On Wednesday, the 18th of September 2019, Momentum Medical Scheme (‘Momentum’) launched their benefit and contribution changes for 2020. An average weighted contribution increase of 8.2% was announced.

Momentum indicated that one of the factors that influenced the contribution increase was the rising cost of Prescribed Minimum Benefits (‘PMB’).

We have analysed the benefit changes that were introduced by Momentum and compiled key highlights for your ease of reference. Please look out for the upcoming member information sessions where we will unpack the detail and the impact of the changes per plan option. Our consultants will be available for one-on-one interaction to assist you with appropriate option selection.

2020 WEIGHTED AVERAGE CONTRIBUTION INCREASE 8.2%

KEY HIGHLIGHTS

  • Rand limit on the chronic conditions increased
  • Co-payments for MRI and CT scans increased
  • Day-to- day benefit limits increased
  • The annual threshold level increased on the Summit plan
  • Sublimits for medical appliances, rehabilitation benefit and HIV related admissions increased
  • A new plan, Evolve, was introduced
  • Maternity benefit programme has been enhanced
  • Two (2) new Multiply reward partners introduced
  • Gap Cover includes violent crime, premium waiver and pregnancy benefit

BENEFIT CHANGES

  • The major medical benefit sublimit has been increased for organ transplants, in-hospital medical and surgical appliances, medical rehabilitation and HIV related admissions on the Summit, Extender, Incentive and Custom options
  • The rand amount available for additional chronic conditions on the Summit, Extender, Incentive and Custom options has been increased.
  • MRI and CT scans will now be covered from the Major Medical Benefit subject to a co-payment of R2,370 on the Summit, Extender, Incentive and Custom options
  • The day-to-day limits for mental health, specialised dentistry, external medical and surgical appliances, optometry and prescribed medication on the Summit, Extender and Incentive options have increased
  • The annual threshold increased by 10% on the Extender option
  • The overall limit for maternity confinements has been removed on the Ingwe option
  • The sublimits for in hospital medical appliances, rehabilitation and HIV related admissions have been increased on the Ingwe option
  • The newly introduced Evolve option provides members with unlimited hospitalisation at Evolve network hospitals. Chronic benefits are available through the state. There will be an upfront co-payment applicable to all major medical admissions except for motor vehicle accidents, maternity confinements and emergency treatment
  • The Maternity benefit has been enhanced to include
  • two (2) doula visits per pregnancy on all options excluding the Ingwe option.
  • home nurse visits on all options, limited to one (1) or three (3) dependents, depending on the option.
COMPLEMENTARY PRODUCTS
  • Wimpy restaurant franchise has been added as new partner to the Multiply rewards program
  • Multiply rewards discounts across a greater range of Clicks products
  • The aggregate cover limit on GapCover has increased from R157,000 to R165,000 per beneficiary, per annum. The following benefits were introduced:
  • Violent crime benefit of R50,000 payable on death or disability, of a member, caused by a violent crime;
  • Premium waiver benefit of R30,000 payable upon the death of the premium payer; and
  • Pregnancy benefit of R2,000 payable when existing member falls pregnant.