3,208, C - R748

Chronic

  • State: P - R1,492, A - R1,492, C - R372

  • Ingwe Primary Care Network: P - R2,266, A - R2,266, C - R667

  • Ingwe Active Network: P - R3,208, A - R3,208, C - R748

Day-to-Day

  • State: P - R1,492, A - R1,492, C - R372

  • Ingwe Primary Care Network: P - R2,266, A - R2,266, C - R667

  • Ingwe Active Network: P - R3,208, A - R3,208, C - R748

 

Monthly Income Range: R17,001 - R22,400

Hospital

  • Connect Network: P - R2,620, A - R2,620, C - R595

  • Ingwe Network: P - R3,252, A - R3,252, C - R958

  • Any: P - R4,117, A - R4,117, C - R1,195

Chronic

  • State: P - R2,620, A - R2,620, C - R595

  • Ingwe Primary Care Network: P - R3,252, A - R3,252, C - R958

  • Ingwe Active Network: P - R4,117, A - R4,117, C - R1,195

Day-to-Day

  • State: P - R2,620, A - R2,620, C - R595

  • Ingwe Primary Care Network: P - R3,252, A - R3,252, C - R958

  • Ingwe Active Network: P - R4,117, A - R4,117, C - R1,195

 

Monthly Income Range: R22,401+

Hospital

  • Connect Network: P - R3,014, A - R3,014, C - R685

  • Ingwe Network: P - R3,265, A - R3,265, C - R962

  • Any: P - R4,134, A - R4,134, C - R1,199

Chronic

  • State: P - R3,014, A - R3,014, C - R685

  • Ingwe Primary Care Network: P - R3,265, A - R3,265, C - R962

  • Ingwe Active Network: P - R4,134, A - R4,134, C - R1,199

Day-to-Day

  • State: P - R3,014, A - R3,014, C - R685

  • Ingwe Primary Care Network: P - R3,265, A - R3,265, C - R962

  • Ingwe Active Network: P - R4,134, A - R4,134, C - R1,199

 

Ingwe Option – Network Hospitals

1. Ingwe Active Primary-Care Providers

  • Members have the freedom to visit any hospital of their choice.

  • This option provides maximum flexibility in accessing healthcare services.

  • Members are not restricted to a specific hospital network, ensuring they can receive medical care at any facility that suits their needs.

2. Ingwe Primary-Care Providers

  • Members must use designated Ingwe Network hospitals or state hospitals for hospitalization.

  • A list of Ingwe Network hospitals can be accessed at this link:
    Ingwe Network Hospital List.

  • This structured approach ensures that members receive treatment within a controlled, cost-effective environment while still providing variety and accessibility.

The Ingwe Option under the Momentum Chronic Benefit for 2025 provides coverage for chronic conditions through the Ingwe Primary Care Network, Ingwe Active Network, or State facilities.

Conditions Covered

The Ingwe Option covers 26 chronic conditions as listed in the Prescribed Minimum Benefits (PMB).

Annual Limit

There is no annual limit on chronic benefits under this option, but coverage is subject to the formulary.

How to Obtain Chronic Benefits

  1. Provider

    • Members must use Ingwe Primary Care Network, Ingwe Active Network, or State facilities for chronic treatment.

  2. Chronic Prescription

    • Must be obtained from a designated GP within the Ingwe network.

  3. Chronic Medication

    • Medication must be sourced from Medipost pharmacy.

    • If opting for State cover, both the prescription and medication must be obtained from a State facility.

Formulary Structure for Ingwe Option

  1. Fixed Formulary applies to Ingwe Primary Care Network and Ingwe Active Network.

  2. Preferred Products are covered up to the Momentum Reference Price.

  3. Non-Preferred Products are not covered under this option.

Chronic Medication Registration Process for Ingwe Option

  1. Requesting Chronic Benefits

    • The treating GP within the Ingwe network or Medipost pharmacist must contact Momentum Medical Scheme at 0860 11 78 59.

  2. Evaluation Process

    • A Chronic Benefit Consultant assesses the request and approves or declines it via phone.

    • If necessary, relevant medical test results may be requested from the provider.

  3. Medication Collection

    • Once approved, medication is collected from Medipost Pharmacy or, if using State cover, from a State facility.

  4. Prescription Renewal

    • A renewed prescription must be submitted every 6 months to maintain access to chronic medication.

This is the full, detailed breakdown of the Ingwe Option under the Momentum Chronic Benefit for 2025.

For the Ingwe Option under the Momentum Oncology Management Programme 2025, the following details are relevant:

Accessing Oncology Benefits

  1. Consultation: Members must consult with a qualified oncologist or hematologist.

  2. Treatment Plan Submission:

    • The treating healthcare provider submits a treatment plan for pre-authorization.

  3. Documentation Submission:

    • The oncologist must submit histology, pathology, and/or radiology reports.

    • The treatment plan must include ICD-10 codes.

  4. Review Process:

    • The Oncology Team will review the request and may request further details if needed.

  5. Response Time:

    • Approval or response is given within 2 to 3 working days.

Annual Limits

  • Ingwe Primary Care/Active:

    • Limit: Oncology benefits are covered as Prescribed Minimum Benefits (PMB) but are only available at state facilities.

  • Ingwe Connect:

    • Limit: PMB benefits available at Connect Network hospitals for approved in-patient care.

    • Out-Patient Oncology Services: Require consultation with ICON oncologists.

Providers

  • Ingwe Primary Care/Active: Treatment and care are only provided at state facilities.

  • Ingwe Connect:

    • Oncology care is available through ICON Network providers.

    • Medication is sourced from Medipost Pharmacy.

