Day-to-day Benefit
For everyday medical expenses. The Day-to-day Benefit covers routine medical costs like doctors' visits and prescribed medication.
- Use the Momentum App to submit day-to-day claims.
- Use the benefit to pay for prescribed and over-the-counter medication.
- Use HealthSaver+ to provide even more day-to-day cover.
What does the Day-to-day Benefit cover?
This benefit pays for day-to-day medical expenses, such as out-of-hospital doctors' visits, eye care, dentistry, and prescribed medication.
For example, when you get the flu and go to your General Practitioner (GP), the doctor is paid using your Day-to-day Benefits. The same applies when you go to your dentist and optician. This benefit also pays for prescribed medication and over-the-counter medication, x-rays, and so much more.
Why do I need it?
Going to the doctor with something as common as the flu can easily cost thousands, from the consultation fee to the medicine and the treatment needed. While these costs may not involve such large once-off payments as, for instance, being admitted to ICU after a car accident, they do tend to occur more regularly and could easily add up to significant expenses throughout the year.
How does it work?
Day-to-day Benefits differ depending on the medical aid plan you have selected. Have a look at what is included in each of our options below.
Ingwe
On the Ingwe Option, you get your day-to-day services from Ingwe Primary Care Network , Ingwe Active Network or State facilities if you selected Ingwe Connect as your hospital provider. You have unlimited GP visits (from the 11th visit onwards, you need to obtain pre-authorisation), basic eye care and dentistry, prescribed medicine, specialist visits. You also get 3 virtual doctor consultations per beneficiary per year from the GP Virtual Consultations and much more.
Evolve
On the Evolve Option, you get 2 virtual consultations per beneficiary per year from the GP Virtual Consultation Network, which includes Hello Doctor. Additional day-to-day healthcare expenses like further GP visits, optometry, dentistry, and specialists can be funded from Momentum's voluntary HealthSaver+ account.
Custom
On the Custom Option, your day-to-day healthcare expenses like GP visits, optometry, dentistry, and specialists can be funded from Momentum's voluntary HealthSaver+ account. Or you can pay for these expenses out of your own pocket.
Incentive
On the Incentive Option, 10% of your total contribution goes to a Medical Savings account. This is advanced upfront for the year and any unused funds at the end of the year will be carried forward to the following year. Once your medical savings have been depleted, you will pay out-of-pocket for day-to-day expenses like GP visits and dentistry. Alternatively, you can use Momentum’s voluntary HealthSaver+ account to save and pay for these expenses.
Extender
On the Extender Option, 25% of your total contribution goes to a Medical Savings account to cover day-to-day healthcare expenses like GP visits, dentistry, and specialists. This is advanced upfront for the year and any unused funds at the end of the year will be carried forward to the following year.
Once medical savings have been depleted, you will fall into the self-funding gap which means that you will have out-of-pocket expenses up until the Threshold, determined by your family size. Alternatively, you can use Momentum’s voluntary HealthSaver+ account to save and pay for these expenses. You must still submit your claims in this period so that we know when you move when you reach the Threshold.
The annual Threshold levels for 2025 are:
(up to a maximum of 3 children)
Summit
On the Summit Option, day-to-day claims are paid at 100% of the Momentum Medical Scheme Rate, subject to certain sub-limits. The overall day-to-day limit is R33 000 per beneficiary for 2025. Any expenses over this amount you will need to pay for. Alternatively, you can use Momentum’s voluntary HealthSaver+ account to save and pay for these expenses.
+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.