2026 Rules Active
2026 Strategy Validated
Classic Comprehensive Family: MSA + ATB
Classic Comprehensive Family with MSA and ATB 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 R30,111 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
If I get diagnosed with cancer, what happens when my cover goes past R500,000? [Classic Comprehensive Family with MSA and ATB]
Cancer cover is limited to R500,000 over a 12-month cycle at 100% DHR, and after that the plan pays up to 80% of DHR (so you may face a 20% shortfall vs DHR on further approved treatment). Strategy reference: atb-2026.
Do I need gap cover because specialists can charge above scheme rates? [Classic Comprehensive Family with MSA and ATB]
In hospital the plan can pay up to 200% of the Discovery Health Rate for certain providers, but many benefits outside hospital are paid around 100% DHR and the plan has specific co-pay triggers, so gap cover is typically recommended. Strategy reference: atb-2026.
Could I really have to pay R8,400 upfront just to have scopes done? [Classic Comprehensive Family with MSA and ATB]
Yes—if both a gastroscopy and colonoscopy are done in the same admission outside the Day Surgery Network, the stated upfront payment can be up to R8,400 on this plan. Strategy reference: atb-2026.
If I do scopes in a doctor’s rooms, can there still be a co-payment? [Classic Comprehensive Family with MSA and ATB]
Yes—when scopes are performed in-rooms at a non-network provider, the stated co-payment for bi-directional scopes is R3,100. Strategy reference: atb-2026.
If I need an MRI that isn’t linked to a hospital admission, do I pay first? [Classic Comprehensive Family with MSA and ATB]
If the scan is not related to an approved hospital admission, the first R4,000 comes from available day-to-day benefits before the rest can be paid from the Hospital Benefit (up to DHR). Strategy reference: atb-2026.
How much do I actually pay every month in 2026 as the main member? [Classic Comprehensive Family with MSA and ATB]
From 1 April 2026 the main-member contribution shown for Classic Comprehensive is R10,037 per month. Strategy reference: atb-2026.
How much Medical Savings do I get in a year on this plan? [Classic Comprehensive Family with MSA and ATB]
Because the Medical Savings Account is described as 25% of the monthly contribution, the calculated annual savings allocation based on R10,037 is R30,111. Strategy reference: atb-2026.
If I use a hospital outside a network, is there an automatic upfront admission penalty? [Classic Comprehensive Family with MSA and ATB]
No specific upfront hospital admission penalty is stated for Classic Comprehensive (the guide describes an upfront amount for non-network planned admissions on Classic Smart instead). Strategy reference: atb-2026.
If I need a planned hip or knee replacement, what’s the risk if I go outside the scheme’s network providers? [Classic Comprehensive Family with MSA and ATB]
For planned hip and knee joint replacements outside the network, the plan’s payment is limited (it pays up to 80% DHR, capped at R31,850 per prosthesis per admission), so there can be large shortfalls if providers charge more. Strategy reference: atb-2026.
How many antenatal visits and pregnancy scans are actually covered? [Classic Comprehensive Family with MSA and ATB]
The Maternity Benefit states cover for up to 12 antenatal consultations and up to two 2D ultrasound scans. Strategy reference: atb-2026.