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24h Emergency: 084 124 | General Contact: 0860 002 378

Pace1

Plan Details

Hospital & Emergencies

Accommodation (hospital stay) and theatre fees

100% Scheme tariff.

Take-home medicine

100% Scheme tariff. Limited to 7 days' medicine

Biological medicine during hospitalisation

Limited to R31 710 per family per annum. Subject to pre-authorisation and funding guidelines.

Treatment in mental health clinic

100% Scheme tariff. Limited to 21 days per beneficiary

Treatment of chemical and substance abuse

100% Scheme tariff. Limited to 21 days or R35 573 per beneficiary. Subject to network facilities.

Consultations and procedures

100% Scheme tariff.

Surgical procedures and anaesthetics

100% Scheme tariff.

Organ transplants

100% Scheme tariff. (PMBs only)

Major medical maxillo-facial surgery strictly related to certain conditions

100% Scheme tariff.  Limited to R14 386 per family

Dental and oral surgery (In- or out of hospital)

Limited to R8 893 per family.

Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)

100% Scheme tariff. Limited to R99 396 per family.

Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Items utilised towards treating or supporting a bodily function.

Sub-limits per beneficiary:
  *Functional R34 000   Pacemaker (dual chamber) R61 862   Vascular R65 000   Endovascular and catheter-based procedures - no benefit   Spinal incl. artificial disk R36 227   Drug-eluting stents - PMBs and DSP products only   Mesh R13 602   Gynaecology/Urology R9 809   Lens implants R7 455 a lens per eye

Prosthesis – External

Limited to R25 242 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.

Exclusions Limits and co-payments applicable. Preferred provider network available.

Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
• Hip replacement and other major joints R36 881   • Knee replacement R49 045   • Minor joints R15 237

Orthopaedic and medical appliances

100% Scheme tariff.

Pathology

100% Scheme tariff.

Basic radiology

100% Scheme tariff.

Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies)

100% Scheme tariff

Oncology

100% Scheme tariff. Subject to pre-authorisation. DSP applies.

Peritoneal dialysis and haemodialysis

100% Scheme tariff. Subject to pre-authorisation and DSPs

Confinements (Birthing)

100% Scheme tariff.

Mammary surgery (Breast cancer patient)

No benefit for reconstructive surgery (which may include symmetrising, partial or total mastectomy etc.) on the unaffected (non-cancerous) breast of a breast cancer patient.

Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)

100% Scheme tariff. Limited to R9 887 per eye.

HIV/AIDS

100% Scheme tariff. Subject to preauthorisation and DSPs

Midwife-assisted births

100% Scheme tariff

Supplementary services

100% Scheme tariff.

Alternatives to hospitalisation

100% Scheme tariff

Palliative care and Home-based care in lieu of hospitalisation

100% Scheme tariff. Limited to R79 275 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.

Day procedures at a day-hospital facility

Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.

International travel cover

Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants. 

Day-to-Day

Overall day-to-day limit

M = R12 007, M1+ = R24 012.

FP and Specialist consultations

Savings first. Limited to M = R2 472, M1+ = R4 970. (Subject to overall day-to-day limit)

Basic and specialised dentistry

Savings and then from day-to-day limits. Orthodontic: Subject to pre-authorisation. Limited to M = R4 550, M1+ = R9 234. (Subject to overall day-to-day limit)

Medical aids, apparatus and appliances

100% Scheme tariff. Savings first. Limited to R12 687 per family. Includes repairs to artificial limbs. (Subject to overall day-to-day limit)

Continuous/Flash Glucose Monitoring (CGM/FGM)

Refer to medical aids, apparatus and appliances limit listed above.

Wheelchairs

Subject to medical apparatus and appliance limits.

Hearing aids

Limited to R8 811 per family every 24 months. 100% Scheme tariff. Subject to pre-authorisation.

Supplementary services

Savings first. Limited to M = R4 852, M1+ = R10 071. (Subject to overall day-to-day limit)

Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)

100% Scheme tariff. Savings first. Limited to R3 989 per family. (Subject to overall day-to-day limit)

Optometry benefit

Benefits available every 24 months from date of service.

Network Provider (PPN)
Consultation - 1 per beneficiary
Frame = R1 000 covered AND
100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR
Contact lenses = R1 840

Non-network Provider
Consultation - R365 fee at non-network provider
Frame = R750 AND
Single vision lenses = R215 OR
Bifocal lenses = R460 OR
Multifocal lenses = R982.50
In lieu of glasses members can opt for contact lenses, limited to R1 840

Basic radiology and pathology

100% Scheme tariff. Savings first. Limited to M = R3 596, M1+ = R7 194. (Subject to overall day-to-day limit)

Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)

100% Scheme tariff. Limited to R16 087 per family.

