2026 Rules Active
2026 Strategy Validated
Elect: Post-Savings Network Routing
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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]
- Medical Savings Account (MSA)
- A fund of R5,688 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
Does this plan cover hip replacements for wear and tear? [Elect Post-Savings Day-to-Day Network Router]
No. Hip and knee replacements are only covered if they are required due to an acute injury (e.g. a car accident). Wear and tear is explicitly excluded. Strategy reference: ter-2026.
What happens if I use a hospital outside the MedPrime Elect network? [Elect Post-Savings Day-to-Day Network Router]
You will be liable for a 35% co-payment on the hospital account. You must use a network hospital to avoid this penalty. Strategy reference: ter-2026.
Is the cancer cover unlimited on MedPrime Elect? [Elect Post-Savings Day-to-Day Network Router]
No, the oncology benefit is limited to R336,000 per family per year. Once this limit is reached, you may have to self-fund. Strategy reference: ter-2026.
Do I have to pay upfront for a gastroscopy or colonoscopy? [Elect Post-Savings Day-to-Day Network Router]
Yes, there is a R4,225 co-payment for endoscopic procedures, even if performed in a day clinic. Strategy reference: ter-2026.
Is there a limit on my day-to-day medical expenses? [Elect Post-Savings Day-to-Day Network Router]
Yes. After your savings are depleted, you have an 'Insured Pooled Benefit' of R7,550 per member. Once this is used, day-to-day cover stops. Strategy reference: ter-2026.
What will I pay if I need an MRI scan? [Elect Post-Savings Day-to-Day Network Router]
You will be responsible for the first R1,700 of the scan cost as a co-payment. Strategy reference: ter-2026.
Are contraceptives covered by the scheme? [Elect Post-Savings Day-to-Day Network Router]
Yes, contraceptives are covered up to R2,470 per year under the preventative care benefit. Strategy reference: ter-2026.
Do I need a referral to see a specialist? [Elect Post-Savings Day-to-Day Network Router]
While you don't strictly need a referral for payment, using the MedPrime Elect Network GPs and Specialists is required to avoid out-of-pocket costs. Strategy reference: ter-2026.
Elect Post-Savings Day-to-Day Network Router strategy verified
Covering 0 family members
2026 rates applied