2026 Rules Active
2026 Strategy Validated
Dental: Wisdom Teeth Co-Pay Avoidance
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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]
Common Questions
Which hospitals can I use on MediPhila? [Dental: Wisdom teeth co-payment avoidance]
You must use the Compact Hospital Network. Voluntary use of a non-network hospital attracts a 30% upfront co-payment. Strategy reference: oid-2026.
Is there a limit on cancer treatment? [Dental: Wisdom teeth co-payment avoidance]
Yes, oncology cover is limited to Prescribed Minimum Benefits (PMB) only. You must use the ICON Network to avoid a 40% co-payment. Strategy reference: oid-2026.
Do I have a medical savings account? [Dental: Wisdom teeth co-payment avoidance]
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. Strategy reference: oid-2026.
Are GP visits unlimited? [Dental: Wisdom teeth co-payment avoidance]
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. Strategy reference: oid-2026.
Do I need a referral to see a specialist? [Dental: Wisdom teeth co-payment avoidance]
Yes, you must be referred by a Network GP. Failure to obtain a referral will result in a 20% upfront co-payment. Strategy reference: oid-2026.
Is casualty covered if I get injured? [Dental: Wisdom teeth co-payment avoidance]
Yes, but it is paid from your R4,700 Day-to-Day Limit. You are limited to 2 facility visits before other limits apply. Strategy reference: oid-2026.
What happens if I need a gastroscopy? [Dental: Wisdom teeth co-payment avoidance]
Gastroscopies are covered in-hospital, but a co-payment applies for adults (children under 8 are exempt). Ensure you use a network provider. Strategy reference: oid-2026.
Does the plan cover MRI scans? [Dental: Wisdom teeth co-payment avoidance]
Yes, but it is limited to R8,600 per family per year and requires pre-authorisation. Strategy reference: oid-2026.
Dental: Wisdom teeth co-payment avoidance strategy verified
Covering 0 family members
2026 rates applied