2026 Rules Active
2026 Strategy Validated
Executive: High Dental + Allied Limits
Executive Dental, Orthodontic and Allied High-Use 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 R34,284 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]
Common Questions
If I’m diagnosed with cancer, what happens if my treatment costs go above the plan’s oncology cover amount? [Executive Dental, Orthodontic and Allied High-Use]
Approved cancer treatment is covered over a 12-month cycle, with the first R500,000 covered; if costs exceed that amount, subsequent treatment may be paid at up to 80% of the Discovery Health Rate unless it is PMB treatment or qualifies for the plan’s extended oncology arrangements. Strategy reference: its-2026.
Does the oncology cover amount apply per year, per diagnosis, or per treatment cycle? [Executive Dental, Orthodontic and Allied High-Use]
The oncology cover amount is described as applying over a 12-month cycle for approved cancer treatment. Strategy reference: its-2026.
Will I ever face a co-payment for oncology treatment even if I’m on the Executive Plan? [Executive Dental, Orthodontic and Allied High-Use]
Yes—once the initial oncology cover amount is exceeded, subsequent non-PMB/non-extended treatment may be paid at up to 80% of the Discovery Health Rate (effectively leaving a possible 20% shortfall). Strategy reference: its-2026.
If my cancer treatment is a Prescribed Minimum Benefit (PMB), can it still be affected by the oncology cover amount? [Executive Dental, Orthodontic and Allied High-Use]
PMB cancer treatment is stated as always covered in full, even if treatment costs exceed the oncology cover amount. Strategy reference: its-2026.
Do I need to register or get approval before cancer treatment will be paid from the Oncology Benefit? [Executive Dental, Orthodontic and Allied High-Use]
Yes—cancer treatment is described as being covered on the Oncology Care Programme once treatment is approved. Strategy reference: its-2026.
If my specialist charges above the Discovery Health Rate during cancer treatment, am I protected from shortfalls? [Executive Dental, Orthodontic and Allied High-Use]
Not necessarily—cancer-related healthcare services are stated as covered up to 100% of the Discovery Health Rate, and a co-payment/shortfall can apply if the provider charges above that rate. Strategy reference: its-2026.
If I’m stable but I’m not using a designated service provider (DSP), what is the risk for PMB cover? [Executive Dental, Orthodontic and Allied High-Use]
Where a designated service provider is required and not used, the brochure indicates payment can drop to 80% of the Discovery Health Rate, leaving the member liable for the difference. Strategy reference: its-2026.
Is hospital cover capped overall on the Executive Plan, or could I still hit an annual hospital limit? [Executive Dental, Orthodontic and Allied High-Use]
The brochure states there is no overall annual limit for hospital cover on the Executive Plan, but some specific treatments and benefits can have limits and rules. Strategy reference: its-2026.
Do I have to preauthorise hospital admissions to avoid payment issues? [Executive Dental, Orthodontic and Allied High-Use]
Yes—the brochure indicates planned hospital stays should be confirmed (preauthorised), and that not doing so can affect cover except where required under defined benefits or PMBs. Strategy reference: its-2026.
If I’m travelling and have a medical emergency, is it treated differently from a normal emergency back home? [Executive Dental, Orthodontic and Allied High-Use]
The brochure states the plan covers medical emergencies when travelling, subject to the plan’s travel/emergency benefit rules and exclusions described in the document. Strategy reference: its-2026.