Rehabilitation services after trauma

100% Scheme tariff.

HIV/AIDS

100% Scheme tariff. Subject to pre-authorisation and DSPs.

Oncology

Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.

Peritoneal dialysis and haemodialysis

100% Scheme tariff. Subject to pre-authorisation and DSPs.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff. Co-payment of 25% for non-formulary medicine.

Non-CDL chronic medicine

7 conditions. 90% Scheme tariff. Limited to M = R7 324, M1+ = R14 648. Co-payment of 25% for non-formulary medicine.

Biological medicine

PMBs only. Subject to pre-authorisation.

Other high-cost medicine

100% Scheme tariff.

Acute medicine

Savings first. Limited to M = R2 591, M1 + = R5 363. (Subject to overall day-to-day limit)

Over-the-counter (OTC) medicine

Member choice:
1. R1 057 OTC limit per family OR
2. Access to full savings for OTC purchases (after R1 057 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
Subject to the available savings.

Preventative care benefits

Flu vaccines
  • All ages
  • 1 per beneficiary per year
  • Applicable to all active members and beneficiaries
Pneumonia vaccines
  • Children <2 years
  • High-risk adult group

       Children:

  • As per schedule of Department of Health

       Adults:

  • Twice in a lifetime with booster above 65 years of age

       Adults:

  • The Scheme will identify certain high-risk individuals who will be advised to be immunised
Travel vaccines
  • All ages
  • Quantity and frequency depending on product up to to the maximum allowed amount
  • Mandatory travel vaccines for typhoid, yellow fever, tetanus, meningitis, hepatitis and cholera from Scheme risk benefits
Paediatric immunisation
  • Babies and children
  • Funding for all paediatric vaccines according to the state-recommended programme
Baby growth and development assessments
  • 0-2 years
  • 3 assessments per year
  • Assessments are done at a Bestmed Network Pharmacy Clinic
Female contraceptives
  • All females of child-bearing age
  • Quantity and frequency depending on product up to the maximum allowed amount.
  • Mirena device - 1 device every 60 months
  • Limited to R2 550 per beneficiary per year. Includes all items classified in the category of female contraceptives
Intrauterine device (IUD) insertion
  • All females of child-bearing age
  • 1 device every 5 years.
  • Consultation and procedure by a gynaecologist or FP.
HPV vaccinations
  • Females 9-26 years of age
  • 3 vaccinations per beneficiary
  • Vaccinations will be funded at Mediscor Reference Price (MRP)
Back and neck preventative programme
  • All ages
  • Subject to pre-authorisation
  • Preferred providers (DBC/Workability Clinics)
  • This is a preventative programme with the objective of preventing back and neck surgery. The Scheme may identify appropriate participants
  • Based on the first assessment, a rehabilitation treatment plan is drawn up and initiated over an uninterrupted period that will be specified by the provider
  • Use of this programme is in lieu of surgery
    Mammogram (tariff code 34100)
    • Females 40 years and older
    • Once every 24 months
    • 100% Scheme tariff
    Preventative dentistry
    PSA screening
    • Males 50 years and older
    • Once every 24 months
    • Can be done at a urologist or Family Practitioner (FP)
    • Consultation paid from the available savings account
    Pap smear
    • Females 18 years and older
    • Once every 24 months
    • Can be done at a gynaecologist or Family Practitioner (FP)
    • Consultation paid from the available savings account

     

    Maternity Benefits

    100% Scheme tariff. Subject to the following benefits:

    Consultations: 
    • 9 antenatal consultations at a Family Practitioner OR gynaecologist OR midwife
    • 1 post-natal consultation at a Family Practitioner OR gynaecologist OR midwife
    Ultrasounds:
    • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a Family Practitioner OR gynaecologist OR radiologist
    • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a Family Practitioner OR gynaecologist OR radiologist
    Supplements:
    • Any item categorised as a maternity supplement can be claimed up to a maximum of R127 per claim, once a month, for a maximum of 9 months

    From R 4620 per month*

    Add Dependants

    Adults
    0
    Children
    0

    Excellent hospital benefits with extensive day-to-day cover. Pace1 is perfect for those who want quality benefits at affordable prices.

    You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.

    Contributions
    Member: R4 620
    Adult dependant: R3 245
    Child dependant: R1 166
    Maximum child dependants: 3

    Bestmed members pay for only three child dependants. The rest is covered at no extra cost. Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.

