2026 Rules Active
2026 Strategy Validated
Sizwe Saver: Day Procedure Scheduler
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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 R11,733 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]
Common Questions
If I get cancer, am I fully covered or is there a yearly cap I could hit? [Access "Saver": Day-Procedure Deductible Scheduler]
This plan has a stated oncology utilisation threshold of R297,079.18 per beneficiary per year, and once you go above that amount a 20% co-payment applies for non-PMB oncology-related costs (and oncology is subject to using the oncology DSP and scheme rules). Strategy reference: ler-2026.
Do I have to use a specific oncology network, or can I go to any oncologist I want? [Access "Saver": Day-Procedure Deductible Scheduler]
Oncology is subject to using the Oncology DSP, and pre-authorisation / scheme rules apply, so using a non-aligned provider may affect how the claim is paid. Strategy reference: ler-2026.
If my doctor recommends a prosthesis (like a hip/knee/shoulder component), what is the maximum this plan will pay in a year? [Access "Saver": Day-Procedure Deductible Scheduler]
There is an annual overall prosthesis limit of R39,048.35 per family per year, and prostheses are also subject to pre-authorisation, managed care protocols, and PMB rules where applicable. Strategy reference: ler-2026.
If my prosthesis costs more than the family prosthesis limit, will I be stuck paying the shortfall myself? [Access "Saver": Day-Procedure Deductible Scheduler]
If the prosthesis costs exceed the stated annual overall prosthesis limit of R39,048.35 per family per year, the amount above the limit would not be covered under that prosthesis limit and would typically remain for the member’s account, subject to scheme rules. Strategy reference: ler-2026.
If I choose a hospital that is not part of the scheme’s DSP arrangements, will my admission still be covered? [Access "Saver": Day-Procedure Deductible Scheduler]
Hospital benefits are stated as only available at the Designated Service Providers (DSPs), and admissions are subject to pre-authorisation and scheme rules, so non-DSP usage is a major risk point. Strategy reference: ler-2026.
If I forget to pre-authorise an elective admission, what happens to my claim? [Access "Saver": Day-Procedure Deductible Scheduler]
All admissions (including PMBs) are subject to pre-authorisation and scheme rules, and the brochure indicates a penalty for non-emergency late pre-authorisations. Strategy reference: ler-2026.
When my savings (MSA) runs out, do I still get any GP consultations covered? [Access "Saver": Day-Procedure Deductible Scheduler]
GP consultations are paid from the MSA, and once depleted the brochure describes a limited additional GP consultation benefit (with a family cap) rather than unlimited ongoing cover. Strategy reference: ler-2026.
When my savings (MSA) runs out, do I still get any specialist consults covered? [Access "Saver": Day-Procedure Deductible Scheduler]
Specialist consultations are paid from the MSA, and once depleted the brochure describes a limited additional specialist consultation benefit (restricted to certain specialist types) rather than unlimited cover. Strategy reference: ler-2026.
If I need an MRI/CT scan, could I still end up paying a co-payment even if I’m approved? [Access "Saver": Day-Procedure Deductible Scheduler]
Advanced specialised radiology is described as subject to clinical protocols and pre-authorisation, and the brochure indicates a percentage co-payment for non-PMB scans (so out-of-pocket costs are possible depending on PMB status). Strategy reference: ler-2026.
Are there any procedures where I automatically pay a co-payment even if I’m admitted properly? [Access "Saver": Day-Procedure Deductible Scheduler]
The brochure notes a percentage co-payment for certain laparoscopic procedures done in-hospital (with stated exceptions), and also references co-payments for day procedures done at certain acute hospitals. Strategy reference: ler-2026.
Access "Saver": Day-Procedure Deductible Scheduler strategy verified
Covering 1 family members
2026 rates applied