    • Non-network providers: Members who use non-network providers will pay an additional 20% of costs.

Treatment Types

  • Active Treatment: Includes chemotherapy, radiotherapy, and necessary medical materials. Pre-authorization is required.

  • Non-Active Treatment: Follow-up care and hormonal therapy are covered after initial treatment, subject to pre-authorization.

Exclusions

  • Any treatments outside SAOC/ICON guidelines.

  • Certain medications may not be covered.

  • Reconstruction surgery is not covered under the oncology benefit.

Avoiding Co-Payments

To minimize out-of-pocket expenses:

  • Use network providers (state facilities for Ingwe Primary Care/Active and ICON Network for Ingwe Connect).

  • Request generic medications where applicable.

  • Ensure correct ICD-10 codes are used in all claims.

Prescribed Minimum Benefit (PMB) Qualification

  • Not all oncology treatments qualify under PMB.

  • Non-PMB treatments are not covered under the Ingwe Option.

Contact Information

For oncology-related questions and approvals:

Support Centers

For additional cancer support:

  • Cancer Association of South Africa (CANSA)

  • People Living With Cancer (PLWC)

  • Reach for a Dream

  • The Sunflower Fund

    • Phone: 0800 12 10 82

This covers all the details related to the Ingwe Option in Momentum's Oncology Management Programme for 2025.

Access to Health Platform Benefits

  • Primary Care Network: Health Platform Benefits are accessible only through a Primary Care Network provider.

  • Certain benefits like health assessments, maternity program benefits, and baby immunizations can be accessed at any healthcare provider.

  • IngweConnect Network members can access Health Platform benefits from any provider.

Preventative Care Benefits

  1. Baby Immunizations:

    • Coverage: For children up to 6 years old, as per Department of Health guidelines.

    • Ingwe Option: Coverage of up to R2,950 for private facilities during the first year. After this, immunizations are available at Department of Health baby clinics.

  2. Flu Vaccines:

    • Coverage: For children (6 months to 5 years), beneficiaries aged 60 and older, and high-risk individuals.

    • Applicable to: All options, including Ingwe.

  3. Tetanus Diphtheria Injection:

    • Coverage: Available as needed.

    • Applicable to: All options, including Ingwe.

  4. Pneumococcal Vaccine:

    • Eligibility: Beneficiaries aged 60 and older, and high-risk individuals.

    • Frequency: Once a year.

    • Applicable to: Evolve, Custom, Incentive, Extender, and Summit options (not specifically mentioned for Ingwe).

Early Detection Tests

  1. Preventative Dental Care:

    • Coverage: Up to R380 per beneficiary at dentists, dental therapists, or oral hygienists.

    • Frequency: Once a year.

    • Applicable to: All options, including Ingwe.

  2. Pap Smear Consultation:

    • Eligibility: Women aged 15 and older.

    • Frequency: Once a year.

    • Ingwe Option: Consultation with a nurse or GP.

  3. Pap Smear (Pathologist):

    • Eligibility: Women aged 15 and older.

    • Frequency: Once a year (standard or liquid-based cytology) or every three years (HPV PCR screening).

    • Applicable to: All options, including Ingwe.

  4. Mammogram:

    • Eligibility: Women aged 38 and older.

    • Frequency: Every two years.

    • Applicable to: Evolve, Custom, Incentive, Extender, and Summit options (not specifically mentioned for Ingwe).

  5. DEXA Bone Density Scan:

    • Eligibility: Beneficiaries aged 50 and older.

    • Frequency: Once every three years.

    • Applicable to: Evolve, Custom, Incentive, Extender, and Summit options (not specifically mentioned for Ingwe).

  6. General Physical Examination:

    • Eligibility:

      • Aged 21 to 29: once every five years.

      • Aged 30 to 59: every three years.

      • Aged 60 to 69: every two years.

      • Aged 70 and older: once a year.

    • Applicable to: All options, including Ingwe.

  7. Prostate Specific Antigen (Pathologist):

    • Eligibility: Men aged 40 and older.

    • Frequency: Based on age.

    • Applicable to: All options, including Ingwe.

  8. Health Assessment:

    • Coverage: Tests for blood pressure, cholesterol, blood sugar, height, weight, and waist circumference.

    • Frequency: Once a year for principal members and adult beneficiaries.

    • Applicable to: All options, including Ingwe.

  9. Cholesterol and Blood Sugar Tests (Pathologist):

    • Frequency: Once a year for principal members and adult beneficiaries.

    • Applicable to: All options, including Ingwe.

  10. Glaucoma Test:

  • Eligibility: Beneficiaries aged 40 to 49 (every two years), and 50 and older (annually).

  • Applicable to: Evolve, Custom, Incentive, Extender, and Summit options (not specifically mentioned for Ingwe).

  1. HIV Test (Pathologist):

  • Eligibility: Beneficiaries aged 15 and older.

  • Frequency: Once every five years.

  • Applicable to: All options, including Ingwe.

Maternity Programme

  1. Registration:

    • Women must register between 8 to 20 weeks of pregnancy to access the maternity program.

  2. Key Benefits:

    • Doula Benefit: Two visits per pregnancy (available for Evolve, Custom, Incentive, Extender, and Summit options; not specified for Ingwe).

    • Antenatal Visits:

      • Ingwe Option: Seven visits.

      • Other Options: Twelve visits.

    • Antenatal and Postnatal Classes:

      • 18-month online subscription or face-to-face classes.

      • Coverage: Up to R430 per pregnancy (for Incentive, Extender, and Summit options).

    • Lactation Specialist Consultation:

      • Initial online consultation covered under Incentive option.

