2026 Rules Active
2026 Validated
ADHD/Acne/Migraine Coverage with Savings
Actuarial Objective
Member with 1-2 non-CDL chronic conditions (severe acne, ADHD, allergic rhinitis, severe eczema, migraine prophylaxis). 80% Scheme tariff, 30% co-pay non-formulary. Limit M R4,358, M1+ R8,865. CDL chronic unlimited. Savings R609/month.
Running Actuarial Simulation...
More Plan Options
Save R15 pm
Bonitas
BonSave
Strategy: BonSave Single MSA Maximization
Upgrade for +R187 pm
Sizwe Hosmed
Gold Ascend EDO
Strategy: Gold Ascend "EDO": Network Hospital Price Leverage
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.
- Medical Savings Account (MSA)
- A fund of R7,308 included in your premium. You use this for day-to-day expenses like GP visits and scripts.
People Also Ask
What happens if I use a non-network hospital?
If you voluntarily use a hospital outside the Beat Network, you will be liable for a co-payment of R15,025, unless it is a medical emergency.
Is my emergency room visit covered by the scheme?
No, casualty and emergency room visits are paid from your Savings Account. There is no separate risk benefit for this unless you are admitted.
Do I have to pay upfront for a gastroscopy or colonoscopy?
Yes, there is a procedure-specific co-payment of R2,000 for scopes (gastroscopies, colonoscopies, etc.). However, this may be waived if performed in a doctor's rooms.
How much cover do I have for a hip replacement?
While the overall family limit for internal prosthesis is R100,818, a specific sub-limit of R42,221 applies to the hip prosthesis itself.
Are my contraceptives covered?
Yes, female contraceptives are covered up to R2,510 per beneficiary per annum (for oral/injectable/implantable) or R3,795 for an IUD every 5 years.
Is there a co-payment for MRI or CT scans?
Yes, a co-payment of R2,000 applies per scan, unless it is for a confirmed Prescribed Minimum Benefit (PMB) condition.
Does this plan cover biological medicines?
Yes, biological medicine during hospitalisation is covered at 100% Scheme tariff, but limited to R24,286 per family per annum.
Are day-to-day GP visits covered by the scheme risk?
No, GP consultations are paid from your Savings Account. Once your savings are depleted, you must pay out-of-pocket.