2026 Rules Active
2026 Strategy Validated
Low-Income Network Cover with Unlimited GP
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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]
Common Questions
Is joint replacement surgery covered? [BonCap Income Band 1 Single Starter]
No, joint replacement surgery is explicitly listed as an exclusion on this plan. Strategy reference: ter-2026.
Can I go to any GP? [BonCap Income Band 1 Single Starter]
No, you must use a BonCap Network GP. One out-of-network visit is allowed per beneficiary with a 30% co-payment unless it is a PMB. Strategy reference: ter-2026.
Do I need a referral to see a specialist? [BonCap Income Band 1 Single Starter]
Yes, you must obtain a referral from a BonCap Network GP to see a specialist, and pre-authorisation is required. Strategy reference: ter-2026.
Is there a co-payment for MRI scans? [BonCap Income Band 1 Single Starter]
Yes, there is a R1,230 co-payment per scan event, unless it is for a Prescribed Minimum Benefit (PMB) condition. Strategy reference: ter-2026.
What happens if I use a non-network hospital? [BonCap Income Band 1 Single Starter]
You will be liable for a 30% co-payment on the hospital account, except in cases of emergency. Strategy reference: ter-2026.
Are there limits on acute medication? [BonCap Income Band 1 Single Starter]
Yes, GP-referred acute medicine is limited to R2,390 for a single member, increasing with family size. Strategy reference: ter-2026.
Is depression covered as a chronic condition? [BonCap Income Band 1 Single Starter]
Yes, Depression is covered as the 28th chronic condition, with medication cover limited to R165 per beneficiary per month. Strategy reference: ter-2026.
How does the casualty benefit work? [BonCap Income Band 1 Single Starter]
You are covered for 2 emergency consultations per family at a casualty ward. If the visit is not classified as an emergency, it will be paid from your day-to-day GP benefit. Strategy reference: ter-2026.
Are contraceptives covered? [BonCap Income Band 1 Single Starter]
Yes, contraceptives are covered up to R1,330 per family, but you must use a Designated Service Provider (DSP) pharmacy to avoid a 40% co-payment. Strategy reference: ter-2026.
Do I have to pay for day surgery? [BonCap Income Band 1 Single Starter]
If you use a network day hospital for listed procedures (like gastroscopies), there is no co-payment. Using an acute hospital will incur a 30% co-payment. Strategy reference: ter-2026.
BonCap Income Band 1 Single Starter strategy verified
Covering 0 family members
2026 rates applied