      • Follow-up consultations covered under Extender and Summit options.

    • Nurse Home Visit: Available the day after returning from the hospital, with additional visits at specified intervals for all options, including Ingwe.

    • Urine Tests (Dipstick): Included in antenatal visits for all options, including Ingwe.

    • Pathology Tests: Various tests covered, including antiglobin, platelet count, and rubella antibody tests.

    • Pregnancy Scans:

      • Ingwe Option: Two scans.

      • Other Options: Coverage for up to three-dimensional and four-dimensional scans at the rate of two-dimensional scans.

    • Paediatrician Visits:

      • Ingwe Option: One visit during the first year.

      • Other Options: Two visits.

Health Line

  • Availability: A 24-hour emergency health advice line is available to all beneficiaries across all options, including Ingwe.

Pre-Notification Process

  • Members can manage pre-notification via:

    • The Momentum App.

    • Web chat feature on the website.

    • WhatsApp or calling 0860 11 78 59.

This covers all the details relevant to the Ingwe Option within the Momentum Health Platform Benefit for 2025.

Co-payments for Ingwe Option:

  1. Hospital Admissions:

    • No co-payment required for hospital admissions.

  2. In-Hospital Dentistry:

    • Covered at State facilities, limited to Prescribed Minimum Benefits (PMBs).

  3. Extraction of Impacted Wisdom Teeth:

    • Not covered under the Ingwe option.

  4. MRI and CT Scans:

    • Limited to PMBs at selected facilities.

Key Notes for Ingwe Option:

  • Pre-authorization:

    • Must be obtained at least 48 hours before hospital admissions or specialized treatments. Failure to obtain pre-authorization will result in a 30% co-payment on claims.

  • Emergency Situations:

    • In the event of an emergency, authorization can be obtained within 72 hours of admission.

  • Non-Network Providers:

    • If members use non-network hospitals or providers, a 30% co-payment will apply.

Additional Information:

  • Health Platform Benefits: Ingwe option members can access Health Platform Benefits only through a Primary Care Network provider.

  • Certain benefits such as health assessments, maternity program benefits, and baby immunizations are accessible at any healthcare provider.

  • HealthSaver+ Funds or Medical Savings may be used to pay for co-payments.

  • Members are encouraged to check their option details to understand which co-payments apply to their specific services.

  • Members can also access additional products offered by Momentum Group, but these are not covered as part of the medical scheme benefits.

Contact Information for Ingwe Option:

For more details or assistance, Momentum Medical Scheme members can contact Momentum via:

Vaccines Covered Under the Health Platform Benefit for the Ingwe Option:

  1. Infant Immunisations (Up to 1 Year):

    • Covered up to R2,950 at private facilities during the first year of life.

    • After the first year, vaccinations can be obtained at Department of Health baby clinics.

    Vaccines Covered for Infants (Under the Ingwe Option):

    • BCG Vaccine (SSI BCG Vaccine): Protection against Tuberculosis (TB) for infants.

    • OPV-Mérieux 20 Dose Vaccine: Protection against Polio virus via live oral vaccination.

    • OPV-Mérieux 10 Dose Plastic: Protection against Polio virus via live oral vaccine.

    • Rotarix Liquid Oral Vaccine: Protection against Rotavirus, which can cause severe diarrhea in infants.

    • Hexaxim Prefilled Syringe (0.5 ml): Protection against Diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (HIB).

    • Prevenar 13 (28 mcg/0.5 ml Prefilled): Protection against Pneumococcal infections.

    • Measbio Multi-Dose Powder Vial: Protection against Measles (injection form).

    • Measles Vaccine (Cipla Vial Powder): Protection against Measles (injection form).

  2. Flu Vaccines (Ingwe Option):

    • Influvac Tetra (Single Dose Pre): Protection against four strains of the flu virus.

    • Vaxigrip Tetra: Protection against four strains of the flu virus.

  3. Tetanus Vaccines (Ingwe Option):

    • Tetavac Prefilled Syringe: Protection against Tetanus infection.

  4. Pneumococcal Vaccines (Ingwe Option):

    • Prevenar 13 (28 mcg/0.5 ml Prefilled): Protection against Pneumococcal infections (also included in infant immunisations).

    Note: Pneumococcal vaccines are generally available under all options except the Ingwe Option, subject to certain criteria.

Important Notes for the Ingwe Option:

  • Primary Care Network Provider: The Ingwe Option benefits are only available through a Primary Care Network provider. This applies to health assessments, maternity benefits, and baby immunisations.

  • Health Platform Benefits: For other vaccines, health assessments, and maternity benefits, members must use the Primary Care Network provider.

  • Department of Health Baby Clinics: After the first year, vaccines can be obtained at Department of Health baby clinics.

  • Other Options: On other options within the Momentum Medical Scheme, members can use any healthcare provider, with Health Platform Benefits reimbursed by the Scheme up to a specified maximum rand amount.

General Notes:

  • Health Platform Benefits are governed by Scheme Rules, with some rules being specific to certain options and age groups.

  • The list of vaccines may change over time, as the Department of Health periodically updates the list of available vaccines.

  • Ingwe Option has a specific set of benefits and restrictions, including limits on vaccine coverage and the requirement to use designated Primary Care Network providers for certain services.

For more details about the Health Platform Benefits, members are encouraged to visit the official Momentum Medical Scheme website at momentummedicalscheme.co.za.

Here’s a detailed summary of the relevant changes for the Ingwe Option under Momentum Medical Scheme for 2025:

Ingwe Option Key Changes for 2025

Major Medical Benefits:

  • Increased Annual Sub-Limits for In-Hospital Benefits:
    The sub-limits for in-hospital benefits have been increased to provide better coverage.

