2026 Rules Active
2026 Validated
Uses Associated hospitals to avoid 30% hospital co-pay
Actuarial Objective
Optimises the Associated-hospitals selection by enforcing compliance, preventing the additional 30% hospital-account co-payment that applies when the member uses non-Associated hospitals after selecting Associated hospitals.
Running Actuarial Simulation...
More Plan Options
Save R316 pm
Bestmed
Beat 1 Network
Strategy: Network Hospital-Only Young Starter
Upgrade for +R45 pm
Fedhealth Medical Scheme
flexiFED 1
Strategy: Budget Hospital Starter
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.
- PMB (Prescribed Minimum Benefits)
- By law, this plan must cover the costs of 27 specific chronic conditions and emergency treatments, even though it is a basic Hospital Plan.
People Also Ask
If I choose the Associated Hospital option, what happens if I go to a non-network hospital?
You will be liable for a 30% co-payment on the hospital account, in addition to the standard R2,000 admission co-payment.
Is there a limit on cancer treatment?
Yes, oncology is covered up to R300,000 per beneficiary per year. Thereafter, a 20% co-payment applies to all costs.
Do I have to pay upfront for a gastroscopy or colonoscopy?
Yes, you will pay a R2,000 co-payment if done in a day hospital or out of hospital. If done in an acute hospital, the co-payment jumps to R7,500 (R2,000 standard + R5,500 penalty).
How do I get my chronic medication if I chose the State option?
You must use State facilities for your chronic script and medication to avoid co-payments. If the State cannot provide the medicine, you may use Ingwe Primary Care Network providers subject to a formulary.
Is there an overall limit for internal prostheses like hip joints?
There is no overall family limit, but there is a strict sub-limit of R62,000 per beneficiary per event (max 2 events per year). You may have out-of-pocket costs if the device exceeds this.
Are MRI and CT scans covered in full?
No, while there is no annual limit, you must pay a R3,850 co-payment per scan, regardless of whether it is done in or out of hospital.
Does this plan cover emergency casualty visits?
No, casualty visits are not covered by the risk benefit. They are subject to your available Momentum HealthSaver funds.
What maternity benefits are included?
The plan covers 12 antenatal visits, 2 ultrasounds (2D), and 2 paediatrician visits in the baby's first year, provided you register on the Maternity programme.