2026 Rules Active
2026 Validated
Contribution-saving path with controllable penalties
Actuarial Objective
Optimises for contribution savings by selecting Associated hospitals plus Associated chronic routing (Associated doctors + courier pharmacy), while avoiding the stated 30% hospital co-payment by staying in-network.
Running Actuarial Simulation...
More Plan Options
Save R291 pm
Bestmed
Beat3 Plus
Strategy: Beat3 Plus Enhanced Family Maternity + High Savings
Upgrade for +R98 pm
Bonitas
Standard Select
Strategy: Standard Select Family 45 Chronic + Nominated GP Compliance
Key Terms for this Strategy
- Medical Savings Account (MSA)
- A fund of R6,399.6 included in your premium. You use this for day-to-day expenses like GP visits and scripts.
- 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
What happens if I use a hospital not on the Associated list?
You will be liable for a 30% co-payment on the hospital account. Always check the Associated Hospital list before admission.
Is there a limit on cancer treatment?
Yes, there is an annual limit of R400,000 per beneficiary. After this amount, a 20% co-payment applies to further claims.
Do I have to pay upfront for an MRI or CT scan?
You must pay a R3,500 co-payment per scan, and it requires pre-authorisation. This applies in and out of hospital.
Does the plan cover a hip or knee replacement in full?
No. While covered, you face a R5,500 co-payment if done in an acute hospital, and the internal prosthesis is limited to R67,000 per event.
Are my day-to-day GP visits covered by the scheme risk?
No, GP visits are paid from your Personal Medical Savings Account (10% of contribution). Once savings are depleted, you pay out of pocket.
What if I need to go to the emergency room (Casualty)?
Casualty visits are paid from your Savings. There is no risk benefit for emergency room facility fees unless you are admitted.
Can I use any doctor for my chronic medication?
You can, but to avoid co-payments or higher contributions, you should select the provider linked to your specific plan option (Any, Associated, or State).
Is there a co-payment for a gastroscopy or colonoscopy?
Yes, R2,000 if performed in a day hospital, or R5,500 in an acute hospital. This applies even if performed out of hospital.