    Get personalised pricing call for more information

    Beat4

    Plan Details

    Hospital & Emergencies

    Accommodation (hospital stay) and theatre fees

    100% Scheme tariff.

    Take-home medicine

    100% Scheme tariff. Limited to 7 days' medicine

    Biological medicine during hospitalisation

    Limited to R26 425 per family per annum. Subject to pre-authorisation and funding guidelines.

    Treatment in mental health clinic

    100% Scheme tariff. Limited to 21 days per beneficiary

    Treatment of chemical and substance abuse

    100% Scheme tariff. Limited to 21 days or R35 573 per beneficiary. Subject to network facilities.

    Consultations and procedures

    100% Scheme tariff.

    Surgical procedures and anaesthetics

    100% Scheme tariff.

    Organ transplants

    100% Scheme tariff. (PMBs only)

    Major medical maxillo-facial surgery strictly related to certain conditions

    100% Scheme tariff.  Limited to R14 518 per family

    Dental and oral surgery (In- or out of hospital)

    Limited to R11 117 per family.

    Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)

    100% Scheme tariff. Limited to R107 122 per family.

    Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Items utilised towards treating or supporting a bodily function.

    Sub-limits per beneficiary:
      *Functional R34 000   Pacemaker (dual chamber) R61 992   Vascular R65 000   Endovascular and catheter-based procedures - no benefit   Spinal incl. artificial disk R37 013   Drug-eluting stents R20 795   Mesh R13 733   Gynaecology/Urology R10 071   Lens implants R7 847 a lens per eye

    Prosthesis – External

    Limited to R25 765 per family. DSPs apply. Includes artificial limbs limited to one (1) limb every 60 months.

    Exclusions Limits and co-payments applicable. Preferred provider network available.

    Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
    • Hip replacement and other major joints R38 059   • Knee replacement R50 562   • Minor joints R15 536

    Orthopaedic and medical appliances

    100% Scheme tariff.

    Pathology

    100% Scheme tariff.

    Basic radiology

    100% Scheme tariff.

    Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies)

    100% Scheme tariff

    Oncology

    100% Scheme tariff. Subject to pre-authorisation and DSPs.

    Peritoneal dialysis and haemodialysis

    100% Scheme tariff. Subject to pre-authorisation and DSPs

    Confinements (Birthing)

    100% Scheme tariff.

    Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)

    100% Scheme tariff.  Limited to R10 333 per eye. Subject to pre-authorisation and protocols.

    HIV/AIDS

    100% Scheme tariff. Subject to preauthorisation and DSPs

    Midwife-assisted births

    100% Scheme tariff

    Supplementary services

    100% Scheme tariff.

    Alternatives to hospitalisation

    100% Scheme tariff

    Palliative care and Home-based care in lieu of hospitalisation

    100% Scheme tariff. Limited to R95 130 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.

    Day procedures at a day-hospital facility

    Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500

    International travel cover

    Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
    Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants. 

    Day-to-Day

    Overall day-to-day limit

    M = R14 125, M1+ = R28 249.

    FP and Specialist consultations

    Savings first.
    Limited to M = R3 597, M1+ = R6 408 
    (Subject to overall day-to-day limit)

    Basic and specialised dentistry

    Savings and then from day-to-day limit.
    Orthodontics are subject to pre-authorisation.
    Limited to M = R6 223, M1+ = R12 499.
    (Subject to overall day-to-day limit)

    Medical aids, apparatus and appliances

    Savings first. 100% Scheme tariff. Limited to R12 687 per family. Includes repairs to artificial limbs. (Subject to overall day-to-day limit).

    Hearing aids

    Subject to pre-authorisation. Limited to R11 627 per family every 24 months. 100% Scheme tariff.

    Supplementary services

    Savings first.
    Limited to M = R5 493, M1+ = R11 156.
    (Subject to overall day-to-day limit)

    Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)

    Savings first. 100% Scheme tariff.
    Limited to R5 493 per family.
    (Subject to overall day-to-day limit)

    Optometry benefit

    Benefits available every 24 months from date of service.

    Network Provider (PPN)
    Consultation - 1 per beneficiary.
    Frame = R1 000 covered AND
    100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR
    Contact lenses = R1 840

    Non-network Provider
    Consultation - R365 fee at non-network provider
    Frame = R750 AND
    Single vision lenses = R215 OR
    Bifocal lenses = R460 OR
    Multifocal lenses = R982.50
    In lieu of glasses members can opt for contact lenses, limited to R1 840

    Basic radiology and pathology

    Savings first.
    Limited to M = R3 596, M1+ = R7 324.
    (Subject to overall day-to-day limit)

    Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)

    100% Scheme tariff. Limited to R18 703 per family.