  • Access to Ingwe Connect Network Hospitals:
    Members of the Ingwe Option will have access to Ingwe Connect Network hospitals for major medical benefits, which ensures a network of facilities for in-hospital care.

Chronic Benefits:

  • Primary Care and Active Network Providers:
    Chronic benefits must be obtained through the Ingwe Primary Care Network or Ingwe Active Network providers.

  • Chronic Care for Connect Network Members:
    Members in the Ingwe Connect Network must access chronic care through State facilities, which might limit their choice of healthcare provider for chronic conditions.

Day-to-Day Benefits:

  • Specialist Visits:
    Members are allowed two specialist visits per year, with an increased limit of R1,350 per visit and a total of R2,700 per family.

  • State Facilities for Day-to-Day Care:
    Day-to-day benefits, such as general consultations, must be accessed through State facilities, except for specialist visits, out-of-network visits, and virtual GP consultations.

Health Platform Benefits:

  • Baby Immunizations:
    The Ingwe Option covers baby immunizations up to R2,950 for the first year of life.

  • Enhanced Dental Coverage:
    There is enhanced coverage for preventative dental care up to R380 per beneficiary.

Contribution Income Bands:

  • Income Band Requirements:
    Contributions for the Ingwe Option are determined by income bands. Proof of income is required for those earning R22,401 per month or less.

Additional Information:

  • Limited Access to Healthcare Providers:
    Most day-to-day benefits must be accessed through State facilities, except in specific cases like specialist visits, out-of-network visits, and virtual consultations.

  • Focus on Primary and Active Network Providers:
    Chronic care is restricted to specific network providers (Primary Care Network or Active Network providers), which may affect member flexibility in accessing care.

For further details, members are encouraged to check the Momentum website or app.

Here’s the detailed summary of the HIV/Aids management programme relevant to the Ingwe Option under Momentum Medical Scheme:

HIV/Aids Management Programme for Ingwe Option Members

Enrollment in the Lifesense HIV Programme:

  • Who Needs to Register:
    Any member who receives a positive HIV test result is required to promptly enroll in the Lifesense HIV programme.

    • Pregnant Members: It is crucial for pregnant members to enroll as soon as they are aware of their HIV status to ensure the necessary measures are in place to protect their unborn child from contracting the virus.

  • HIV Elisa Test:
    The HIV Elisa test, used for screening, is covered under the Health Platform Benefit, but this benefit is only available through providers in the Ingwe Primary Care Network.

PEP (Post-Exposure Prophylaxis) Treatment:

  • Access to PEP:
    Members who have experienced potential exposure to the HIV virus (e.g., needle stick injury, sexual assault) can access post-exposure prophylaxis (PEP) treatment by contacting Lifesense.

Medication Access:

  • Anti-Retroviral (ARV) Medication for Ingwe Option Members:
    Members enrolled in the Ingwe Option can obtain their ARV medication through Medipost, which is the designated provider for this option.

How to Register:

  • Registration Process:
    The registration process is confidential and straightforward. Either the member or their treating physician should contact Lifesense using the contact details provided.

    • Lifesense Contact Details:

      • Tel: 0860 50 60 80

      • Fax: 0860 80 49 60

    • Lifesense will collaborate with the member’s healthcare providers to create a personalized treatment plan and provide ongoing education, support, and medication.

Annual Limits:

  • Management of Benefits:
    The Scheme will manage the annual limits associated with the HIV programme to ensure appropriate treatment and care.

Summary for Ingwe Option Members:

  • Enrollment in Lifesense Programme is Essential upon receiving a positive HIV test result.

  • HIV Elisa Test is covered under Health Platform Benefits but only through providers in the Ingwe Primary Care Network.

  • PEP Treatment is available for members who have had potential HIV exposure.

  • ARV Medication is available through Medipost.

  • Pregnant members should enroll early to ensure their child's safety.

For further details, Ingwe Option members should contact Lifesense directly using the contact information provided.

Here’s the detailed summary of specialized scans relevant to the Ingwe Option under Momentum Medical Scheme for 2025:

Specialized Scans for Ingwe Option Members

General Requirements for Specialized Scans:

  • Pre-authorization:
    Pre-authorization is required for all specialized scans, including MRI, CT, MRCP, whole body radioisotope, and PET scans, even if hospital admission has already been authorized. This ensures that necessary approvals are in place for smoother processes.

Coverage for Ingwe Option Members:

  1. Ingwe Connect Plan (Network Members):

    • MRI and CT scans:

      • Covered only under Prescribed Minimum Benefits (PMB) when performed at hospitals within the Ingwe Connect Network.

    • Other Specialized Scans (e.g., MRCP, PET, etc.):

      • Also covered under PMB, but scans must be performed at state facilities.

    • Important:
      To avoid out-of-pocket expenses, members must use services within the designated Ingwe Connect Network.

  2. Ingwe Network Hospitals or Any Hospital Options:

    • Specialized scans:
      Covered under Prescribed Minimum Benefits (PMB) when performed at state facilities.

    • Note:
      Members should be aware of the coverage parameters to ensure they receive full benefits for specialized scans.

Co-payment Details:

  • Co-payments for Non-Network Facilities:
    Members enrolled in the Ingwe Option need to ensure scans are conducted at in-network facilities to avoid additional out-of-pocket costs. The document does not specify further co-payment details for the Ingwe Option as it primarily covers Prescribed Minimum Benefits at state facilities.

2025 Amendments:

  • The benefit and contribution amendments for 2025 related to specialized scans have been submitted to the Council for Medical Schemes and are pending approval from the Regulator.

