At a glance
- Plan type
- Hospital plan
- Hospitals
- Network hospitals
- Hospital and specialists
- 100% of Scheme tariff
- Day-to-day costs
- Your own
- Chronic conditions
- 26
- Cancer
- R200 000 a year
- Children you pay for
- Up to 3
- Children on the plan to age
- 21
- Plan type
- Hospital plan
- Hospitals
- Network hospitals
- Hospital and specialists
- 100% of Scheme tariff
- Day-to-day costs
- Your own
- Chronic conditions
- 26
- Cancer
- R200 000 a year
- Children you pay for
- Up to 3
- Children on the plan to age
- 20
Monthly contributions
2027 rates take effect on 1 January 2027. You pay for up to 3 children.
| Member | 2026 | 2027 | Change |
|---|---|---|---|
| Main member | R2 029 | R2 176 | +7.2% |
| Adult dependant | R2 029 | R2 176 | +7.2% |
| Child | R2 029 | R2 176 | +7.2% |
Benefits
Momentum has published its full 2027 rules, but we hold only the main rows so far. A row without a 2027 entry shows the 2026 rule, marked.
Benefits in force for 2026.
In hospital
Hospitals
Network hospitals only (Evolve Hospital Network)
Momentum Evolve Network Hospital List, p1
Hospitals
Network hospitals only (Evolve Hospital Network)
2027 Momentum Medical Scheme Marketing brochure, p3
Specialists in hospital
100% of Scheme tariff. A specialist who charges more leaves a shortfall.
Specialists in hospital
100% of Scheme tariff. A specialist who charges more leaves a shortfall.
2027 Momentum Medical Scheme Marketing brochure, p3
Chronic and cancer
Chronic conditions
26 conditions (the 27 on the Chronic Disease List plus others the scheme adds).
Chronic conditions
26 conditions (the 27 on the Chronic Disease List plus others the scheme adds).
2027 Momentum Medical Scheme Marketing brochure, p3
Cancer
Up to R200 000 a year.
Momentum Annexure B(2) 2026 (Evolve), p12
Cancer
Up to R200 000 a year.
2027 Momentum Medical Scheme Marketing brochure, p8
Day to day
Maternity
Maternity Programme, paid from savings.
Momentum Focus on the Maternity Programme
Maternity
Maternity Programme, paid from savings.
2027 Momentum Medical Scheme Marketing brochure, p17
Children on the plan
As dependants up to age 21.
Children on the plan
As dependants up to age 20.
GP visits
Limited to 2 Virtual consultations, with a GP on the Scheme’s Preferred Provider GP Virtual Consultation network, per beneficiary per year, subject to PMBs
Momentum Annexure B(2) 2026 (Evolve), p9
GP visits
4 virtual GP consultations/year (Hello Doctor); further day-to-day via optional HealthSaver.
Momentum Focus on Individual Contributions 2027, p1
Specialist visits
Limited to PMBs at State Hospital Network facilities subject to part (4) in Annexure D
Momentum Annexure B(2) 2026 (Evolve), p9
Specialist visits
Not covered.
Momentum Focus on Individual Contributions 2027, p1
Prescribed medicine (acute)
Not covered.
Momentum Annexure B(2) 2026 (Evolve), p13
Prescribed medicine (acute)
Not covered.
Momentum Focus on Individual Contributions 2027, p1
Basic dentistry
1.1 In Hospital (Conservative and PMBs only
Momentum Annexure B(2) 2026 (Evolve), p9
Basic dentistry
Not covered.
Momentum Focus on Individual Contributions 2027, p1
Eyes (optometry)
Not covered.
Momentum Annexure B(2) 2026 (Evolve), p13
Eyes (optometry)
Not covered.
Momentum Focus on Individual Contributions 2027, p1
Basic X-rays
1.2 Out-of-hospital PMBs only
Momentum Annexure B(2) 2026 (Evolve), p9
Basic X-rays
Not covered.
Momentum Focus on Individual Contributions 2027, p1
Blood tests (pathology)
2. Out-of-hospital PMBs only Limited to PMBs at State Hospital Network
Momentum Annexure B(2) 2026 (Evolve), p10
Blood tests (pathology)
Not covered.