    Oncology

    Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.

    HIV/AIDS

    100% Scheme tariff. Subject to pre-authorisation and DSPs.

    Peritoneal dialysis and haemodialysis

    100% Scheme tariff. Subject to pre-authorisation and DSPs.

    Rehabilitation services after trauma

    100% Scheme tariff.

    Medicines

    CDL and PMB chronic medicine

    100% Scheme tariff. Co-payment of 20% for non-formulary medicine.

    Non-CDL chronic medicine

    9 conditions. 90% Scheme tariff.
    Limited to M = R8 331, M1+ = R16 663. Co-payment of 20% for non-formulary medicine.

    Biologicals medicine

    PMBs only as per funding protocol. Subject to pre-authorisation

    Other high-cost medicine

    100% Scheme Tariff.

    Acute medicine

    Savings first. Limited to M = R3 178, M1 + = R6 421 (Subject to overall day-to-day limit)

    Over-the-counter (OTC) medicine

    Member choice:
    1. R1 057 OTC limit per family OR
    2. Access to full savings for OTC purchases (after R1 057 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
    Subject to the available savings.

    Preventative care benefits

    Flu vaccines
    • All ages
    • 1 per beneficiary per year
    • Applicable to all active members and beneficiaries
    Pneumonia vaccines
    • Children <2 years
    • High-risk adult group

           Children:

    • As per schedule of Department of Health

           Adults:

    • Twice in a lifetime with booster above 65 years of age

           Adults:

    • The Scheme will identify certain high-risk individuals who will be advised to be immunised
    Travel vaccines
    • All ages
    • Quantity and frequency depending on product up to to the maximum allowed amount
    • Mandatory travel vaccines for typhoid, yellow fever, tetanus, meningitis, hepatitis and cholera from Scheme risk benefits
    Paediatric immunisation
    • Babies and children
    • Funding for all paediatric vaccines according to the state-recommended programme
    Baby growth and development assessments
    • 0-2 years
    • 3 assessments per year
    • Assessments are done at a Bestmed Network Pharmacy Clinic
    Female contraceptives
    • All females of child-bearing age
    • Quantity and frequency depending on product up to the maximum allowed amount.
    • Mirena device - 1 device every 60 months
    • Limited to R2 550 per beneficiary per year. Includes all items classified in the category of female contraceptives
    Intrauterine device (IUD) insertion
    • All females of child-bearing age.
    • 1 device every 5 years.
    • Consultation and procedure by a gynaecologist or FP.
    HPV vaccinations
    • Females 9-26 years of age
    • 3 vaccinations per beneficiary
    • Vaccinations will be funded at Mediscor Reference Price (MRP)
    Back and neck preventative programme
    • All ages
    • Subject to pre-authorisation
    • Preferred providers (DBC/Workability Clinics)
    • This is a preventative programme with the objective of preventing back and neck surgery. The Scheme may identify appropriate participants
    • Based on the first assessment, a rehabilitation treatment plan is drawn up and initiated over an uninterrupted period that will be specified by the provider
    • Use of this programme is in lieu of surgery
      Mammogram (tariff code 34100)
      • Females 40 years and older
      • Once every 24 months
      • 100% Scheme tariff
      Preventative dentistry
      PSA screening
      • Males 50 years and older
      • Once every 24 months
      • Can be done at a urologist or Family Practitioner (FP)
      • Consultation paid from the available savings account
      Pap smear
      • Females 18 years and older
      • Once every 24 months
      • Can be done at a gynaecologist or Family Practitioner (FP)
      • Consultation paid from the available savings account

       

      Maternity benefits

      100% Scheme tariff. Subject to the following benefits:

      Consultations: 
      • 9 antenatal consultations at a Family Practitioner OR gynaecologist OR midwife
      • 1 post-natal consultation at a Family Practitioner OR gynaecologist OR midwife
      Ultrasounds:
      • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a Family Practitioner OR gynaecologist OR radiologist
      • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a Family Practitioner OR gynaecologist OR radiologist
      Supplements:
      • Any item categorised as a maternity supplement can be claimed up to a maximum of R127 per claim, once a month, for a maximum of 9 months

      From R 5513 per month*

      Add Dependants

      Adults
      0
      Children
      0

      A comprehensive plan for those with specific healthcare needs, including chronic benefits and savings.

      You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.

      Contributions
      Member: R5 513
      Adult dependant: R4 553
      Child dependant: R1 362
      Maximum child dependants: 3

      Bestmed members pay for only three child dependants. The rest is covered at no extra cost. Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.

