Posted on April 29, 2021 by Staff Writer
The Momentum group’s footprints can be traced back to 1966, when the company shook the financial sector industry by exciting growth and takeovers. The financial sector couldn’t help it but to notice this vigorously growing company.
The company became known as ‘Momentum’ in 1973 after the acquisition of ‘Momentum Assurance Corporation’. Apart from that, strategic acquisitions and mergers form a large part of the interesting background of this organisation.
To date, Momentum has developed a diversified product portfolio that includes healthcare, car and home insurance, life cover, savings and investments among others. In this publication we review their Healthcare/medical aid products for 2021.
The Momentum Healthcare product has six options of medical plans you can sign up for. Depending on your needs, affordability and personal preference, the scheme provides diverse options allowing you to choose what will fit you best. The following are plans offered by momentum:
- Ingwe Option
- Evolve option
- Custom option
- Incentive option
- Extender option
- Summit option
In all the options there is a reward system for members that contribute up to R3000 a month. The fact that contributions differ from one plan to another, so do benefits and procedures of each plan. Lets tla look at some notable features of each option:
The Ingwe Option provides affordable access to entry-level individuals, mostly the first time earning youths. With the Ingwe option you can choose to use any hospital, the Ingwe Network of private hospitals, or State hospitals for a lower contribution.
Ingwe covers 26 chronic conditions, and thus at par with the Chronic Disease List in Prescribed Minimum Benefits. For treatment of the chronic conditions, you can consult either Ingwe Primary Care Network providers or Ingwe Active Primary Care Network providers,depending on your provider of choice.
There is an option of utilising the Ingwe Healthsaver to cater for increased day-to-day cover, should you decide that you need more. HealthSaver is a complementary product offered by Momentum that lets you save for medical expenses not covered on your option.
Under the hospitalisation benefit, hospital accounts and related costs incurred are covered, provided that treatment has been authorised. Well, pre-authorisation is a norm that every policy holder should get used to because most schemes use the same procedure.
If authorisation is not obtained, a 30% copayment will apply on all accounts related to the event and Momentum will only be responsible for 70% of the negotiated tariff. However, incase of emergencies, you or a family member can obtain authorization within 72 hours of hospitalization.
Momentum policy holders can have upto 4 dependencies, one being an adult dependent and up to 3 child dependants. Hence, contributions are determined by your family composition, monthly income and your choice of hospital.
State hospitals reduce your contribution, while choosing any other private hospitals outside the network increases your monthly contribution. So, if you want to get your treatments from a private hospital but still want to lower your contribution, then Ingwe Network hospitals will be your ideal choice.
Principal member only – R455 for low income earners to R2984 for high income earners.
Principal + 1 adult – R910 to R5968
Principal + 1 child – R847 to R3850
2 adults + 1 child – R1302 to R6834
2 adults +2 children – R1694 to 7700
2 adults + 3 children – R2086 to R8566
The Evolve option
Evolve is in the second tier of the plans offered by Momentum. It is an ideal option for an individual or family that is comfortable with receiving their chronic benefits from a state hospital while assured that hospitalization is covered in a private hospital.
Subscribers are liable for co-payments on all Major Medical Benefits, hence, you will have to part with R1 640 in every authorisation. However, there are cases like motor vehicle accidents, maternity confinements or emergency treatment where the co-payment might not be required.
As long as authorization is obtained,hospital accounts and related costs incurred in hospital are covered, thus from admission to the time of discharge. Evolve pays claims at 100% with the Momentum Medical Scheme rate and does not have any overall annual limits as most plans do.
The plan covers 26 chronic conditions in a state facility according to the Chronic Disease List in Prescribed Minimum Benefits. Chronic treatment benefits include services like seeing doctors, scripts and medication.
As much as the evolve option gives you peace of mind as far as hospitalisation is concerned, the plan does not cater for your day-to-day medical needs. Members pay their day-to-day medical expenses from their own pockets, however you can utilise HealthSaver and save up for such expenses.
