2026 Rules Active

2026 Strategy Validated
Custom: Associated Hospital Penalty Avoid
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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 choose the Associated Hospital option, what happens if I go to a non-network hospital? [Custom Associated Hospital (Penalty avoidance)]
You will be liable for a 30% co-payment on the hospital account, in addition to the standard R2,000 admission co-payment. Strategy reference: oid-2026.
Is there a limit on cancer treatment? [Custom Associated Hospital (Penalty avoidance)]
Yes, oncology is covered up to R300,000 per beneficiary per year. Thereafter, a 20% co-payment applies to all costs. Strategy reference: oid-2026.
Do I have to pay upfront for a gastroscopy or colonoscopy? [Custom Associated Hospital (Penalty avoidance)]
Yes, you will pay a R2,000 co-payment if done in a day hospital or out of hospital. If done in an acute hospital, the co-payment jumps to R7,500 (R2,000 standard + R5,500 penalty). Strategy reference: oid-2026.
How do I get my chronic medication if I chose the State option? [Custom Associated Hospital (Penalty avoidance)]
You must use State facilities for your chronic script and medication to avoid co-payments. If the State cannot provide the medicine, you may use Ingwe Primary Care Network providers subject to a formulary. Strategy reference: oid-2026.
Is there an overall limit for internal prostheses like hip joints? [Custom Associated Hospital (Penalty avoidance)]
There is no overall family limit, but there is a strict sub-limit of R62,000 per beneficiary per event (max 2 events per year). You may have out-of-pocket costs if the device exceeds this. Strategy reference: oid-2026.
Are MRI and CT scans covered in full? [Custom Associated Hospital (Penalty avoidance)]
No, while there is no annual limit, you must pay a R3,850 co-payment per scan, regardless of whether it is done in or out of hospital. Strategy reference: oid-2026.
Does this plan cover emergency casualty visits? [Custom Associated Hospital (Penalty avoidance)]
No, casualty visits are not covered by the risk benefit. They are subject to your available Momentum HealthSaver funds. Strategy reference: oid-2026.
What maternity benefits are included? [Custom Associated Hospital (Penalty avoidance)]
The plan covers 12 antenatal visits, 2 ultrasounds (2D), and 2 paediatrician visits in the baby's first year, provided you register on the Maternity programme. Strategy reference: oid-2026.
Custom Associated Hospital (Penalty avoidance) strategy verified
Covering 0 family members
2026 rates applied
