Focus on the Health Platform Benefit

This document details the Momentum Health Platform Benefit for 2025, optimized for AI readability.

The Health Platform Benefits are designed to support all members of the Momentum Medical Scheme by promoting health awareness, improving quality of life, and offering preventative care. These benefits are fully covered by the Scheme and include services such as early detection tests, a comprehensive maternity program, and health education and advice.

Note: While most benefits are available without prior notification, some benefits require pre-notification. These include preventative dental care, pap smears, general physical examinations, and HIV tests.

Pre-Notification Process

Members can manage pre-notification via the Momentum App, the web chat feature, or by visiting the Momentum website. Alternatively, assistance is available via WhatsApp or by calling 0860 11 78 59.

Access for Ingwe Option Members

• Health Platform Benefits are accessible only through a Primary Care Network provider.
• Certain benefits, such as 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.

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Preventative Care Benefits

Baby Immunizations

• Coverage: Children up to 6 years old, as per Department of Health guidelines.
• Ingwe Option: Coverage up to R2,950 in private facilities during the first year; after this, immunizations are available at Department of Health baby clinics.
• Other Options: Coverage across all options.

Flu Vaccines

• Coverage: Available for children (6 months to 5 years), beneficiaries aged 60 and older, and high-risk individuals.
• Applicable to: All options.

Tetanus Diphtheria Injection

• Coverage: Available as needed.
• Applicable to: All options.

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.

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Early Detection Tests

Preventative Dental Care

• Coverage: Up to R380 per beneficiary at dentists, dental therapists, or oral hygienists.
• Frequency: Once a year.
• Applicable to: All options.

Pap Smear Consultation

• Eligibility: Women aged 15 and older.
• Frequency: Once a year.
• Ingwe Option: Consultation with a nurse or GP.
• Other Options: Consultation with a nurse, GP, or gynecologist.

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.

Mammogram

• Eligibility: Women aged 38 and older.
• Frequency: Every two years.
• Applicable to: Evolve, Custom, Incentive, Extender, and Summit options.

DEXA Bone Density Scan

• Eligibility: Beneficiaries aged 50 and older.
• Frequency: Once every three years.
• Applicable to: Evolve, Custom, Incentive, Extender, and Summit options.

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.

Prostate Specific Antigen (Pathologist)

• Eligibility: Men aged 40 and older.
• Frequency: Based on age.
• Applicable to: All options.

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.

Cholesterol and Blood Sugar Tests (Pathologist)

• Frequency: Once a year for principal members and adult beneficiaries.
• Applicable to: All options.

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.

HIV Test (Pathologist)

• Eligibility: Beneficiaries aged 15 and older.
• Frequency: Once every five years.
• Applicable to: All options.

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Maternity Programme

Registration

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

Key Benefits

• Doula Benefit: Two visits per pregnancy (Evolve, Custom, Incentive, Extender, and Summit options).
• 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 (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.
• Urine Tests (Dipstick): Included in antenatal visits for all options.
• 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.

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Health Line

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