2026 Rules Active
2026 Strategy Validated
Budget Priority: 15% MSA + Limited ATB
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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
- Medical Savings Account (MSA)
- A fund of R17,376 included in your premium. You use this for day-to-day expenses like GP visits and scripts. [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
If I’m diagnosed with cancer, what happens when my treatment costs go beyond the Oncology Benefit limit? [Essential Priority Budget Limited ATB]
The Oncology Benefit covers the first R250000, and after that the Scheme covers up to 80% of further approved costs (meaning a 20% member share on those additional amounts). Strategy reference: atb-2026.
Do I have to pay upfront for a gastroscopy or colonoscopy if it’s done in hospital? [Essential Priority Budget Limited ATB]
Yes, an upfront payment can apply for scope admissions in hospital (for example R7500 for the hospital account on a scope admission, depending on the setting and provider). Strategy reference: atb-2026.
If I do a scope in a doctor’s rooms instead of a day clinic/hospital, can I still face a co-payment? [Essential Priority Budget Limited ATB]
Yes—if the scope is performed in rooms by a non-network provider, a co-payment can apply (for example R1800 for a single scope). Strategy reference: atb-2026.
If I need an MRI or CT scan, do I pay something first before the Scheme pays? [Essential Priority Budget Limited ATB]
Yes, the first R4000 of an MRI/CT scan is paid from day-to-day benefits before the balance is covered from the Hospital Benefit (subject to the rules described). Strategy reference: atb-2026.
If I need a joint replacement, is there an upfront payment I must plan for? [Essential Priority Budget Limited ATB]
Yes—joint replacements fall under the list of procedures with an upfront payment, shown as R23700 in the guide. Strategy reference: atb-2026.
Do I have to use a specific GP for chronic medicine cover to work properly? [Essential Priority Budget Limited ATB]
Yes—you must nominate a network GP (Primary Care GP) and, to be covered in full for GP consultations, you must visit your nominated Primary Care network GP. Strategy reference: atb-2026.
How many antenatal visits and pregnancy scans are covered on this plan? [Essential Priority Budget Limited ATB]
The maternity basket includes up to 8 antenatal consultations and up to 2 pregnancy ultrasound scans covered as described in the guide. Strategy reference: atb-2026.
If I don’t use Discovery’s designated providers for oncology medicine, can that cost me extra? [Essential Priority Budget Limited ATB]
Yes—the guide notes a 20% co-payment can apply for oncology medicine if you don’t use the designated service provider approach described, and oncology medicine is covered up to 100% of the Discovery Health Rate or the Oncology Reference Price (whichever is applicable). Strategy reference: atb-2026.
Essential Priority Budget Limited ATB strategy verified
Covering 2 family members
2026 rates applied