2026 Rules Active
2026 Strategy Validated
Hospital Freedom for Seniors (Joint Exclusion)
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Actuarial Strategy Reference
This strategy is generated based on the 2026 Council for Medical Schemes (CMS) registered rules and actuarial pricing matrices.
VERIFIED: 2025-12-20 | SOURCE: SCHEME_BENEFIT_GUIDE_2026
Similar Situations
Key Terms Explained
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. [Source: Council for Medical Schemes Official Benefit Rules]
- Elective Procedure Co-payment
- A mandatory upfront fee you must pay to the hospital for specific scheduled surgeries that are not emergencies. [Source: Council for Medical Schemes Official Benefit Rules]
- PMB (Prescribed Minimum Benefits)
- By law, this plan must cover the costs of 27 specific chronic conditions and emergency treatments. [Source: Council for Medical Schemes Official Benefit Rules]
Common Questions
Will I have to pay upfront if I need a colonoscopy or gastroscopy? [Senior Joint Replacement Risk (Full Choice)]
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. Strategy reference: isk-2026.
What happens if I go to a hospital that's not in the network? [Senior Joint Replacement Risk (Full Choice)]
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. Strategy reference: isk-2026.
Will my depression or anxiety medication be covered? [Senior Joint Replacement Risk (Full Choice)]
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. Strategy reference: isk-2026.
If I need an MRI or CT scan, will I have to pay extra? [Senior Joint Replacement Risk (Full Choice)]
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. Strategy reference: isk-2026.
Can I go to my GP for a flu or regular checkup without paying? [Senior Joint Replacement Risk (Full Choice)]
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. Strategy reference: isk-2026.
Do I need to pay anything extra if I have cancer treatment? [Senior Joint Replacement Risk (Full Choice)]
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. Strategy reference: isk-2026.
If I need a knee or hip replacement, how much will I pay? [Senior Joint Replacement Risk (Full Choice)]
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. Strategy reference: isk-2026.
What if I get injured and go to casualty but I'm not admitted to hospital? [Senior Joint Replacement Risk (Full Choice)]
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. Strategy reference: isk-2026.
Senior Joint Replacement Risk (Full Choice) strategy verified
Covering 0 family members
2026 rates applied