2026 Rules Active
2026 Validated
Type 2 Diabetes/Hypertension Hospital Plan
Actuarial Objective
Member with 1-2 CDL conditions (27 conditions list). CDL chronic medicine unlimited at 100% Scheme tariff. 30% co-pay for non-formulary. Network pharmacies required. No non-CDL chronic (e.g., severe acne, ADHD).
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Medshield
MediPhila
Strategy: Starter: Compact-network hospital risk transfer
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Fedhealth Medical Scheme
flexiFED 1
Strategy: Budget Hospital Starter
Key Terms for this Strategy
- Network Restriction
- You must use hospitals and doctors listed in the scheme's specific network. Voluntary use of non-network providers will result in a heavy co-payment.
- Elective Procedure Co-payment
- A mandatory upfront fee you must pay to the hospital for specific scheduled surgeries (like hip/knee replacements) that are not emergencies.
- PMB (Prescribed Minimum Benefits)
- By law, this plan must cover the costs of 27 specific chronic conditions and emergency treatments, even though it is a basic Hospital Plan.
People Also Ask
Will I have to pay upfront if I need a colonoscopy or gastroscopy?
Yes, there is a R2,000 co-payment for each scope procedure (colonoscopy, gastroscopy, cystoscopy, hysteroscopy, sigmoidoscopy). This co-payment does not apply if the procedure is for a Prescribed Minimum Benefit (PMB) condition.
What happens if I go to a hospital that's not in the network?
If you voluntarily choose a non-network hospital on the Beat 1 Network option, you will incur a maximum co-payment of R15,025. You can avoid this by selecting the standard (non-network) option at R2,523 per month instead of R2,269.
Will my depression or anxiety medication be covered?
Only if your condition is listed on the Chronic Disease List (CDL). Beat 1 covers only CDL and PMB chronic conditions. Non-CDL chronic medicine has no benefit and must be paid out-of-pocket.
If I need an MRI or CT scan, will I have to pay extra?
Yes, there is a R2,600 co-payment per scan for MRI, CT, and nuclear/isotope studies. The co-payment does not apply to confirmed PMB conditions. There is also a family annual limit of R20,920 for all specialised imaging combined.
Can I go to my GP for a flu or regular checkup without paying?
No. Beat 1 is a hospital plan - general out-of-hospital GP visits are for your own account. The only GP visits covered are the 6 antenatal consultations during pregnancy, and preventative screenings like Pap smears or PSA tests.
Do I need to pay anything extra if I have cancer treatment?
Oncology is covered at 100% Scheme tariff, but Essential ICON protocols apply, meaning you must use designated or preferred oncology providers. If you go outside the ICON network, you may face significant out-of-pocket costs.
If I need a knee or hip replacement, how much will I pay?
Joint replacement surgery is excluded except for PMB conditions. If it qualifies as a PMB, coverage is limited to R51,686 for knee/shoulder and R41,918 for hip/major joints, subject to the overall prosthesis limit of R99,764 per family per year.
What if I get injured and go to casualty but I'm not admitted to hospital?
There is no casualty facility benefit on Beat 1. This is a pure hospital plan, so you are only covered if you are admitted to hospital. If you are treated and discharged from the emergency room without admission, the costs are for your own account.