2026 Rules Active
2026 Validated
PMB chronic cover, but only if you stay DSP/formulary-compliant
Actuarial Objective
Optimised for members with stable CDL conditions (including depression listed on the option’s chronic disease list) whose financial outcome depends on chronic programme registration, pharmacy network usage from rand one, and formulary adherence to avoid co-payments.
Running Actuarial Simulation...
More Plan Options
Save R105 pm
Bonitas
BonStart Plus
Strategy: BonStart Single Edge Co-Payment Disaster Cover
Upgrade for +R124 pm
Bestmed
Beat 1 Network
Strategy: Network Hospital-Only Young Starter
Key Terms for this Strategy
- 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
Which hospitals can I use on MediPhila?
You must use the Compact Hospital Network. Voluntary use of a non-network hospital attracts a 30% upfront co-payment.
Is there a limit on cancer treatment?
Yes, oncology cover is limited to Prescribed Minimum Benefits (PMB) only. You must use the ICON Network to avoid a 40% co-payment.
Do I have a medical savings account?
No, MediPhila does not have a savings account. It uses a defined Day-to-Day Limit of R4,700 per family for out-of-hospital expenses.
Are GP visits unlimited?
No, you are limited to a specific number of visits per year (e.g., 8 visits for a main member) at a MediPhila Network GP.
Do I need a referral to see a specialist?
Yes, you must be referred by a Network GP. Failure to obtain a referral will result in a 20% upfront co-payment.
Is casualty covered if I get injured?
Yes, but it is paid from your R4,700 Day-to-Day Limit. You are limited to 2 facility visits before other limits apply.
What happens if I need a gastroscopy?
Gastroscopies are covered in-hospital, but a co-payment applies for adults (children under 8 are exempt). Ensure you use a network provider.
Does the plan cover MRI scans?
Yes, but it is limited to R8,600 per family per year and requires pre-authorisation.