Summary for Ingwe Option Members:

  • Pre-authorization is required for all specialized scans.

  • MRI and CT scans are covered under PMB only if performed at hospitals within the Ingwe Connect Network.

  • Other specialized scans (e.g., MRCP, PET) are also covered under PMB, but only if performed at state facilities.

  • To avoid out-of-pocket expenses, members must use in-network providers.

Here’s the detailed summary of the Day-to-day Benefit relevant to the Ingwe Option under Momentum Medical Scheme:

Day-to-day Benefit for Ingwe Option Members:

Overview of Day-to-day Benefit:

  • The Day-to-day Benefit is designed to assist members with routine medical expenses, such as visits to healthcare professionals and the cost of prescribed medications. This benefit helps ensure that members can manage their health effectively without facing prohibitive out-of-pocket costs.

Accessing Day-to-day Benefits for Ingwe Option:

  • Members enrolled in the Ingwe Option can access their Day-to-day Benefits through healthcare providers that are part of the Ingwe Network or the Ingwe ActiveNetwork.

    • Ingwe Network: A network of approved providers and facilities for accessing routine healthcare services.

    • Ingwe ActiveNetwork: An extended network that offers additional flexibility in accessing day-to-day healthcare services.

General Benefit Structure for Ingwe Option:

  • The Day-to-day Benefit ensures that members enrolled in the Ingwe Option can access a wide range of healthcare professionals and facilities that are part of the Ingwe Network or Ingwe ActiveNetwork.

  • There is no mention of a Personal Medical Savings Account or similar structure for the Ingwe Option in the document. Instead, the benefit is likely managed through direct access to the network of approved providers.

Claims Process for Ingwe Option Members:

  • To submit claims for day-to-day expenses, members can take a photograph of the claim and upload it via the Momentum App.

  • Alternatively, claims can be submitted through:

Required Information for Claims:

When submitting a claim, members need to ensure they provide all necessary information clearly:

  • Membership number

  • Principal member’s name and surname

  • Patient’s name and surname

  • Treatment date

  • Amount charged

  • ICD-10 code, tariff code, and/or Nappi code

  • Service provider’s name and practice number

  • Proof of payment (if applicable)

This information helps expedite the claims process and ensures the member receives their benefits efficiently.

Summary for Ingwe Option Members:

  • Day-to-day Benefits are available through healthcare providers within the Ingwe Network or Ingwe ActiveNetwork.

  • Members can submit claims via the Momentum App, email, or postal service.

  • Claims should include detailed information like the membership number, patient details, and service provider information.

    1. Bipolar Affective Disorder and Schizophrenia (Chronic Disease List)

    • Medication: Benefits are available through applicable chronic network providers.

    • Doctors, Pathology, and Radiology: Limited to PMBs at State facilities.

    2. Depression, Acute Stress Disorder (with trauma), Alcohol and Drug Rehabilitation

    • Medication: No benefits provided under this option.

    • In-Hospital Care: Limited to PMBs at State facilities.

    • Out-of-Hospital Care: Limited to PMBs at State facilities.

    3. General Mental Health Benefit Rules

    • Designated Service Providers (DSP): Benefits are accessible only through Designated Service Providers in line with the benefit option.

    • Pre-Authorisation: Required for both inpatient and outpatient benefits.

    • Treatment Plan: Necessary from your treating physician.

    • Exclusions: Educational assessments, disability evaluations, forensic investigations, and marriage counseling are not included in the mental health benefit framework.

    4. Specific Rules for Conditions Under PMBs (Bipolar, Schizophrenia, Depression, etc.)

    • Pre-Authorisation Process: Required for both inpatient and outpatient care.

    • Treatment Plan: Must be submitted by the treating physician for evaluation and approval.

    5. Chronic Medication and Benefits:

    • Medication for bipolar affective disorder and schizophrenia is covered through applicable chronic network providers under the Chronic Disease List (CDL).

    • For depression, acute stress disorder, and substance abuse rehabilitation, medication is not covered, and in-hospital treatment is limited to PMBs at State facilities.

    6. Specific Care Providers:

    • The use of State facilities is required for some inpatient and outpatient care under the Ingwe option, especially for mental health treatments.

    This option includes coverage for chronic conditions like bipolar affective disorder and schizophrenia but limits most other mental health care to State facilities, and there are no benefits for outpatient psychotherapy or medications beyond chronic care.

The maternity program offered by Momentum Medical Scheme is comprehensive and provides a range of benefits to ensure that expectant mothers receive high-quality care during pregnancy and the postpartum period. Here’s an overview:

Registration:

  • When to Register: Start from the 8th week of pregnancy.

  • Methods to Register:

    • Momentum App

    • Website: momentummedicalscheme.co.za

    • WhatsApp or Helpline (0860 11 78 59)

Required Information for Registration:

  • Email address

  • Name, surname, and practice number of healthcare provider

  • Medical and surgical history

  • Expected delivery date

Key Features of the Program:

Partnership with BabyYumYum:

  • MyMomentum BabyYumYum Portal provides personalized support and information on parenthood.

  • Home visits from Momentum Wellness midwives for assistance with newborn care.

  • Benefits include:

    • Stylish nappy bags and vouchers for family meal delivery for higher options (Incentive, Extender, Summit).

    • Antenatal and postnatal support.

Antenatal and Postnatal Care:

  • Antenatal Visits:

    • Ingwe Option: 7 visits.

    • Evolve, Custom, Incentive, Extender, Summit: 12 visits.

    • Includes urine dipstick tests during visits.

  • Scans:

    • All options cover two pregnancy scans, with 3D/4D options for higher plans.

