2026 Rules Active
2026 Strategy Validated
ADHD & Non-CDL Cover for Your Family
Family Managing Child's ADHD on a Budget strategy verified
Covering 3 family members
2026 rates applied
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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 R13,524 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
Will I have to pay out-of-pocket for my MRI or CT scan? [Family Managing Child's ADHD on a Budget]
Yes. The plan charges a R2,000 co-payment per MRI, CT, or nuclear/isotope scan, even though the plan covers 100% Scheme tariff. This co-pay does not apply if the scan is confirmed as a Prescribed Minimum Benefit (PMB). The annual family limit for all specialised imaging combined is R41,840. Strategy reference: ent-2026.
Is my depression medication covered? [Family Managing Child's ADHD on a Budget]
Yes. Major depression is classified as a Non-CDL chronic condition (Non-CDL 6), meaning medication is covered at 90% Scheme tariff with an annual limit of R8,414 for a member (R16,827 for member and family). Once this limit is depleted, approved chronic claims continue from Scheme risk. A 25% co-payment applies to non-formulary medicine. Strategy reference: ent-2026.
Can I use any hospital or am I restricted to a network? [Family Managing Child's ADHD on a Budget]
You can use any hospital in South Africa. Pace1 is an 'Any' provider plan with no network restrictions. All in-hospital benefits are paid at 100% Scheme tariff without penalties for using non-network facilities. Strategy reference: ent-2026.
What happens if I need a knee replacement? [Family Managing Child's ADHD on a Budget]
Knee and shoulder replacements are covered at 100% Scheme tariff with a prosthesis sub-limit of R56,344 per family per annum. This sub-limit forms part of the overall internal prosthesis limit of R114,189. Joint replacement surgery (except PMBs) requires the use of preferred providers, otherwise limits and co-payments apply. Strategy reference: ent-2026.
Do I pay upfront for a gastroscopy or colonoscopy? [Family Managing Child's ADHD on a Budget]
No co-payment is required for in-hospital or out-of-hospital scope procedures (gastroscopy/colonoscopy) on this plan. However, if the day procedure is done in an acute hospital instead of a day hospital, a R2,872 co-payment applies per event unless arranged with the Scheme beforehand using a Designated Service Provider (DSP). Strategy reference: ent-2026.
How much do I pay for day-to-day doctor visits? [Family Managing Child's ADHD on a Budget]
GP, nurse, and specialist consultations are paid from your Medical Savings Account first, then from the day-to-day benefit at 100% Scheme tariff. The annual limit is R2,840 for a member or R5,710 for member and family, subject to the overall day-to-day limit of R13,794 (member) or R27,586 (member and family). Strategy reference: ent-2026.
Will cancer treatment bankrupt me? [Family Managing Child's ADHD on a Budget]
No. Oncology is covered at 100% Scheme tariff with unlimited annual cover, subject to pre-authorisation and Essential ICON protocols. Designated or preferred service providers must be used. Both in-hospital and out-of-hospital oncology treatment is covered without an annual Rand limit. Strategy reference: ent-2026.
What if I run out of savings before the end of the year? [Family Managing Child's ADHD on a Budget]
Once your annual Medical Savings Account (R1,127/month = R13,524/year) is depleted, out-of-hospital benefits are paid from the day-to-day benefit at 100% Scheme tariff (subject to sub-limits). After the day-to-day benefit is exhausted, you can access vested savings. Any unused savings transfer to a vested account after 5 months and remain your property. Strategy reference: ent-2026.
Are my children covered for vaccinations? [Family Managing Child's ADHD on a Budget]
Yes. All paediatric immunisations are covered according to the state-recommended programme. Additional preventative care includes flu vaccines (1 per beneficiary per year), pneumonia vaccines (as per Department of Health schedule), and HPV vaccinations for females aged 9-26 (3 vaccinations per beneficiary). Travel vaccines for typhoid, yellow fever, tetanus, meningitis, hepatitis, and cholera are also funded from Scheme risk. Strategy reference: ent-2026.
Can I use a non-network specialist without penalties? [Family Managing Child's ADHD on a Budget]
Yes. The plan allows you to use any specialist (in-hospital or out-of-hospital) without network restrictions or penalties. Specialist consultations in-hospital are covered at 100% Scheme tariff. Out-of-hospital specialist visits are paid from savings first, then from the day-to-day consultation benefit (limited to R2,840 member / R5,710 member+family), at 100% Scheme tariff. Strategy reference: ent-2026.