Yes. On Beat4, casualty and emergency room visits are paid from your medical savings account first, then from day-to-day benefits. There is no dedicated casualty benefit paid from scheme risk. If you've exhausted your savings early in the year, you'll need to use your vested savings or pay out of pocket until day-to-day limits kick in.

Yes, there is a R2,000 co-payment per MRI or CT scan. However, this co-payment does not apply if the scan is for a confirmed Prescribed Minimum Benefit (PMB) condition. The combined in- and out-of-hospital benefit for specialised imaging is limited to R41,840 per family per year.

Yes, but with limits. Major depression is classified as a Non-CDL chronic condition. Medication is covered at 90% Scheme tariff with a limit of R9,571 for a single member or R19,143 for a family per year. Once this non-CDL limit is depleted, approved major depression medicine will continue to be paid from Scheme risk.

Knee replacements are excluded unless they qualify as Prescribed Minimum Benefits (PMBs). If your knee replacement is a PMB, the prosthesis is limited to R58,086 and must fit within the overall family prosthesis limit of R123,064 per year. Non-PMB joint replacements are not covered.

You can use any private hospital in South Africa. Beat4 does not restrict you to a specific network. However, Designated Service Providers (DSPs) and Preferred Providers apply for certain benefits, and using non-DSPs may result in reduced cover or co-payments for specific procedures.

You will incur a R2,000 co-payment for colonoscopies and R2,000 for gastroscopies. This co-payment does not apply if the procedure is for a confirmed PMB condition. The procedure itself is covered at 100% Scheme tariff, subject to pre-authorisation.

Cancer treatment (oncology) is covered at 100% Scheme tariff with no annual limit, subject to Essential ICON protocols, pre-authorisation, and use of designated or preferred service providers. However, biological medicine during hospitalisation is limited to R30,357 per family per year.

Yes. A co-payment of R2,872 will be incurred per event if a day procedure is performed in an acute hospital that is not a day hospital. However, if you use a DSP who does not work in a day hospital and arrange it with the Scheme beforehand, the co-payment will not apply.

Yes, but with conditions. The default option provides a R1,214 over-the-counter (OTC) limit per family. Alternatively, you can choose to access your full savings for OTC purchases after the R1,214 limit through a self-payment gap accumulation option. Only vitamins, sunscreen, and minerals with NAPPI codes on the Scheme formulary are covered.

All unused funds in your annual medical savings account at the end of the year will be carried over to your vested savings account after 5 months and will remain your property. Vested savings are only used when both your annual savings and Scheme risk benefits are depleted.