  • Pathology Tests:

    • Covered for various tests based on the option selected (blood tests, urine tests, etc.).

Postpartum Care:

  • Home Visits:

    • Nurses visit after childbirth; additional visits for higher options.

  • Baby Immunizations:

    • Covered for all members, with limits based on option.

  • Pediatrician Visits:

    • Ingwe: 1 visit.

    • Evolve, Custom, Incentive, Extender, Summit: 2 visits.

Doula and Maternity Coaches:

  • Doula Benefit:

    • 2 visits for Evolve, Custom, Incentive, Extender, and Summit options.

  • Maternity Coaches:

    • Support and guidance, especially for high-risk pregnancies.

BellyBabies Program:

  • Online antenatal and postnatal education and consultations with lactation specialists.

  • Coverage for video consultations and classes depending on the option.

Hello Doctor+:

  • 24/7 access to a healthcare professional via phone, tablet, or computer.

Adding Your Baby:

  • Newborn Registration:

    • Must be done within 30 days of birth for the baby to be added to the scheme.

Summary of Benefits per Option:

  • Ingwe Option: Limited visits, baby immunizations up to R2,800, 1 pediatrician visit.

  • Evolve and Custom Options: Includes additional benefits such as 12 antenatal visits, 2 pediatrician visits, and doula visits.

  • Incentive, Extender, and Summit Options: Full benefits, including family meal vouchers and an extended BellyBabies program.

For more details or to register, visit momentummedicalscheme.co.za or contact Momentum directly through the app or helpline.

What is the benefit?

  • Health Platform Benefits: These benefits promote health awareness, enhance quality of life, and provide peace of mind through various preventative care services. These include:

    • Early detection of health issues

    • Maternity program (supporting expecting mothers)

    • Health education and advice

    • Preventative services like dental consultations, pap smears, general physical examinations, and HIV tests (with pre-notification required for some).

Who is eligible?

  • Members of the Momentum Medical Scheme.

How often can these benefits be accessed?

  • Health Platform Benefits are generally available without the need for prior notification, except for specific services that require pre-notification.

On which option are these benefits available?

  • For members on the Ingwe Option, the Health Platform Benefits must be accessed through a chosen Network provider.

    • Exceptions for accessing the benefits outside of the Network provider:

      • Health assessments

      • Benefits related to the maternity program

      • Baby immunizations

    • These services can be obtained from any healthcare provider (not limited to the Network provider) and are covered up to R2,800 during the baby's first year of life.

Pre-notification required for the following services:

  • Dental consultations

  • Pap smears

  • General physical examinations

  • HIV tests

These services can be accessed through:

  • Momentum App

  • Web chat facility

  • Website: momentummedicalscheme.co.za

  • WhatsApp or phone: 0860 11 78 59 for assistance

 

Hello Doctor Service:

  • Free Medical Advice: Members of the Momentum Medical Scheme, including those on the Ingwe Option, can access Hello Doctor for free medical advice, available 24/7.

    • Access via: The Momentum App (tap the Hello Doctor icon to request a call from a doctor).

    • Alternatively, members can dial *120*1019# on any basic mobile phone to connect with a doctor.

    • No service fees or charges, as doctors return the call, and members do not need to use airtime.

    • Requires data or Wi-Fi connection.

Virtual Telehealth Consultations:

  • Available for a Fee: Virtual consultations are available for R265 per consultation, where doctors can diagnose and treat conditions, as well as electronically prescribe medications.

  • Free Consultations for Ingwe Members:

    • Ingwe Option members are entitled to three free virtual consultations per year.

    • Virtual consultations can be paid for using the HealthSaver+ account, medical savings account, or a credit/debit card.

Service Restrictions for Ingwe Members:

  • Members must follow the Scheme Rules, including using Designated Service Providers as per the Momentum Medical Scheme option.

  • Hello Doctor offers advice but not necessarily comprehensive care, so it is recommended to seek in-person consultations for concerning symptoms or medical emergencies.

Additional Information:

  • Momentum's Complementary Products: Momentum Metropolitan Holdings offers additional products that can enhance your medical aid experience. However, these are not considered medical scheme benefits and are separate from the Momentum Medical Scheme.

  • Being a member of the Momentum Medical Scheme does not require opting into these additional products.

Relevant Information for the Ingwe Option:

Prevention:

  • Members are encouraged to take advantage of the preventative screening tests available through the Health Platform Benefit to help avoid expensive medical treatments in the future.

Rates Charged by Providers:

  • Ingwe Option members should ensure they use healthcare providers that are part of the designated networks for general practitioners, dentists, and optometrists.

    • This ensures that the rates charged by these providers are in line with what the Ingwe Option covers, reducing out-of-pocket expenses.

  • For hospitalization, members should select the appropriate Network or Associated hospitals along with specialists affiliated with those hospitals to ensure fees align with coverage limits.

  • To find designated providers in their area, members can:

    • Log in to the Momentum App.

    • Visit momentummedicalscheme.co.za.

    • Contact the customer service through web chat, email (member@momentumhealth.co.za), WhatsApp, or call 0860 11 78 59.

Pharmacies:

  • Ingwe Option members should use pharmacies that are included in the Momentum Medical Scheme pharmacy list to avoid additional administration or dispensing fees on medications.

Generic vs. Original Medication:

  • Members are encouraged to ask their doctor or pharmacist about generic medications, which are usually much cheaper than brand-name drugs but offer the same therapeutic benefits. This switch can result in significant savings.

Get a Quote:

  • For high-cost treatments, particularly dental procedures, it is advised to request quotes from providers beforehand.