Principal member only – R1 345
Principal + 1 adult – R2 690
Principal + 1 child – R2 690
2 adults + 1 child – R4 035
2 adults +2 children – R5 380
2 adults + 3 children – R 6 725
Well, third in tier l is the custom option which gives you access to any hospital of your choice. Momentum’s custom option gives you comprehensive hospital cover in a private hospital of your choice without any annual limits.
Likewise, custom members are liable to pay co-payments for Major Medical Benefits, except in the case of motor vehicle accidents, maternity confinements and emergency treatments.
Should you wish to get discounts on your contribution, then you might consider using a network of private hospitals listed in the Custom plan.
That goes with the Chronic treatment as we, you can choose an associated hospital so as to get discounts on the monthly contributions. Furthermore, you can push your contributions even lower by opting to use state facilities to receive your chronic benefits.
The scheme will not cover the daily medical expenses you might incur, however you can add the HealthSaver to cover your day-to-day healthcare expenses.
The custom contribution ranges depending on whether you will be using any or associated hospital for hospital benefits and whether you are using any or associated or state facilities for chronic conditions.
Contributions become lower as you choose your service providers, for instance; a plan that uses associated hospitals for hospital benefits and state facilities for chronic conditions becomes lower .
Below are the contribution ranges:
Principal member only – R1 706 to R2 891
Principal + 1 adult – R2 997 to R5 211
Principal + 1 child – R2 311 to R3 923
2 adults + 1 child – R3 602 to R6 243
2 adults +2 children – R4 207 to 7 275
2 adults + 3 children – R4 812 to R8 307
The incentive option has similar features as the custom option except that in ‘inceptive’ you get to have your day-to-day medical benefits covered by the scheme.
So in all the contributions you make, 10% credited to your medical savings account managed is by the scheme. You get to make daily healthcare payments using that allocated annual 10% of the contributions.
In a case where you need more day-to-day cover, then you will have to utilise the Momentum Healthsaver to pay your bills.
Likewise, contributions are influenced by the choice of providers, and it ranges as follows:
Principal member only – R2 224 to R3 899
Principal + 1 adult – R3 980 to R7 067
Principal + 1 child – R3 077 to R5 419
2 adults + 1 child – R4 833 to R8 587
2 adults +2 children – R5 686 to R10 107
2 adults + 3 children – R6 539 to R11 627
The Momentum’s Extender option is a great deal for individuals or families that need comprehensive healthcare cover. The plan has massive benefits from preventative, hospital, chronic conditions and daily healthcare needs. It gives you peace of mind as you know your lifestyle is well managed to avoid health complications and even if an unfortunate event happens, you will have a strong backup.
In case of hospitalisation, the scheme covers all associated specialists in full while other specialists are covered upto 200% of the Momentum Medical Scheme rate. When it comes to hospital groups’ accounts, the scheme fully covers the accounts at the rate agreed upon with the respective group.
The extender has R500 000 oncology cover per beneficiary every year, then a 20% copayment applies should the limit be exceeded. Besides cancer related benefits, members are also covered for transplants, rehabilitation, trauma benefits and seven days’ supply of take home medication among other hospital benefits.
On top of the 26 conditions under Prescribed Minimum Benefits, the extender has 36 additional benefits that are subject to a R10 700 limit per family. Checking the list of chronic conditions covered is one of the vital exercises when examining the scoop of a medical cover.
Of your monthly contributions, 25% is allocated to your Medical Savings Account. The savings account is credited with the all year allocation in advance to allow you to start using the funds even before contribution.
Funds in your savings account are meant to cover your day-to-day medical needs like GP visits and prescribed medicines. Should you not deplete the credit in your savings account, then the balance therein will be carried for use in the following year.
However, in an event that your savings account is depleted while you still have some day-to-day medical expenses, then you will have to pay from your own pocket or use the HealthSaver.
