2026 Rules Active
2026 Strategy Validated
Unlimited Network GP from Rand 1
Network GP From Rand 1 Maximizer 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
- 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
If I land in a non-network hospital for an emergency, will Fedhealth still pay? [Network GP From Rand 1 Maximizer]
Emergency treatment can be accessed at any hospital, but once stabilised you may need to transfer to a network hospital to avoid network-related co-payments and penalties. Strategy reference: ily-2026.
Do I have to nominate a specific GP, or can I just visit any GP when I’m sick? [Network GP From Rand 1 Maximizer]
Full cover rules rely on using a nominated Fedhealth Network GP, and using non-network GP routes is limited and conditional. Strategy reference: ily-2026.
If I see a specialist without my GP referring me first, will the scheme still pay? [Network GP From Rand 1 Maximizer]
Specialist access is tied to the referral pathway, and non-referral use can trigger scheme-rule consequences (including co-payments) depending on the situation. Strategy reference: ily-2026.
Is oncology fully covered, or only at a specific provider? [Network GP From Rand 1 Maximizer]
Oncology is funded at PMB level of care and is tied to the designated service provider arrangement (ICON), with a co-payment risk if a non-DSP route is used. Strategy reference: ily-2026.
Will my cancer scans like PET-CT be covered if my doctor sends me to a non-network provider? [Network GP From Rand 1 Maximizer]
High-cost oncology imaging is subject to PMB/DSP rules and scheme protocols, and non-DSP use can trigger a co-payment requirement. Strategy reference: ily-2026.
If I go to casualty for stitches or a fracture but I’m not admitted, will it count? [Network GP From Rand 1 Maximizer]
Trauma treatment in a casualty ward is covered under specific authorisation rules, and non-PMB casualty use can result in a co-payment. Strategy reference: ily-2026.
Do I need authorisation for planned admissions, and what happens if I forget? [Network GP From Rand 1 Maximizer]
Planned hospital admissions require pre-authorisation, and late/no authorisation can lead to penalties under the scheme rules. Strategy reference: ily-2026.
Are MRI/CT scans really unlimited, and do I need approval first? [Network GP From Rand 1 Maximizer]
MRI/CT scans are covered subject to authorisation requirements and scheme protocols, so approval rules still apply even where the benefit is described as broad. Strategy reference: ily-2026.
Is depression medication covered as a chronic benefit on this plan? [Network GP From Rand 1 Maximizer]
Depression is listed as an additional chronic condition on this option, but formulary/DSP rules and approved medication lists still apply. Strategy reference: ily-2026.
If I want a C-section for non-medical reasons, will I be penalised? [Network GP From Rand 1 Maximizer]
Elective (non-medically indicated) Caesarean sections are shown as attracting a co-payment on this option, so the clinical reason and authorisation pathway matter. Strategy reference: ily-2026.