  • Members should also contact Momentum for pre-authorization before undergoing any procedures in hospitals or day surgery centers. This will help determine any potential co-payments or shortfalls in claims reimbursement, allowing for better financial planning.

Eligibility and Coverage:

  • Organ transplant benefits for Ingwe Option members are subject to Prescribed Minimum Benefits (PMB) and must be accessed through State facilities.

Organ Transplant Benefit Registration:

  • Once the need for an organ transplant is determined, the transplant coordinator from the respective transplant unit must initiate the registration process by sending an email with supporting documentation to the Disease Risk Management Department at renalcare@momentumhealth.co.za.

  • Key documents required for registration include:

    • Comprehensive treatment plan and detailed quotation from the transplant unit.

    • Motivational letter from the treating physician with ICD-10 codes.

    • Psychosocial assessment by a psychiatrist/psychologist.

    • Supporting test results.

    • Breakdown of hospitalization costs.

    • Annual costing estimate for immunosuppressive therapy.

    • Detailed cost estimate for the surgery.

Live Organ Donor Request:

  • The Ingwe Option does not cover the search for a donor but will cover necessary tests once a donor is identified and approved.

  • Required documentation for live organ donors:

    • Blood group for both donor and recipient.

    • Crossmatch results.

    • Physician’s letter confirming the donor’s medical fitness.

Immunosuppressive Therapy:

  • Immunosuppressive therapy for Prescribed Minimum Benefit (PMB) transplants is covered across all options, provided registration and approval are obtained via the Designated Services Provider.

  • For post-transplant care, Ingwe Option members must register for immunosuppressive therapy benefits to receive medications for preventing organ rejection.

Organ Transplant Authorization Renewal:

  • If waiting for a transplant, Ingwe Option members must submit a new cost estimate to the specialized coach in the Disease Risk Management Department once a suitable donor is found.

  • If authorization for chronic medication related to immunosuppressants has expired, a new prescription must be submitted to the chronic department via email or fax.

Important Notes:

  • Ingwe Option members must use State facilities for organ transplant-related services, including immunosuppressive therapy, post-transplant benefits, and chronic medication.

Donor Benefits:

  • Ingwe Option members do not have a specific allocation for live donor or cadaver donor expenses, as donor costs are typically directed to the State facilities where the transplant is carried out.

For further assistance or inquiries, Ingwe Option members can contact Momentum through:

The Ingwe Option is not covered under the International Emergency Travel benefit offered by the Momentum Medical Scheme. Specifically, members enrolled in the Ingwe Option do not qualify for the international travel coverage, which applies only to members enrolled in the Evolve, Custom, Incentive, Extender, and Summit Options.

Here’s a summary of the relevant details:

  • Eligibility: The Ingwe Option does not provide coverage for the International Emergency Travel benefit.

  • Coverage Limits: As the Ingwe Option is excluded from this benefit, no coverage limits or details on emergency travel benefits apply to Ingwe members.

  • Pre-Notification and Co-Payment: Ingwe members are not eligible for the pre-notification process or co-payment requirements associated with this benefit.

  • Exclusions: The Ingwe Option is specifically excluded from the emergency travel coverage entirely.

Therefore, Ingwe Option members will not be able to access emergency treatment, optometry, dental care, or other related benefits during international travel under this specific plan.

The Ingwe Option provides the following dental benefits:

  1. Basic Dentistry (Extractions, Fillings)

    • Benefit: Basic dental services, including examinations, fillings, and x-rays.

    • Limit: One dental consultation per beneficiary per year.

    • Coverage: Coverage applies to specified tariff codes. Pre-authorization is required for more than four fillings or extractions.

  2. Specialized Dentistry (Bridges, Crowns)

    • Benefit: Not covered under the Ingwe Option.

  3. In-Hospital Dental and Oral Benefits

    • Benefit: Not covered under the Ingwe Option.

    • Coverage: Trauma-related dental care is only covered at state facilities under Prescribed Minimum Benefits (PMB).

Summary for Ingwe Option:

  • Basic Dentistry is covered with a limit of one consultation per year and pre-authorization required for multiple procedures.

  • Specialized Dentistry (bridges, crowns) is not covered.

  • In-Hospital Dental Care is not covered, except for trauma-related care at state facilities (PMBs).

 
 

Ingwe Option - Medical Rehabilitation Benefits:

  • Coverage Amount:

    • Provides R15,900 per beneficiary for medical rehabilitation and step-down facilities.

  • Excluded Services:

    • Private nursing and hospice services are not included in this coverage.

Available Rehabilitation Services Under the Ingwe Option:

  1. Step-down facilities: Transitional care for patients who have been discharged from acute care hospitals but still require additional rehabilitation support.

  2. Occupational therapy: Helps individuals develop, recover, or maintain the skills needed for daily living and work.

  3. Speech therapy: Assists individuals with communication disorders or swallowing difficulties, aiming to improve speech clarity and effectiveness.

  4. Physiotherapy: Focuses on improving movement and managing pain through exercises, techniques, and modalities.

  5. Wound care: Involves the management and treatment of wounds to promote healing and prevent infection.

  6. Stoma care: Provides specialized support for individuals who have undergone stoma surgeries.

  7. Home nursing: Skilled nursing services provided at home for individuals who require medical care but prefer to remain in their own environment.

  8. Social workers: Offer emotional support, counseling, and connect patients with community resources to aid in recovery.

Eligibility and Requirements:

  • Eligibility: The medical rehabilitation benefit under the Ingwe Option is available to members who have experienced significant life-altering events or injuries that typically require hospitalization. A discharge plan created by the treating doctor is essential for this process.

