2026 Rules Active
2026 Strategy Validated
85 Chronic Conditions: Including Osteoarthritis
58-Condition Biologic & Osteoarthritis Manager strategy verified
Covering 1 family members
2026 rates applied
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Momentum
Summit
Summit: Full Choice Specialist Funding
Top-Tier Option
Most comprehensive plan available.
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 R7,728 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 go to a non-network GP because my usual doctor is unavailable, will the visit still count toward my threshold and get reimbursed later? [58-Condition Biologic & Osteoarthritis Manager]
Non-network GP consultations are not treated the same as network GP consultations, and the option rules describe different funding pathways (savings/OHEB/threshold) depending on whether a network GP was used. Strategy reference: ior-2026.
Do I need to nominate a specific network GP, and what happens if I don’t use that nominated GP? [58-Condition Biologic & Osteoarthritis Manager]
The option rules describe cover being strongest when using a nominated network GP, and claims can be processed differently when a non-network GP is used. Strategy reference: ior-2026.
If I see a specialist without a referral from my network GP, will I pay a penalty or co-payment? [58-Condition Biologic & Osteoarthritis Manager]
The option rules state that referral rules apply for network specialist pathways and that failing to follow referral requirements can trigger co-payments depending on the benefit category. Strategy reference: ior-2026.
If I need emergency trauma care at a casualty ward but I’m not admitted, will it still be paid from risk? [58-Condition Biologic & Osteoarthritis Manager]
The option rules describe trauma treatment in a casualty ward as covered from risk subject to authorisation rules and timelines. Strategy reference: ior-2026.
If I forget to get authorisation after an emergency hospital visit, will the scheme penalise the claim? [58-Condition Biologic & Osteoarthritis Manager]
The option rules require authorisation within specified timeframes for emergencies, and missing these steps can lead to penalties or reduced funding. Strategy reference: ior-2026.
Are MRI/CT scans covered out of hospital, and do I still need pre-authorisation? [58-Condition Biologic & Osteoarthritis Manager]
The option rules state specialised radiology (including MRI/CT) is covered from risk but requires pre-authorisation, and specific non-PMB cost-sharing rules can apply. Strategy reference: ior-2026.
If I need a planned hip or knee replacement, do I have to use specific contracted provider networks to avoid a co-payment? [58-Condition Biologic & Osteoarthritis Manager]
The option rules state that certain joint replacements require using contracted provider arrangements and completing programme steps to avoid co-payments and benefit exclusions. Strategy reference: ior-2026.
Is cancer treatment covered only if I register on the oncology disease management programme? [58-Condition Biologic & Osteoarthritis Manager]
The option rules require registration on the oncology disease management programme after diagnosis and describe ongoing management requirements for changes to treatment plans. Strategy reference: ior-2026.
If I’m pregnant, how long do I have to add my newborn, and what happens if I miss that window? [58-Condition Biologic & Osteoarthritis Manager]
The option rules state there is a limited period after birth to add a newborn underwriting-free, and missing that timeframe can result in underwriting being applied. Strategy reference: ior-2026.
Do I only pay for three children, and does the child rate apply up to a specific age? [58-Condition Biologic & Osteoarthritis Manager]
The option rules state a maximum of three children are paid for (with additional children covered) and that child rates apply up to a specified age limit. Strategy reference: ior-2026.