2026 Rules Active
2026 Strategy Validated
Large Family Hospital Safety Net: 5+ Kids Pay for 3
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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
- Network Restriction
- You must use hospitals and doctors listed in the scheme's specific network. Voluntary use of non-network providers will result in a heavy co-payment. [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]
- PMB (Prescribed Minimum Benefits)
- By law, this plan must cover the costs of 27 specific chronic conditions and emergency treatments. [Source: Council for Medical Schemes Official Benefit Rules]
Common Questions
Can I choose to have a Caesarean section? [BonCore Large Family Disaster Leverage]
No, C-sections are only covered for approved PMB emergencies. Elective C-sections are not covered. Strategy reference: cap-2026.
Do I have savings for day-to-day doctors? [BonCore Large Family Disaster Leverage]
No, there is no medical savings account. You only have a 'Benefit Booster' of up to R1,000 per family if you complete a wellness screening. Strategy reference: cap-2026.
Is my hip replacement covered? [BonCore Large Family Disaster Leverage]
No, joint replacement surgery and internal prostheses are excluded unless it is a Prescribed Minimum Benefit (PMB) case. Strategy reference: cap-2026.
What happens if I use a hospital not on the list? [BonCore Large Family Disaster Leverage]
You will be liable for a co-payment of R14,680 unless it is a medical emergency. Strategy reference: cap-2026.
Are MRI and CT scans covered? [BonCore Large Family Disaster Leverage]
MRI and CT scans are covered for PMB conditions only. There is no benefit for non-PMB scans. Strategy reference: cap-2026.
Do I have to pay a co-payment for admission? [BonCore Large Family Disaster Leverage]
Yes, there is a R5,500 co-payment per admission, except for motor vehicle accidents, maternity confinements, and PMB emergencies. Strategy reference: cap-2026.
Is depression medication covered? [BonCore Large Family Disaster Leverage]
Yes, depression is covered as an additional chronic condition, with medication cover up to R165 per beneficiary per month. Strategy reference: cap-2026.
Do I get any cover for emergency room visits? [BonCore Large Family Disaster Leverage]
Yes, you are covered for 2 emergency consultations per family at a casualty ward, strictly for emergencies only. Strategy reference: cap-2026.
BonCore Large Family Disaster Leverage strategy verified
Covering 6 family members
2026 rates applied