2026 Rules Active
2026 Validated
Smaller MSA at 15% with Limited ATB and 100% Hospital Tariff
Actuarial Objective
For budget members who need a limited Above Threshold Benefit but accept a smaller MSA (15% of contributions), reduced Personal Health Fund (R6,000 boosted to R12,000) and 100% hospital tariff.
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Medihelp
MedPrime
Strategy: Savings Rollover + Interest Maximiser
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Bonitas
Standard
Strategy: Standard Family 45 Chronic Conditions + Full Hospital Choice
Key Terms for this Strategy
- Medical Savings Account (MSA)
- A fund of R17,376 included in your premium. You use this for day-to-day expenses like GP visits and scripts.
- Elective Procedure Co-payment
- A mandatory upfront fee you must pay to the hospital for specific scheduled surgeries (like hip/knee replacements) that are not emergencies.
People Also Ask
If I’m diagnosed with cancer, what happens when my treatment costs go beyond the Oncology Benefit limit?
The Oncology Benefit covers the first R250000, and after that the Scheme covers up to 80% of further approved costs (meaning a 20% member share on those additional amounts).
Do I have to pay upfront for a gastroscopy or colonoscopy if it’s done in hospital?
Yes, an upfront payment can apply for scope admissions in hospital (for example R7500 for the hospital account on a scope admission, depending on the setting and provider).
If I do a scope in a doctor’s rooms instead of a day clinic/hospital, can I still face a co-payment?
Yes—if the scope is performed in rooms by a non-network provider, a co-payment can apply (for example R1800 for a single scope).
If I need an MRI or CT scan, do I pay something first before the Scheme pays?
Yes, the first R4000 of an MRI/CT scan is paid from day-to-day benefits before the balance is covered from the Hospital Benefit (subject to the rules described).
If I need a joint replacement, is there an upfront payment I must plan for?
Yes—joint replacements fall under the list of procedures with an upfront payment, shown as R23700 in the guide.
Do I have to use a specific GP for chronic medicine cover to work properly?
Yes—you must nominate a network GP (Primary Care GP) and, to be covered in full for GP consultations, you must visit your nominated Primary Care network GP.
How many antenatal visits and pregnancy scans are covered on this plan?
The maternity basket includes up to 8 antenatal consultations and up to 2 pregnancy ultrasound scans covered as described in the guide.
If I don’t use Discovery’s designated providers for oncology medicine, can that cost me extra?
Yes—the guide notes a 20% co-payment can apply for oncology medicine if you don’t use the designated service provider approach described, and oncology medicine is covered up to 100% of the Discovery Health Rate or the Oncology Reference Price (whichever is applicable).