Medical aid without gap cover? It’s like a stamp without ink; the stamp needs ink to make a mark.
The same goes for Momentum Medical Aid and TRA Gap Cover. Together, these two could ensure your healthcare journey is protected against costly shortfalls that arise during in-hospital procedures or specialist treatments.
Even with Momentum’s wide range of medical aid options and benefits, there may still be instances where the scheme doesn’t pay the full amount charged by healthcare providers. That’s where medical gap cover from TRA (Total Risk Administrators) comes in, helping to close the difference between what your medical aid pays and what the practitioner charges.
Why Momentum Members May Choose TRA Gap Cover
Momentum is well known in South Africa for its scope of insurance and financial service offerings. Momentum’s Medical Aid offers a range of healthcare solutions to individuals and families. Its benefit options are structured across hospital plans, savings accounts, and comprehensive cover, all designed to support a variety of healthcare needs and lifestyles, meeting you where you are in life.
However, like all medical aid schemes, members can still experience tariff shortfalls or co-payments for certain procedures, especially where in-hospital specialists or facilities charge above the medical scheme rate (MSR).
Gap cover may help manage:
- Tariff shortfalls on in-hospital procedures and medical practitioner costs
- Co-payments for oncology, day surgeries, or advanced diagnostics
- Sub-limits or exclusions for prostheses and other specialist treatments
- Out-of-pocket hospital expenses during emergency or trauma admissions
- Certain procedures that aren’t fully covered within your medical scheme limit
- Support for private ward use or authorised in-hospital maternity care
Gap cover complements your Momentum Medical Scheme membership by offering financial protection, particularly when costs exceed the Momentum Medical Scheme Rate.
Momentum’s Medical Aid Plan Structure
Momentum’s medical aid plans offer a range of coverage options from core hospital cover to comprehensive medical aid cover. The plans differ in terms of medical scheme benefits, provider choice, day-to-day benefits, and scheme risk allocations.
Ingwe Option
Designed for students or entry-level earners, this hospital plan offers cover for PMB (Prescribed Minimum Benefits) conditions and hospital treatment through selected provider networks. While affordable, co-payments may apply for certain hospital admissions or treatments outside the network.
Evolve Option
A hospital plan designed for young professionals. It includes hospital cover via a dedicated Evolve Network and focuses on essential benefits. Gaps may occur when procedures fall outside the covered network or scheme tariff.
Custom & Incentive Options
These mid-range options include hospital cover from chosen providers, plus additional day-to-day benefits through savings or incentives. However, co-payments for scopes, radiology, or certain surgical procedures can still apply, especially when not using dedicated service providers.
Extender Option
A more comprehensive plan including a savings component and a Threshold benefit. While it offers broader day-to-day and hospital cover, shortfalls may still occur for higher-cost procedures or specialist charges above the Momentum medical scheme rate.
Summit Option
Momentum’s top-tier product with extensive hospital cover and no overall annual limit. Still, even high-end plans may leave members liable for tariff gaps, co-payments, or sub-limits in areas such as oncology or internal prostheses, where gap cover could assist.
Across all Momentum Medical Scheme plans, members can also benefit from Health Platform Benefits, Multiply rewards, and tools like HealthSaver+. Yet, none of these replace the need for cover against hospital shortfalls.
TRA’s Gap Cover Policies
TRA offers several tiered gap cover plans, each designed to match different medical aid structures — from network-based hospital plans to premium comprehensive cover.
Basic Cover 300
This policy is ideal for members wanting basic, affordable protection from core medical aid shortfalls.
- Up to 300% shortfall cover
- Casualty benefit for accident-related injuries
- One specialist consultation shortfall per year
Vital Cover Plus
A popular mid-tier option is affordable, offering protection during hospital admissions or specific procedures performed in-hospital with basic oncology support.
