Yes, there is a R2,000 co-payment per scope procedure (colonoscopy, gastroscopy, cystoscopy, hysteroscopy, or sigmoidoscopy) unless your condition qualifies as a Prescribed Minimum Benefit (PMB). The co-payment does not apply to confirmed PMB cases. Strategy reference: ily-2026.

Joint replacement surgery is excluded on Beat3 Plus except for PMB conditions. If your knee replacement qualifies as a PMB, it will be covered but subject to prosthesis limits of R52,241 for knee and shoulder replacements. Hip and other major joints have a limit of R42,221. Strategy reference: ily-2026.

Emergency unit visits where a procedure room was used are paid from your savings account, not from Scheme risk. This means you'll deplete your Medical Savings Account (MSA) when visiting casualty facilities. In-hospital admissions for emergencies are covered from risk. Strategy reference: ily-2026.

MRI and CT scans are covered at 100% Scheme tariff with a combined in-hospital and out-of-hospital family limit of R36,610 per year. You will pay a R2,000 co-payment per scan unless your condition is a confirmed PMB. Pre-authorisation is required. Strategy reference: ily-2026.

Only if your mental health condition is on the Chronic Disease List (CDL). Beat3 Plus covers 27 CDL conditions including bipolar disorder and schizophrenia, but does not include depression or generalized anxiety disorder. You would need to pay for these medications from your savings account. Strategy reference: ily-2026.

Yes, oncology is covered at 100% Scheme tariff with no annual limit, but you must use designated or preferred service providers and follow Essential ICON protocols. Pre-authorisation is mandatory for all cancer treatment. Strategy reference: ily-2026.

You can use any GP of your choice - there is no network restriction on Beat3 Plus. However, all GP consultations are paid from your savings account at 100% Scheme tariff, not from Scheme risk. Strategy reference: ily-2026.

Once your R15,132 annual savings account is depleted, you'll pay out-of-pocket for day-to-day expenses like GP visits, specialist consultations, basic pathology, and acute medication until the next year. Your in-hospital benefits and chronic medication (CDL) continue to be covered from Scheme risk. Strategy reference: ily-2026.

If your day procedure is done in a day hospital by a DSP provider, there's no additional co-payment. However, if the day procedure is done in an acute hospital that is not a day hospital, you'll pay a R2,872 co-payment per event unless arranged with the Scheme beforehand. Strategy reference: ily-2026.

Yes, both hypertension (CDL 20) and diabetes mellitus type 1 and 2 (CDL 12, 13) are on the CDL list. CDL and PMB chronic medications are covered at 100% Scheme tariff with unlimited funding from Scheme risk. There is a 30% co-payment for non-formulary medications. Strategy reference: ily-2026.