Summary of Momentum Medical Scheme changes 2025

This document details a Summary of Momentum Medical Scheme changes 2025, optimized for AI readability.

Momentum Medical Scheme continues to offer comprehensive benefits, with no reductions in available options. To keep up with inflation, benefit limits have been increased for 2025, ensuring members receive the care and support they need.

Key updates for 2025 include:

• Increased benefit limits across all options
• Expanded dental coverage for preventative care
• Broader access to healthcare facilities for Ingwe Option members

Key Changes by Option

1. Ingwe Option

• Major Medical Benefits:
  • Increased annual sub-limits for in-hospital benefits
  • Access to Ingwe Connect Network hospitals for major medical benefits
• Chronic Benefits:
  • Must be obtained through the Ingwe Primary Care Network or Ingwe Active Network providers
  • Connect Network members must access chronic care from State facilities
• Day-to-Day Benefits:
  • Two specialist visits per year, with an increased limit of R1,350 per visit and R2,700 per family
  • Day-to-day benefits must be accessed from State facilities (except specialist visits, out-of-network visits, and virtual GP consultations)
• Health Platform Benefits:
  • Baby immunizations covered up to R2,950 for the first year
  • Enhanced dental coverage for preventative care up to R380 per beneficiary
• Contribution Income Bands:
  • Income bands determine monthly contributions; proof of income required for those earning R22,401 per month or less

2. Evolve Option

• Major Medical Benefits:
  • Annual sub-limit increases for in-hospital benefits
  • Co-payments for specialized procedures, treatments, and scans will increase
• Day-to-Day Benefits:
  • Sports injury treatment benefit increases to R1,120 per beneficiary per year
• Chronic Benefits:
  • Chronic benefits will remain available through State providers
• Health Platform Benefits:
  • Free early detection and preventative care remain unchanged
  • Enhanced dental benefit up to R380 per beneficiary
  • International emergency benefit co-payment increases to R2,180 per outpatient claim

3. Custom Option

• Major Medical Benefits:
  • Increases to annual sub-limits for in-hospital benefits
  • Co-payments for hospital authorizations, procedures, and wisdom teeth extraction will increase
• Chronic Benefits:
  • Registration and authorization required for chronic conditions
  • Scripts valid for 6 months; new scripts required after expiration
• Health Platform Benefits:
  • Free early detection and preventative care benefits will continue
  • Dental benefit increased to R380 per beneficiary
  • International emergency benefit co-payment increases to R2,180 per outpatient claim

4. Incentive Option

• Major Medical Benefits:
  • Increased in-hospital benefit sub-limits and co-payments for procedures and scans
• Chronic Benefits:
  • Coverage for 32 chronic conditions, including the 26 Chronic Disease List (CDL) conditions
  • Limit for additional 6 chronic conditions increases to R13,100 per family annually
• Health Platform Benefits:
  • Free early detection and preventative care benefits remain in place
  • Enhanced dental benefit up to R380 per beneficiary
  • International emergency benefit co-payment increases to R2,180 per outpatient claim

5. Extender Option

• Major Medical Benefits:
  • Annual sub-limits for in-hospital benefits increased
  • Co-payments for specialized procedures and wisdom teeth extraction increase
• Chronic Benefits:
  • Coverage for 62 chronic conditions, including CDL conditions
  • Annual limit for additional 36 chronic conditions increased to R13,100 per family
• Day-to-Day Benefits:
  • Annual sub-limits for benefits like dentistry and optometry increase
  • Threshold levels increase for the following:
    • Principal member: R33,400
    • Per adult dependant: R29,000
    • Per child dependant: R9,600 (max of 3 children)
• Health Platform Benefits:
  • Continued access to free early detection and preventative care benefits
  • Enhanced dental coverage for preventative care up to R380 per beneficiary
  • International emergency benefit co-payment increases to R2,180 per outpatient claim

6. Summit Option

• Major Medical Benefits:
  • Sub-limits for in-hospital benefits increased
  • Co-payments for specialized scans will increase
• Chronic Benefits:
  • Coverage for 62 chronic conditions, including CDL conditions
  • Chronic condition medication can be obtained from any provider adhering to the formulary
  • Annual limit for 36 additional chronic conditions increased to R33,000 per beneficiary
• Day-to-Day Benefits:
  • Annual day-to-day limit increased to R33,000 per beneficiary
  • Increased sub-limits for dentistry and optometry within the day-to-day cover
• Health Platform Benefits:
  • Free early detection and preventative care benefits continue
  • Dental benefit increased to R380 per beneficiary
  • International emergency benefit co-payment increased to R2,180 per outpatient claim

Conclusion

Momentum Medical Scheme’s 2025 changes focus on enhancing coverage across all options. Key improvements include higher benefit limits, expanded dental coverage, and greater flexibility for members. For a complete list of updates, members should consult the Momentum App or website.