You will face a R15,025 co-payment per hospital admission if you voluntarily use a non-DSP hospital (except in emergencies). The DSP hospital network consists of National Hospital Network (NHN) and Mediclinic (MC) hospitals. In emergencies at non-DSP hospitals, you must be stabilised and then transferred to the closest DSP hospital via Netcare 911.

No. You must use Rhythm General Practitioners (GPs) exclusively. The Rhythm GP will refer you to a Rhythm Specialist DSP if specialist consultation is required. Out-of-network GP visits are limited to R1,802 per family per year for casualty/emergency visits only. You cannot freely choose your own doctors outside the network.

No. Depression is not listed in the CDL (Chronic Disease List) or PMB chronic conditions covered by Rhythm2. Only the 27 CDL conditions and 17 PMB chronic conditions are covered. Non-CDL conditions like major depression, ADHD, severe acne, and migraine prophylaxis are not funded on this plan.

Yes. Colonoscopies, gastroscopies, cystoscopies, hysteroscopies, and sigmoidoscopies all have a R2,000 co-payment per procedure. This co-payment does not apply if the procedure is confirmed as a Prescribed Minimum Benefit (PMB) condition. The co-payment applies to both in-hospital and out-of-hospital scope procedures.

Yes. The plan charges a R2,600 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 R18,828. PET scans are excluded except for PMBs.

Knee and shoulder replacements are covered at 100% Scheme tariff with a prosthesis sub-limit of R43,122 per family per annum (for PMBs). This sub-limit forms part of the overall internal prosthesis limit of R67,162. Joint replacement surgery is excluded except for PMB conditions, and you must use preferred providers or face additional limits and co-payments.

Yes, but with strict limits. Out-of-network GP visits and casualty visits are limited to R1,802 per family per year. This includes basic radiology, pathology, and medicine received during the casualty visit. You must pay upfront and claim reimbursement using an out-of-network claim form. Once the R1,802 limit is reached, all costs are for your own account.

Yes. All paediatric immunisations are covered according to the state-recommended programme. Additional preventative care includes flu vaccines (1 per beneficiary per year at Rhythm Network GP or pharmacy), pneumonia vaccines (as per Department of Health schedule), and HPV vaccinations for females aged 9-26 (3 vaccinations per beneficiary). Travel vaccines are also covered.

Arthroscopic procedures have a R3,660 co-payment per event. This also applies to back and neck surgery (R3,660) and laparoscopic procedures (R3,660). These co-payments do not apply if the procedure is for a confirmed PMB condition. All surgeries must be pre-authorised and performed at DSP hospitals.

No. Rhythm2 has no Medical Savings Account (MSA). This is a network-based plan where out-of-hospital benefits are paid directly from Scheme risk at 100% Scheme tariff, subject to network protocols. GP consultations are unlimited, and most day-to-day services are covered through the Rhythm Network Providers without using savings.