Focus on the Day-to-day Benefit

Below is information about focus on the Day-to-day Benefit

The Day-to-day Benefit is designed to assist members with their routine medical expenses, which commonly include visits to healthcare professionals and the cost of prescribed medications. This benefit is essential for ensuring that members can manage their health effectively without facing prohibitive out-of-pocket costs.

For those enrolled in the Ingwe Option, members can access their day-to-day benefits through providers that are part of the Ingwe Network or the Ingwe ActiveNetwork. This ensures that members have a wide range of healthcare professionals and facilities available to them, facilitating easier access to necessary medical services. On the other hand, members who choose the Evolve and Custom Options have the opportunity to enhance their coverage by adding the Momentum HealthSaver+, a supplementary product that helps fund their day-to-day healthcare expenses. This option provides additional flexibility and support for managing healthcare costs.

Members on the Incentive Option benefit from a unique structure where 10% of their total contributions is allocated to a dedicated Personal Medical Savings Account (Savings). This account is specifically intended to cover day-to-day healthcare expenses. Furthermore, members have the option to receive credit in advance for the remaining months of the year, allowing them to manage their healthcare needs proactively. Importantly, any unused balance in the Savings account at the close of the year will be carried forward to the next benefit year, ensuring that members do not lose out on their contributions.

In a similar vein, the Extender Option allocates 25% of the total contributions to a dedicated Savings account for day-to-day healthcare expenses. This structure also allows for upfront credit advances for the remaining months, with any unused balance rolling over into the next year. However, it is crucial for members to be aware that if the funds in their Savings account are insufficient to cover their annual day-to-day medical expenses, they will face a self-funding gap. This gap requires members to pay out of pocket up to a predetermined Threshold, which varies based on family size.

The Threshold levels for 2024 are as follows: the principal member has a Threshold of R30,400; each adult dependant has a Threshold of R26,400; and each child dependant has a Threshold of R8,700, with a maximum of three children eligible. Once a member reaches their Threshold, any subsequent claims will be paid from Extended Cover at the Momentum Medical Scheme Rate, although this is subject to specific sub-limits. It is important to note that day-to-day limits will accumulate both before and after reaching the Threshold, ensuring that members can maximize their benefits.

For those on the Summit Option, claims are reimbursed at 100% of the Momentum Medical Scheme Rate, also subject to certain sub-limits, with an overall day-to-day limit of R31,300 per beneficiary. This structure provides members with comprehensive coverage for their day-to-day medical needs.

When it comes to submitting claims, the process is designed to be straightforward. The most convenient method is to take a photograph of the claim using a cellphone and upload it via the Momentum App. However, members also have the option to submit claims via email or postal service. For email submissions, claims should be sent to [e-mail]. For postal submissions, claims should be mailed to: Momentum Medical Scheme Claims, PO Box 2338, Durban, 4000.

To ensure a smooth claims process, it is essential that members provide all necessary information clearly on the claim. This includes the membership number, the principal member’s name and surname, the patient’s name and surname, the treatment date, the amount charged, the relevant ICD-10 code, tariff code and/or Nappi code, the service provider’s name and practice number, and proof of payment, if applicable. Providing complete and accurate information will help expedite the claims process and ensure that members receive their benefits without unnecessary delays.