- Up to 700% tariff shortfall cover
- Co-payments on scopes and scans
- Cover for limited in-hospital dental treatment
- Basic oncology cover
Super Cover Plus
Similar to Vital Cover Plus, with additional cover for specialist treatments and private ward benefits.
- 700% tariff shortfall protection
- Comprehensive co-payment support
- Oncology and prosthesis sub-limit benefits
- Private ward and maternity stay benefits
- Global fee shortfall cover and new-tech oncology treatment support
Absolute Cover Plus
TRA’s most comprehensive option, ideal for those seeking a full scope of cover. Benefits include:
- All benefits from other tiers
- Extended oncology cover
- Cosmetic breast reconstruction for cancer patients
- Cover for high-cost prostheses and internal devices
- Casualty, trauma counselling, and private ward access
- Accidental death benefit and travel insurance
All policies are backed by TRA Assist, a 24/7 digital support app offering access to emergency help, nurse lines, claim tracking, and document downloads.
How TRA Gap Cover Works
Gap cover is a separate entity from medical aid; it’s not a replacement, but a complement. Gap cover can only be instated if the member is part of an existing medical aid scheme.
This insurance product steps in when your medical aid pays less than the provider charges for an in-hospital procedure or related service.
When admitted for treatment, your medical scheme may only cover up to a certain tariff. If the doctor charges more, you are liable for the difference, unless you have gap cover.
Depending on your policy, TRA may help cover:
- Tariff shortfalls up to 700% of the Momentum medical scheme rate
- Co-payments for scopes, oncology, scans, and day procedures
- Casualty benefit for accident-related emergency visits
- Specialist shortfalls linked to in-hospital care provided
- Maternity and private ward shortfall costs
- Oncology extender benefits and support for new-tech treatments
- Travel insurance and policy continuation cover
The 2025 annual limit for TRA gap cover is R210,580 per insured individual (adjusted annually).
TRA Waiting Periods
While TRA does not apply a general three-month waiting period, certain waiting periods apply based on condition type:
- 10 months for scopes, childbirth, joint replacements, spinal surgery, etc.
- 6 months for pre-existing conditions
- 9 months for oncology patients, unless the condition has been in remission for over 2 years
If you’re moving from another provider and join TRA within 90 days, some waiting periods may be reduced or waived depending on your previous gap cover.
Who Should Consider TRA Gap Cover?
Medical aid members may benefit from TRA Gap Cover if you:
- Need regular hospital admissions or in-hospital care
- May undergo specialist-led oncology treatment or surgery
- Use Momentum plans that include co-payments or medical scheme limits
- Want peace of mind for high-cost procedures performed in-hospital
- Unable to upgrade to a more expensive medical aid plan
- May require maternity care or support for baby bump benefit-related claims
- Want coverage for violent crime, accidents, or bereavement counselling
Submitting Claims and Getting Support
TRA makes claims and support super straightforward for medical aid members:
- Manual claims can be submitted via the app or email
- Claims are processed three times per week
- Access the TRA Assist app for trauma counselling, nurse advice, and roadside help
Get a TRA Gap Cover Quote
If you’re a member of Momentum Medical Aid, gap cover from TRA could be the cherry on the cake, the ink to your stamp – an essential layer of protection you didn’t know you needed.
From everyday co-payments to rare but costly medical emergencies, TRA Gap Cover helps cover all the costs that your medical aid may leave behind.
Get a quote or sign up for TRA Gap Cover today and keep your healthcare support complete, just like the perfect pair.
Disclaimer:
This article was created for Total Risk Administrators (TRA) to provide general information on how TRA Gap Cover may support members of Momentum Medical Scheme. It does not provide personal financial advice. TRA is a separate entity to Momentum Medical Aid and is not affiliated with the scheme. All medical aid references are based on public information as of 2025 and may change. Always consult Momentum Medical Scheme for current details. Always review the full TRA policy documentation for cover specifics, limitations, and waiting periods. TRA is underwritten by Auto&General Insurance Company Ltd, an authorised FSP and licensed non-life insurer.
