Focus on the Day-to-day Benefit

+Momentum Medical Scheme members may choose to make use of additional products available from Momentum Group Limited and its
subsidiaries as well as Momentum Multiply (herein collectively referred to as Momentum). Momentum is not a medical scheme and is a
separate entity to Momentum Medical Scheme. Momentum products are not medical scheme benefits. You may be a member of Momentum
Medical Scheme without taking any of the products offered by Momentum.
Focus on the Day-to-day Benefit
This benefit provides for day-to-day medical expenses, such as doctors’ visits and prescribed medication.
On the Ingwe Option, members who choose Connect Network hospitals need to use State facilities,
while members who choose Ingwe Network hospitals need to use Ingwe Primary Care Network
providers. Members who choose Any hospital need to use Ingwe Active Network providers.
On the Evolve and Custom Options, members can add the Momentum HealthSaver+
to fund their
day-to-day healthcare expenses.
On the Incentive Option, 10% of the total contribution goes to a dedicated Personal Medical Savings
Account (Savings) to cover day-to-day healthcare expenses. Credit can be advanced upfront for the
remaining months in the year and any unused Savings balance at the end of the year will be carried
forward to the following benefit year.
On the Extender Option, 25% of the total contribution goes to a dedicated Savings account to cover
day-to-day healthcare expenses. Credit can be advanced upfront for the remaining months in the year.
Any unused Savings balance at the end of the year will be carried forward to the following benefit year.
If this component is not enough to cover annual day-to-day expenses, members will have a self-funding
gap to pay out of their own pocket up to the Threshold, which is determined by the family size (see
below). Although claims add up to the Threshold at 100% of the Momentum Medical Scheme Rate,
members may claim a higher amount from Savings if the provider charges more than the Momentum
Medical Scheme Rate. This will result in a bigger self-funding gap. Members can add the Momentum
HealthSaver+
, a complementary product available from Momentum, to fund their self-funding gap.
The annual Threshold levels for 2025 are:
• Principal member: R33 400
• Per adult dependant: R29 000
• Per child dependant: R9 600 (maximum of 3 children)
Once the Threshold has been reached, claims will be paid from Extended Cover at the Momentum
Medical Scheme Rate, subject to certain sub-limits. These day-to-day limits accumulate before and after
the Threshold.
On the Summit Option, claims are paid at 100% of the Momentum Medical Scheme Rate, subject to
certain sub-limits and an overall day-to-day limit of R33 000 per beneficiary.
Focus on the Day-to-day Benefit 2025 Page 2 of 2
How to claim
The easiest way to submit a claim is by taking a photo of it with your cellphone and uploading it via the
Momentum App.
You can also submit your claim via email or post as follows:
• Email your claim to [e-mail]
• Post your claim to: Momentum Medical Scheme Claims, PO Box 2338, Durban, 4000
Please make sure that the following information is clearly visible on the claim:
• Your membership number
• The principal member’s name and surname
• The patient’s name and surname
• The treatment date
• The amount charged
• The ICD-10 code, tariff code and/or nappi code
• The service provider’s name and practice number
• Proof of payment, if you have paid the claim.
Momentum Medical Scheme’s 2025 benefit and contribution amendments have been submitted to the
Council for Medical Schemes and are subject to approval by the Regulator.