Momentum Health: Your Guide to Mental Health and Therapy Coverage
TherapyRoute
Clinical Editorial
Cape Town, South Africa
❝Momentum Health, South Africa's third-largest open medical aid, offers distinct mental health benefits, particularly on its higher-end plans, with detailed coverage for therapy, psychiatry, and in-hospital treatment to help members maximise their benefits.❞
Momentum Health is the third-largest open medical aid in South Africa, holding a significant 8.7% of the market share. Known for its incentive-based approach to healthcare, Momentum offers a range of plans that reward members for healthy living. This article will provide a detailed analysis of Momentum Health's mental health coverage, based on their 2024 and 2025 policy documents. We will explore their benefit structure, how to access care, and what you can expect in terms of coverage for therapy and psychiatry.
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Find Your TherapistTable of Contents | Jump Ahead
Momentum's Approach to Mental Health
Understanding Your Momentum Health Mental Health Benefits
How to Access Your Momentum Health Benefits
Network vs Non-Network Providers: A Detailed Comparison
How to Claim for Therapy Sessions
The Verdict: Is Momentum Health a Good Choice for Mental Health?
Global Helplines & Emergency Services
Momentum's Approach to Mental Health
Momentum Health's mental health benefits are structured differently from those of Discovery Health and Bonitas. Instead of a dedicated mental health programme, Momentum provides a generous annual benefit for psychology and therapy on its higher-end plans. This approach offers members more flexibility in their choice of provider, but it also requires them to be more proactive in managing their benefits.
The Major Medical Benefit: Your Safety Net
For in-hospital treatment, Momentum's Major Medical Benefit provides extensive cover. This includes admissions to psychiatric facilities for the treatment of mental health conditions. As with all medical aids, this benefit provides unlimited cover for Prescribed Minimum Benefit (PMB) conditions like major affective disorders (including unipolar and bipolar depression) and schizophrenic and paranoid delusional disorders, provided you use a network hospital.Understanding Your Momentum Health Mental Health Benefits
Momentum Health's benefits for mental health are primarily determined by the plan you have chosen. Here is a breakdown of what you can expect.In-Hospital Treatment
If you require hospitalisation for a mental health condition, Momentum's Major Medical Benefit will cover the costs. For PMB conditions, this cover is unlimited, subject to the use of network providers. For non-PMB conditions, your cover will be determined by your plan's limits.Key Points for In-Hospital Care:
- Pre-authorisation is essential. You must get approval from Momentum Health before being admitted to the hospital.
- Use a network hospital. To ensure you are fully covered, it is always best to use a hospital in the Momentum network.
- Co-payments may apply. If you choose to use a non-network hospital, you may have to pay a co-payment.
Out-of-Hospital Treatment
Momentum's out-of-hospital benefits for mental health are particularly strong on their higher-end plans.Psychology and Therapy
The standout feature of Momentum's mental health coverage is the generous benefit for psychology and therapy on their Incentive and Extender plans. On the Incentive Option, for example, members have access to R48,400 per beneficiary per year for psychology and therapy consultations. [3] This is one of the highest individual benefits for therapy in the South African market.Psychiatry
Consultations with a psychiatrist are covered from your plan's specialist benefit. The amount of cover you have will depend on your plan. On the Incentive and Extender plans, this benefit is generous, while on the savings plans, you will pay for these consultations from your Medical Savings Account.Medication
Chronic medication for mental health conditions is covered under the Chronic Benefit. You will need to register your condition with Momentum to access this benefit. The scheme has a list of covered conditions and a formulary (a list of approved medications) that you will need to adhere to.
Prescribed Minimum Benefits (PMBs) - Covered on ALL Plans
|
PMB Code |
Condition |
Coverage |
Professional Context |
|---|---|---|---|
| 902T | Major affective disorders, including unipolar and bipolar depression | Unlimited hospital + 15 outpatient sessions | Executive function support and mood stabilisation |
| 907T | Schizophrenic and paranoid delusional disorders | Unlimited hospital + ongoing treatment | Comprehensive psychiatric care with privacy protection |
| 908T | Anorexia Nervosa and Bulimia Nervosa | Hospital care + 15 outpatient sessions | Stress-related eating disorder support |
| 182T | Abuse or dependence on psychoactive substances, including alcohol | Hospital rehabilitation + outpatient support | Confidential addiction treatment for professionals |
| 901T | Acute stress disorder accompanied by recent significant trauma | Hospital care + 12 outpatient sessions | Workplace trauma and acute stress intervention |
| 903T | Attempted suicide, irrespective of cause | Hospital care + outpatient support | Crisis intervention with professional discretion |
How to Access Your Momentum Health Benefits
- Check Your Plan's Benefits: The first step is to understand the specific benefits available on your plan. You can find this information in your member guide or by logging in to the Momentum website or app.
