2026 Rules Active
2026 Strategy Validated
Incentive: Associated Hospital Saver
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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
- 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. [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
What happens if I use a hospital not on the Associated list? [Incentive Network Saver (Associated hospitals + Associated chronic)]
You will be liable for a 30% co-payment on the hospital account. Always check the Associated Hospital list before admission. Strategy reference: ver-2026.
Is there a limit on cancer treatment? [Incentive Network Saver (Associated hospitals + Associated chronic)]
Yes, there is an annual limit of R400,000 per beneficiary. After this amount, a 20% co-payment applies to further claims. Strategy reference: ver-2026.
Do I have to pay upfront for an MRI or CT scan? [Incentive Network Saver (Associated hospitals + Associated chronic)]
You must pay a R3,500 co-payment per scan, and it requires pre-authorisation. This applies in and out of hospital. Strategy reference: ver-2026.
Does the plan cover a hip or knee replacement in full? [Incentive Network Saver (Associated hospitals + Associated chronic)]
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. Strategy reference: ver-2026.
Are my day-to-day GP visits covered by the scheme risk? [Incentive Network Saver (Associated hospitals + Associated chronic)]
No, GP visits are paid from your Personal Medical Savings Account (10% of contribution). Once savings are depleted, you pay out of pocket. Strategy reference: ver-2026.
What if I need to go to the emergency room (Casualty)? [Incentive Network Saver (Associated hospitals + Associated chronic)]
Casualty visits are paid from your Savings. There is no risk benefit for emergency room facility fees unless you are admitted. Strategy reference: ver-2026.
Can I use any doctor for my chronic medication? [Incentive Network Saver (Associated hospitals + Associated chronic)]
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). Strategy reference: ver-2026.
Is there a co-payment for a gastroscopy or colonoscopy? [Incentive Network Saver (Associated hospitals + Associated chronic)]
Yes, R2,000 if performed in a day hospital, or R5,500 in an acute hospital. This applies even if performed out of hospital. Strategy reference: ver-2026.
Incentive Network Saver (Associated hospitals + Associated chronic) strategy verified
Covering 0 family members
2026 rates applied