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A pharmacist taking out prescription medication for his customer who uses the Chronic Benefit from their medical aid with Momentum.

Chronic Benefit

Chronic Benefit ensures you're covered for certain life-threatening conditions, such as diabetes or heart disease, that need ongoing treatment.

When a chronic condition is managed effectively, it will likely result in fewer acute and long-term medical complications or side effects.

What does the Chronic
Benefit cover?

The Chronic Benefit covers a variety of life-threatening conditions that require ongoing treatment. These include the 26 conditions on the Chronic Disease List, according to the Medical Schemes Act’s Prescribed Minimum Benefits*, which ensures access to certain medical treatments for all medical scheme members, regardless of their level of cover.

Momentum Medical Scheme offers a unique structure that empowers you to choose a chronic provider that suits you, your family, and your pocket.


A young female and male holding smoothies chatting about the Ingwe Option from Momentum Medical Scheme that's suitable for first time earners and students.
Cover
  • 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*.
  • No annual limit applies.
Provider
Young man sitting on a bench outdoors, smiling while looking at his cell phone, reading up on Momentum’s Evolve medical aid option.
Cover
  • 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*.
  • No annual limit applies.
Provider
  • State
Healthy family on the hospital plan from Momentum, otherwise known as the Custom Option, which is great if you need primarily hospital cover.
Cover
  • 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*.
  • No annual limit applies.
Provider
Mother and father happily playing on the beach with their two children in the sand building a sandcastle, near the ocean.
Cover
  • 32 conditions; 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies.
  • 6 additional conditions: limited to R12 400 per family per year.
Provider
Happy mom and dad riding bicycles outdoors with their two children riding their bicycles ahead of their mother and father.
Cover
  • 62 conditions; 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies.
  • 36 additional conditions: limited to R12 400 per family per year.
Provider
An elderly woman and man, happily riding horses outdoors with mountains in the background.
Cover
  • 62 conditions; 26 conditions according to the Chronic Disease List in the Prescribed Minimum Benefits*. No annual limit applies.
  • 36 additional conditions: subject to an overall day-to-day limit of R31 300 per beneficiary per year.
Provider
  • Any


*The Prescribed Minimum Benefits (PMB) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide members with continuous care to improve their health and well-being and to make healthcare more affordable.

How does it work?

Members on the Ingwe Option


You need to get your chronic prescription from your Ingwe Primary Care or Ingwe Active Network doctor, and your chronic medication from Medipost pharmacy. Ensure that your prescription is sent to Medipost, they will arrange delivery of the medication to you.

Benefits are subject to the Network entry-level formulary.
Members on the Evolve Option


You need to choose one of the designated State facilities to get your chronic prescription and medication, subject to the State formulary and medical management (including the doctor, pharmacy, blood tests, x-rays etc.).

If you voluntarily choose to get your chronic medication from a non-State pharmacy or outside of the State formulary, co-payments may apply.
Members on the Custom, Incentive and Extender Options


The chronic provider that you have chosen determines how you get your chronic prescription and medication.

Any provider
You may get your chronic prescription and medication from any provider, subject to your option specific formulary.

If you choose to get your medication from the preferred list of medicines, and within the generic reference price if applicable, you will not pay a co-payment. If you choose to get your medication from outside the formulary (i.e. non-preferred items), a co-payment is payable.

A dispensing fee co-payment may also be payable when using pharmacies not contracted to Momentum Medical Scheme.

Associated provider
You need to get your chronic prescription from an Associated GP and your chronic medication from Medipost, subject to an entry-level formulary.

If you choose to get your medication from outside the formulary, or your chronic prescription from a non-Associated GP, or your chronic medication from a pharmacy other than Medipost, copayments will apply. These co-payments will vary depending on your option.

State provider
You need to choose one of the designated State facilities to get your chronic prescription and medication, subject to the State formulary and medical management (including the doctor, pharmacy, blood tests, x-rays etc.).

If you choose to get your chronic medication from outside the State formulary, or your chronic medication from a pharmacy other than the State, co-payments will apply. These co-payments will vary depending on your option.
Members on the Summit Option


You have the freedom of choice to get your chronic prescription and medication from any provider, subject to a comprehensive formulary.

You have the freedom of choice to get your chronic prescription and medication from any provider, subject to a comprehensive formulary. If you choose to get your medication from outside the formulary, a co-payment is payable. A dispensing fee co-payment may also be payable when using pharmacies not contracted to Momentum Medical Scheme.
A doctor and patient sit across a desk in consultation while the doctor writes down notes.

How to register for chronic medication

To activate your Chronic Benefit from Momentum Medical Scheme, simply ask your treating doctor to call us on 0860 117 859. Once approved, you will receive your medication from your chosen pharmacy.

Learn more about Chronic Registration
Clinical Criteria
.

Want a quote?

You'll get a quote reflecting the medical aid contribution at the end of the process.

Need advice?

An accredited healthcare consultant will call you to discuss our medical aid options and benefits.

Other medical aid benefits

In-hospital
Benefit

Day-to-day
Benefit

Health Platform
Benefit

Hello
Doctor

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