Momentum Focus on Individual Contributions 2027, p1
Full benefit list
Every benefit we hold for Evolve, in Momentum’s own wording, from its 2026 documents. Momentum’s full 2027 list is not in our records yet.
In hospital
Surgery and anaesthetics
100% of MMSR
Momentum Annexure B(2) 2026 (Evolve), p8
Hospital stay and theatre
Accommodation in a general ward, high 100% of MMSR No limit
Momentum Annexure B(2) 2026 (Evolve), p8
Day procedures
A standard co-payment of R2 000 is payable per authorisation for all Hospital, including Dental admissions.
Momentum Annexure B(2) 2026 (Evolve), p4
Day procedures
failing which a co-payment of 30% on the whole event shall apply and the Scheme will be responsible for 70% of the negotiated tariffs
Momentum Annexure B(2) 2026 (Evolve), p6
Step-down and sub-acute care
R61 000 per family – subject to PMBs
Momentum Annexure B(2) 2026 (Evolve), p8
Mental health admissions
Limited to PMBs at chosen Hospital Network facility, sub-limit of 21 days subject to PMBS
Momentum Annexure B(2) 2026 (Evolve), p9
Birth (in hospital)
Costs covered in Evolve Network Provider hospitals subject to part (4) in Annexure D
Momentum Annexure B(2) 2026 (Evolve), p9
Procedures in the doctor’s rooms
Specialised Procedures/Treatment as listed in Annexure F
Momentum Annexure B(2) 2026 (Evolve), p14
Cancer treatment
Limited to R200 000 p.b. per annum, after limit is reached; a 20% co-payment will apply.
Momentum Annexure B(2) 2026 (Evolve), p12
Dialysis
Limit to PMBs at State facilities subject to part (4) in Annexure D
Momentum Annexure B(2) 2026 (Evolve), p11
Organ and stem cell transplants
Limited to PMBs at State facilities subject to part (4) in Annexure D
Momentum Annexure B(2) 2026 (Evolve), p12
Internal prostheses
R43 900 p.b per event, maximum of 2 events per year
Momentum Annexure B(2) 2026 (Evolve), p13
HIV/AIDS
R50 500 per family subject to the Hospital benefit above - subject to PMBs
Momentum Annexure B(2) 2026 (Evolve), p14
Medicine on discharge
To Take Home Medication 100% of MMSR Limited to 7 days’ supply
Momentum Annexure B(2) 2026 (Evolve), p8
Medical appliances
R7 850 per family
Momentum Annexure B(2) 2026 (Evolve), p13
Care after a hospital stay
Certain day-to-day benefits after a traumatic incident resulting from the following conditions will be covered for a period of 18 months after the event
Momentum Annexure B(2) 2026 (Evolve), p15
Day to day
GP visits
Limited to 2 Virtual consultations, with a GP on the Scheme’s Preferred Provider GP Virtual Consultation network, per beneficiary per year, subject to PMBs
Momentum Annexure B(2) 2026 (Evolve), p9
Specialist visits
Limited to PMBs at State Hospital Network facilities subject to part (4) in Annexure D
Momentum Annexure B(2) 2026 (Evolve), p9
Casualty visits
3.3 Non-emergency casualty No Benefit No Benefit - subject to PMBs
Momentum Annexure B(2) 2026 (Evolve), p9
Prescribed medicine (acute)
Not covered. 2. Prescribed acute medication No Benefit No Benefit
Momentum Annexure B(2) 2026 (Evolve), p13
Over-the-counter medicine
Not covered. 1. Over-the-counter medication (Incl. Vitamins) No Benefit No Benefit
Momentum Annexure B(2) 2026 (Evolve), p13
Chronic medicine (Chronic Disease List)
Subject to the State entry level formulary as detailed in C of this Annexure B3
Momentum Annexure B(2) 2026 (Evolve), p13
Chronic medicine (other conditions)
Not covered. Unless a benefit is a PMB, if it is not explicitly listed, it is not covered
Momentum Annexure B(2) 2026 (Evolve), p7
Basic dentistry
1.1 In Hospital (Conservative and PMBs only
Momentum Annexure B(2) 2026 (Evolve), p9
Specialised dentistry
