2026 Rules Active
2026 Validated
Hospital risk transfer with strong constraints
Actuarial Objective
Optimises for Evolve Network hospitalisation while accepting State-only chronic routing and a standard per-authorisation co-payment on major medical usage.
Running Actuarial Simulation...
More Plan Options
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Bestmed
Rhythm1
Strategy: Rhythm1 Entry-Level Earner (<R9k)
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Bonitas
BonStart Plus
Strategy: BonStart Single Edge Co-Payment Disaster Cover
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.
- PMB (Prescribed Minimum Benefits)
- By law, this plan must cover the costs of 27 specific chronic conditions and emergency treatments, even though it is a basic Hospital Plan.
People Also Ask
Can I use a private doctor for my chronic diabetes or blood pressure?
No. On the Evolve Option, chronic benefits are available from State facilities only. You must use State doctors, scripts, and medication for the 26 covered conditions.
Do I have to pay every time I go to the hospital?
Yes, there is a standard co-payment of R2,000 per authorisation for all hospital admissions, unless it is for a motor vehicle accident, maternity, or emergency.
What if I need a hip or knee replacement?
Joint replacements (hip and knee) are limited to Prescribed Minimum Benefits (PMB) at State facilities only. There is no private hospital benefit for these surgeries.
Is there a limit on cancer treatment?
Yes, oncology is covered up to R200,000 per beneficiary per year. Thereafter, a 20% co-payment applies. You must use the Evolve Network of Oncologists.
Do I get day-to-day GP visits?
You get 2 virtual GP consultations via the Hello Doctor app. For physical GP visits, there is no benefit unless you have funds in your optional HealthSaver account.
Are MRI and CT scans covered?
Yes, there is no annual limit for scans in or out of hospital, but a co-payment of R3,850 applies per scan.
What happens if I need a gastroscopy?
You will pay a R2,000 co-payment if done in a day hospital. If done in an acute hospital, the co-payment increases to R7,500 (R2,000 standard + R5,500 penalty).
Is dentistry covered?
There is a preventative dental care benefit of R500 per beneficiary per year. Major dentistry is not covered.