  • Treatment Registration:

    • For registration in step-down facilities, home nursing, hospice, or wound care services, a letter of motivation from the treating doctor is required. This letter must include a detailed clinical report, diagnosis with ICD-10 code, current clinical condition, treatment plans, and assessments as applicable.

    • Important Notes:

      • The scheme will evaluate the discharge plan or request within 48 hours of submission.

      • In cases of appeal, members can email subacute@momentum.co.za for further review.

Key Exclusions:

  • Private nursing and hospice services are not included in the Ingwe Option.

This option offers significant support for medical rehabilitation, but it's crucial to note that certain services like private nursing and hospice are not covered.

The Ingwe option for Momentum Medical Scheme members covers treatment for chronic renal disease through the Prescribed Minimum Benefits (PMBs), especially at state facilities. If you're enrolled in this option and diagnosed with chronic renal disease, here's how the treatment process works:

Key Details for the Ingwe Option:

  1. Chronic Renal Failure Treatment:

    • The treatment plan will be customized based on your health profile and the stage of the disease, which could include blood pressure medication, cholesterol-lowering statins, dialysis, kidney transplantation, and more.

    • Treatment costs for prescribed medication, dialysis, and consultations are covered under the Major Medical Benefit, based on the approved formulary.

  2. Dialysis and State Facilities:

    • If you are enrolled in the Ingwe Option, you are covered for treatment at State facilities for renal dialysis. In cases where chronic dialysis or treatment is unavailable or inaccessible at State facilities, you must provide supporting documentation from the State facility and a motivation letter from your nephrologist to get approval for alternative treatment providers.

  3. Pre-authorization Process:

    • If hospitalization or renal dialysis is required, pre-authorization must be requested via the Momentum App, web chat, email (preauthorisation@momentumhealth.co.za), WhatsApp, or phone (0860 11 78 59).

    • If dialysis is not available at State facilities, the required documentation should be sent to renalcare@momentumhealth.co.za for review.

  4. Program Benefits:

    • Medications for chronic renal disease are covered under the Major Medical Benefit if they are listed on the formulary for the Ingwe Option.

    • Investigations and consultations related to chronic renal disease are also included under the Major Medical Benefit.

    • A Dialysis and Transplant Programme Coach will be assigned to coordinate care and ensure you receive the necessary support for dialysis or kidney transplantation if diagnosed with end-stage renal disease.

  5. Chronic Medication:

    • Medications are covered according to the formulary, with copayments applicable if the prescribed medication is not included in the formulary.

    • If you select Medipost as your chronic medication provider, you’ll have full coverage. For other pharmacies, Momentum will reimburse only 50% of the formulary price.

  6. Registration Process:

    • To enroll in the program, your healthcare provider must complete the chronic renal application form, along with pathology reports, blood count, iron profile, and a chronic prescription with ICD-10 codes.

    • These documents should be emailed to renalcare@momentumhealth.co.za and chronic@momentumhealth.co.za for registration.

  7. Support and Communication:

    • Momentum Medical Scheme maintains ongoing communication to encourage adherence to clinical care, working closely with your treating physician.

    • The Scheme will assist in identifying suitable healthcare providers for your treatment and provide guidance on obtaining chronic medication.

  8. Further Assistance:

    • For questions, additional information, or assistance, you can reach out via:

In summary, if you are a member of the Ingwe Option, you are covered for chronic renal disease treatment, including dialysis at State facilities, with support for your medication and specialist care needs. The program offers structured assistance and ensures the availability of the necessary resources for managing your condition effectively.

  1. Eligibility for HealthReturns:

    • Members enrolled in the Ingwe and Fusion Options are excluded from the HealthReturns program.

    • Only members of the Momentum Medical Scheme (except for those in the Ingwe and Fusion Options) can access Multiply Inspire at no cost and earn HealthReturns.

  2. HealthReturns Access:

    • HealthReturns can only be accessed by members who are not enrolled in the Ingwe Option.

    • Members enrolled in the Inspire and Inspire Plus Terms and Conditions are eligible to earn HealthReturns, but this is not the case for Ingwe members.

  3. Access to Multiply Inspire:

    • Members in the Ingwe Option cannot access the Multiply Inspire program, which is required to earn HealthReturns.

    • Therefore, HealthReturns are not available to members of the Ingwe Option because they do not have access to Multiply Inspire.

In summary, the Ingwe Option is excluded from participating in the HealthReturns program, meaning that members enrolled in the Ingwe Option cannot earn HealthReturns or participate in activities and rewards related to Multiply Inspire.

  • Ingwe Health Plan: A health insurance product designed for lower-income individuals, providing essential coverage.

  • Coverage Areas:

    • Primary healthcare, including consultations, diagnostic services, and chronic care management.

    • Hospitalization benefits (subject to conditions and limits).

    • Emergency medical services (EMS) may be covered.

  • Pre-authorization: Required for certain treatments or hospital admissions.

  • Exclusions:

    • Elective procedures may not be covered.

    • Specific treatments, such as cosmetic surgeries, may be excluded.

    • Some high-cost medical services, including advanced treatments, may not be included.

  • Waiting Periods: Standard waiting periods for new policyholders, typically ranging from 3 to 6 months depending on the nature of the treatment.

  • Premiums:

    • Affordable premiums designed for individuals with lower incomes.

    • Premiums vary based on age, family size, and other factors.

    • Flexible payment plans, including monthly, quarterly, or annual payment options.

  • Limitations:

    • Coverage limits per type of treatment, such as consultations, medication, and diagnostic tests.

    • Limited hospital admission days, with extended stays requiring additional out-of-pocket payments or specific approval.

  •  

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