1.3 Maxillo facial surgery (trauma only) PMBs only
Momentum Annexure B(2) 2026 (Evolve), p9
Eyes (optometry)
Not covered. 1. Frames No Benefit No Benefit
Momentum Annexure B(2) 2026 (Evolve), p13
Blood tests (pathology)
2. Out-of-hospital PMBs only Limited to PMBs at State Hospital Network
Momentum Annexure B(2) 2026 (Evolve), p10
Basic X-rays
1.2 Out-of-hospital PMBs only
Momentum Annexure B(2) 2026 (Evolve), p9
MRI, CT and PET scans
2.2 Out-of-hospital PMBs only
Momentum Annexure B(2) 2026 (Evolve), p9
Physiotherapy and other therapists
2 visits per beneficiary per annum (either physiotherapy or biokineticist), subject to a R1 200 limit per beneficiary per year
Momentum Annexure B(2) 2026 (Evolve), p8
Alternative healthcare
Acupuncturist, Physiotherapy, Homeopathy, Naturopathy, Herbology, Audiology,
Momentum Annexure B(2) 2026 (Evolve), p8
Psychologist and counselling visits
Limited to PMBs at State Hospital Network facilities subject to part (4) in Annexure D
Momentum Annexure B(2) 2026 (Evolve), p9
Maternity care (out of hospital)
12 antenatal visits per confinement (Subject to registration on the maternity management programme).
Momentum Annexure B(2) 2026 (Evolve), p9
Contraceptives
Not covered. Unless a benefit is a PMB, if it is not explicitly listed, it is not covered
Momentum Annexure B(2) 2026 (Evolve), p7
Screening and prevention
Screening and prevention
Full general physical examination by a chosen Network Provider according to the following age bands
Momentum Annexure B(2) 2026 (Evolve), p17
Conditions
The Chronic Disease List conditions are Prescribed Minimum Benefits on every medical aid. How each one works on a medical aid:
- Addison's Disease
- Asthma
- Bipolar Disorder
- Bronchiectasis
- Dysrhythmia
- Heart Failure
- Cardiomyopathy
- COPD
- Chronic Kidney Disease
- Coronary Artery Disease
- Crohn's Disease
- Type 1 Diabetes
- Type 2 Diabetes
- Epilepsy
- Glaucoma
- Haemophilia
- HIV (Human Immunodeficiency Virus)
- High Cholesterol
- Hypertension
- Hypothyroidism
- Multiple Sclerosis
- Parkinson's Disease
- Rheumatoid Arthritis
- Schizophrenia
- Systemic Lupus Erythematosus (SLE)
- Ulcerative Colitis
Momentum’s 2026 documents name no chronic conditions beyond the Chronic Disease List on Evolve.
Questions about Evolve
Answered from Momentum’s documents.
How does Momentum describe Evolve?
In Momentum’s own words (2027 Momentum Medical Scheme Marketing brochure, p7): “The Evolve Option provides cover for hospitalisation at the Evolve Network of private hospitals (see page 40 for this list). There is no overall annual limit for hospitalisation.”
How much does Evolve cost in 2027?
From 1 January 2027: R2 176 a month for the main member, R2 176 for an adult dependant and R2 176 for a child. You pay for up to 3 children.
How much is Evolve going up for 2027?
For the main member, from R2 029 to R2 176 a month, +7.2%.
Does Evolve pay for GP visits and day-to-day costs?
No. Evolve is a hospital plan, so day-to-day costs are your own.
How many chronic conditions does Evolve cover?
26: the 27 on the Chronic Disease List and others the scheme adds.
Until what age can children stay on as dependants?
Up to age 20 in 2027 (21 in 2026).
Will I have a shortfall if my specialist charges more?
Evolve pays specialists in hospital at 100% of the Scheme tariff. If a specialist charges more than that, the difference is a shortfall. Gap cover is the product that pays shortfalls.
Factual information from Momentum Medical Scheme’s published documents. It is not advice. Compiled by Eldon de Waal, CFA, the licensed advisor behind AURA. Catalogue v175, built 2026-10-19.