Likewise, contributions are influenced by the choice of providers, and it ranges as follows:
Principal member only – R5 231 to R7 419
Principal + 1 adult – R9 198 to R13 394
Principal + 1 child – R6 768 to R9 547
2 adults + 1 child – R10 735 to R15 522
2 adults +2 children – R12 222 to R17 650
2 adults + 3 children – R13 809 to R19 778
The Summit option is ideal for a family which requires extensive hospital cover from a hospital or service provider of choice. This is the option I can refer to as Momentum’s ‘first class’ package, and you must be willing and ready to pay fitting contributions for such a service.
Any specialists you choose to use is covered at 300% of the Momentum Scheme rate while associated specialists and hospital accounts are fully covered. It doesn’t matter the choice of your service provider, there are no applicable overall annual limits in hospitalisation.
The plan doesn’t have annual limits on:
- high and intensive care
- maternity confinement and neonatal intensive care
- oncology and renal dialysis
- organ transplant recipients and other medical events
The chronic conditions benefits in the summit option are similar to those of the extender. However the summit subscribers have a slightly extended limit of R26 900 per family every year, which is more than double of the extender limit.
The R26 900 is a combined limit incorporating both the 36 additional conditions and the day-to-day medical cover. The summit does not have a medical savings account, hence you can use the HealthSaver to increase your daily medical cover.
Members of the summit option pay fixed monthly contributions irregardless of the hospital or medical facility used. The contributions are set such that members are not limited with choice and have higher sub limits on subjected benefits.
2021 contributions are as follows:
Principal member only – R10 642
Principal + 1 adult – R19 153
Principal + 1 child – R13 087
2 adults + 1 child – R21 598
2 adults +2 children – R24 043
2 adults + 3 children – R26 488
The Momentum HealthSaver is a complementary product accessible to all Momentum members who wish to save more for their daily healthcare needs. Your HealthSaver account earns you a 10% interest on available positive balance.
Positive HealthSaver balances can be used to cover other medical events that are not included in your medical scheme plan. Funds can be used to pay for:
- Hospital co-payments when scheme’s limits are reached
- Day-to-day medical expenses such as pharmacies, vitamins and fitness programs
- Affiliated gym fees and purchasing fitness devices
- Your Momentum monthly contribution among other various uses
HealthReturns is a stimulus program that rewards members for living a healthy lifestyle and following up on their health status by doing regular check ups. Momentum pays families upto R3000 returns per month for healthy living.
To earn the HealthReturns, members need to:
- Go for annual health assessments, this helps identify medical needs at an early stage and get appropriate help earlier. Health assessments help reduce the costs of treatments as the condition would be treated while it is still on its early stages.
- Comply with chronic protocols; members need to claim for chronic medication for all of the CDL conditions in which they are registered, this includes managing a lifestyle recommended for the respective chronic conditions. To earn more HealthReturns, Momentum encourages members to get more pathology tests if need be, this will help detect any health challenges earlier.
- Be active; the Momentum Medical Scheme contribution and Healthy Heart Score determine how much you can earn. The scheme looks at the number of your active days in a month combined with your fitness assessment routine to determine your returns.
Competitive advantages of the Momentum Health medical scheme
- The HealthSaver does not only help you pay for additional health needs, but it also assists members to pay their contribution during dire months.
- Momentum has made it easier to reach R3 000 p/m in Health returns by introducing KidsReturns
- All Momentum members have free access to expect health advice at any time through the Hello Doctor functionality, without having face to face consultation.
- The Momentum Health Platform Benefit allows all first adult beneficiaries to have free annual health assessment that measures their height and weight, blood pressure, Cholesterol and blood sugar and waist circumference.
Disadvantages of the Momentum Healthcare scheme
- The KidsReturns is not available for the Ingwe members, of which they probably need it the most to cover their daily healthcare needs since the scheme does not cover them.
- Momentum’s day-to-day healthcare cover benefits are not as sufficient especially for members who have daily health complications that need to be monitored.
Momentum has quite broad plan options to choose from, making it easy for both low and high income earners to find their appropriate plan within the scheme. The scheme seems to emphasize preventative activities making it a convenient scheme that will help you keep track of your health status.