Hospital admissions are subject to pre-authorisation and scheme rules, and emergency admissions must still be notified within the required timeframe. Strategy reference: age-2026.

Gold Ascend EDO limits hospital access to hospitals within the Scheme network, so using a non-network hospital may affect cover depending on scheme rules and authorisation requirements. Strategy reference: age-2026.

Oncology is limited to R252 825.30 per beneficiary per year, and treatment above that amount is subject to a 20% co-payment. Strategy reference: age-2026.

Once oncology spending goes above R252 825.30 in the year, the portion above the limit is subject to a 20% co-payment (and oncology use is tied to the oncology DSP requirement). Strategy reference: age-2026.

Internal and external prostheses are subject to an overall family prosthesis limit of R35 935.99 per year, so amounts above that limit may create a member shortfall (unless PMB rules change how the claim is handled). Strategy reference: age-2026.

Non-PMB MRI and CT scans attract a 10% co-payment and are also managed under scan frequency/authorisation rules. Strategy reference: age-2026.

Maternity ultrasound cover includes 2 x 2D scans per pregnancy (with one 3D scan listed), and the maternity basket is tied to registration on the Scheme’s Bambino Programme and managed-care rules. Strategy reference: age-2026.

The maternity basket lists an additional 10 antenatal visits per pregnancy (split between GP/midwife and specialist obstetrician). Strategy reference: age-2026.

Day-to-day out-of-hospital benefits are stated as being subject to MSA (with certain listed risk benefits carved out), and the GP/specialist benefit is shown as subject to a day-to-day limit. Strategy reference: age-2026.

The in-hospital section states admissions are subject to scheme rules and notification requirements, and it notes penalties can apply when authorisation/notification rules are not followed. Strategy reference: age-2026.