2026 Rules Active
2026 Validated
Pregnancy pathway with pre-auth and network discipline
Actuarial Objective
Optimised for pregnancy planning where value depends on pre-authorisation, Compact Hospital Network confinement, and avoiding elective/voluntary choices that trigger upfront co-payments.
Running Actuarial Simulation...
More Plan Options
Save R116 pm
Momentum
Evolve Option
Strategy: Evolve Maternity Path (Co-pay exception aware)
Upgrade for +R440 pm
Momentum Medical Scheme
Custom Option
Strategy: Custom Associated Hospital (Penalty avoidance)
Key Terms for this Strategy
- Elective Procedure Co-payment
- A mandatory upfront fee you must pay to the hospital for specific scheduled surgeries (like hip/knee replacements) that are not emergencies.
People Also Ask
Which hospitals can I use on MediPhila?
You must use the Compact Hospital Network. Voluntary use of a non-network hospital attracts a 30% upfront co-payment.
Is there a limit on cancer treatment?
Yes, oncology cover is limited to Prescribed Minimum Benefits (PMB) only. You must use the ICON Network to avoid a 40% co-payment.
Do I have a medical savings account?
No, MediPhila does not have a savings account. It uses a defined Day-to-Day Limit of R4,700 per family for out-of-hospital expenses.
Are GP visits unlimited?
No, you are limited to a specific number of visits per year (e.g., 8 visits for a main member) at a MediPhila Network GP.
Do I need a referral to see a specialist?
Yes, you must be referred by a Network GP. Failure to obtain a referral will result in a 20% upfront co-payment.
Is casualty covered if I get injured?
Yes, but it is paid from your R4,700 Day-to-Day Limit. You are limited to 2 facility visits before other limits apply.
What happens if I need a gastroscopy?
Gastroscopies are covered in-hospital, but a co-payment applies for adults (children under 8 are exempt). Ensure you use a network provider.
Does the plan cover MRI scans?
Yes, but it is limited to R8,600 per family per year and requires pre-authorisation.