Yes, Momentum Medical Scheme will terminate your membership if you do not pay your contributions or if we get confirmation that you or your dependants have committed fraud.

You can submit claims for medical treatment up until the day your medical scheme membership expires. If you have given written notice of your intention to end your membership on the 31^st of December, and you go to the doctor on that day, you can still submit a claim for that doctor's visit. Anything after midnight on that date will not be processed.

No, as that is not legal. Claiming twice for the same medical expenses is seen as fraud. It is important to make sure when you are moving medical aids that you terminate your membership with the current medical scheme before your membership of the new medical scheme starts.

There are a few ways you can avoid out-of-pocket expenses:

• If you have chosen to use a network provider, such as hospitals or doctors, be sure to use providers on the network.

• Always use a contracted pharmacy for your prescribed medication.

• For over-the-counter medicines, you can use Momentum’s HealthSaver⁺ account, which lets you make provision for healthcare expenses not covered on your option.

• If pre-approval is required for certain doctor or specialist visits, ensure you get the authorisation number before your appointment.

You will be stabilised at the closest hospital and transported to the nearest hospital on your network hospital list. This will not apply if you have selected Any hospital provider.

The benefits of a health management programme are numerous, from providing a treatment plan that includes cover for visits to doctors and specialists and other service providers for the treatment you need for your condition to investigations, such as pathology tests, which are necessary to manage your condition and many other additional benefits for treatment that is considered medically necessary. If you need to be hospitalised for some conditions, we will allocate a case manager to follow up regarding your hospital stay.

In terms of the Medical Schemes Act, medical schemes may apply waiting periods to new members joining the Scheme.

If a 3-month general waiting period is applied, you must wait 3 months from the date that your membership commences before you can claim from your Momentum Medical Scheme benefits.

A 12-month waiting period may also be applied to specific medical conditions. If this waiting period is applied, you must wait 12 months from the date your Momentum Medical Scheme membership starts before you can claim benefits for the condition.

Should you qualify for the Prescribed Minimum Benefits, you would be eligible to obtain treatment at a State facility, provided that the Prescribed Minimum Benefits cover the condition. A list of the Prescribed Minimum Benefits is available on www.medicalschemes.com.

Yes, the Scheme will still cover chronic medication and hospitalisation.

Yes, it is important to continue submitting your claims, otherwise we will not know that you have passed the self-funding gap and qualify for the Extended Cover benefits.

Some medical scheme options have a medical savings account. This is a percentage of your monthly contribution, up to a maximum of 25% and is used to pay for day-to-day medical expenses. Certain sub-limits may still apply.

On the Incentive Option, 10% of your contribution is available in a savings account. When your Savings is depleted, you must pay for your day-to-day medical expenses out of your pocket. On the Extender Option, 25% of your contribution is available in a savings account to cover day-to-day expenses. Suppose this component is not enough to cover your annual day-to-day expenses. In that case, you will also have access to the Extended Cover benefit, which provides further cover for day-to-day benefits once your day-to-day claims have reached the Threshold (a pre-determined amount based on your family size).

It is important to note that your Savings do not pay for chronic and hospitalisation benefits. Funds in the savings account that are not utilised are carried over to the following year. If you resign from the Scheme and still have funds in your savings account, this will be paid out to you.