- Get Pre-Authorisation: For any planned hospital admissions, make sure you get pre-authorisation from Momentum.
- Choose Your Provider: Momentum offers more flexibility in provider choice than some other schemes, but it is still advisable to use a network provider to minimise your costs.
- Submit Your Claims: Your healthcare provider will usually submit claims directly to Momentum. You can track your claims and benefits on the Momentum member portal or app.
Network vs Non-Network Providers: A Detailed Comparison
Your choice between a network and a non-network provider has significant financial and administrative implications. Here’s a detailed breakdown to help you make an informed decision:| Feature | Network Providers (DSPs) | Non-Network Providers |
|---|---|---|
| :--- | :--- | :--- |
| Cost | Lower out-of-pocket costs. You are only responsible for a small co-payment, if any. | Higher out-of-pocket costs. You are responsible for the full fee upfront. |
| Billing | The provider bills Momentum Health directly (bulk-billing). | You pay the provider and then claim back from Momentum Health. |
| PMB Coverage | Full cover for PMB conditions, with no co-payments. | You may be liable for a co-payment of up to 20% of the cost of treatment. |
| Rates | Charge at or close to the Momentum Health Rate. | Can charge significantly above the Momentum Health Rate, and you are responsible for the difference. |
What is a Designated Service Provider (DSP)? A DSP is a healthcare provider (doctor, hospital, or pharmacy) that has a special agreement with Momentum Health to provide services at a pre-negotiated rate. For PMB conditions, you must use a DSP to get full cover. If you choose to use a non-DSP for a PMB condition, you may have to pay a significant co-payment.
Why We Recommend Network Providers For most members, using a network provider is the most cost-effective and hassle-free option. You will have lower out-of-pocket costs, less paperwork, and access to the full range of your benefits. While non-network providers offer more choice, this comes at a significant financial cost.
How to Claim for Therapy Sessions
Understanding the claims process can save you time and ensure you get reimbursed quickly:Option 1: Network Provider (Recommended)
- Book with a network provider who accepts Momentum Health
- Show your Momentum Health card at the appointment
- Provider submits claim directly to Momentum Health (bulk billing)
- You pay only your portion (co-payment if applicable)
Option 2: Non-Network Provider
- Pay the full session fee upfront to your therapist
- Get a detailed invoice with the following information:
- Your membership number
- Provider's practice number
- Date of service
- ICD-10 diagnosis code
- Procedure code (usually 0134 for psychology consultation)
- Amount charged
- Submit your claim within 4 months via:
- Momentum app (fastest)
- Online member portal
- Email to claims@momentumhealth.co.za
- Post to Momentum Health Claims, PO Box 2338, Durban, 4000
Required Documentation for Claims
- Detailed tax invoice from your therapist
- Proof of payment (if paying upfront)
- Referral letter (if required by your plan)
- Diagnosis confirmation (may be requested)
Claims Processing Time
- Electronic claims: 5-7 working days
- Manual claims: 10-15 working days
- Complex claims: Up to 30 days
The Verdict: Is Momentum Health a Good Choice for Mental Health?
Momentum Health is an excellent choice for individuals who want a high degree of flexibility and a generous benefit for outpatient therapy. The likelihood of getting your mental health treatment paid for by Momentum is high, especially if you are on the Incentive or Extender plans. The key to making the most of your Momentum benefits is to understand your specific plan's limits and to manage your benefits effectively. If you are looking for a medical aid that provides a substantial benefit for therapy and allows you to choose your own provider, Momentum Health is a strong contender.Global Helplines & Emergency Services
If you are in immediate distress, please reach out for help. You are not alone.- Find a helpline, suicide hotline, or crisis line in your country: https://www.therapyroute.com/article/helplines-suicide-hotlines-and-crisis-lines-from-around-the-world
- Find an emergency ambulance number in your country: https://www.therapyroute.com/article/ambulance-emergency-numbers-worldwide-list-by-therapyroute
References
Momentum Medical Scheme 2025 Brochure
Momentum Official Claims Submission Page
Discovery Health - Momentum Health Technical Analysis
Disclaimer: The information in this article is based on 2024/2025 policy documents. Benefit amounts and contact details can change. Always verify current details with your medical aid scheme before making any healthcare decisions.
Important: TherapyRoute does not provide medical advice. All content is for informational purposes and cannot replace consulting a healthcare professional. If you face an emergency, please contact a local emergency service. For immediate emotional support, consider contacting a local helpline.
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About The Author
TherapyRoute
Cape Town, South Africa
“Our in-house team, including world-class mental health professionals, publishes high-quality articles to raise awareness, guide your therapeutic journey, and help you find the right therapy and therapists. All articles are reviewed and written by or under the supervision of licensed mental health professionals.”
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