      Get personalised pricing call for more information

      Pace2

      Plan Details

      Hospital & Emergencies

      Accommodation (hospital stay) and theatre fees

      100% Scheme tariff.

      Take-home medicine

      100% Scheme tariff. Limited to 7 days’ medicine.

      Treatment in mental health clinic

      100% Scheme tariff. Limited to 21 days per beneficiary per beneficiary

      Treatment of chemical and substance abuse

      100% Scheme tariff. Limited to 21 days or R35 573 per beneficiary. Subject to network facilities.

      Consultations and procedures

      100% Scheme tariff.

      Surgical procedures and anaesthetics

      100% Scheme tariff.

      Organ transplants

      100% Scheme tariff. (PMBs only)

      Major medical maxillo-facial surgery strictly related to certain conditions

      100% Scheme tariff.

      Dental and oral surgery (In- or out of hospital)

      Limited to R14 779 per family.

      Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)

      100% Scheme tariff. Limited to R127 646 per family.

      Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Items utilised towards treating or supporting a bodily function.

      Sub-limits per beneficiary:
        *Functional R36 000   Pacemaker (dual chamber) R68 989   Vascular R65 000   Spinal incl. artificial disk R63 993   Drug-eluting stents R20 926   Mesh R20 926   Gynaecology/Urology R15 628   Lens implants R13 419 per lens per eye   Joint replacements:   Hip replacement and other major joints R57 479   Knee replacement R66 700   Other minor joints R24 783

      Prosthesis – External

      Limited to R30 080 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.

      Orthopaedic and medical appliances

      100% Scheme tariff.

      Pathology

      100% Scheme tariff.

      Basic radiology

      100% Scheme tariff.

      Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans only included as indicated per option)

      100% Scheme tariff

      Oncology

      Oncology programme. 100% of Scheme tariff. Subject to pre-authorisation and DSP.

      Peritoneal dialysis and haemodialysis

      100% Scheme tariff Subject to pre-authorisation and DSPs

      Confinements (Birthing)

      100% Scheme tariff.

      Mammary surgery on the unaffected (non-cancerous) breast of a breast cancer patient

      100% Scheme tariff for reconstructive surgery (which may include symmetrising, partial or total mastectomy etc.) on the unaffected (non-cancerous) breast of a breast cancer patient. The benefit is limited to R40 476
      and is subject to pre-authorisation.

      Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)

      100% Scheme tariff. Limited to R10 331 per eye.

      HIV/AIDS

      100% Scheme tariff. Subject to preauthorisation and DSPs

      Midwife-assisted births

      100% Scheme tariff

      Supplementary services

      100% Scheme tariff.

      Alternatives to hospitalisation

      100% Scheme tariff

      Palliative care and Home-based care in lieu of hospitalisation

      100% Scheme tariff limited to R126 840 per annum. Subject to available benefit, pre-authorisation and treatment plan.

      Day procedures at a day-hospital facility

      Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.

      International travel cover

      Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
      Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants. 

      Day-to-Day

      Overall day-to-day limit

      M = R15 000, M1+ = R30 000.

      FP and Specialist consultations

      Savings first.
      Limited to M = R4 579, M1+ = R9 280.
      (Subject to overall day-to-day limit)

      Basic and specialised dentistry

      Savings and then from day-to-day limit.
      Limited to M = R7 628, M1+ = R15 256.
      (Subject to overall day-to-day limit)

      Orthodontic dentistry

      Savings first. 100% Scheme tariff. Subject to pre-authorisation. Limited to R7 399 per event for beneficiaries up to 18 years of age. Subject to overall day-to-day limit.

      Medical aids, apparatus and appliances

      Savings first. Limited to R11 509 per family.
      Includes repairs to artificial limbs.
      (Subject to overall day-to-day limit)

      Wheelchairs

      Limited to R15 564 per family every 48 months.

      Hearing aids

      Limited to R31 716 per beneficiary every 24 months subject to pre-authorisation.

      Supplementary services

      Savings first.
      Limited to M = R3 500, M1+ = R7 000.
      (Subject to overall day-to-day limit)

      Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)

      Savings first. Limited to R7 176 per family.
      (Subject to overall day-to-day limit)

      Optometry benefit

      Benefits available every 24 months from date of service.

      Network Provider (PPN)
      Consultation - 1 per beneficiary.
      Frame = R1 040 covered AND
      100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
      Lens enhancement = R750 covered OR
      Contact lenses = R2 010

      Non-network Provider
      Consultation - R365 fee at non-network provider
      Frame = R780 AND
      Single vision lenses = R215 OR
      Bifocal lenses = R460 OR
      Multifocal lenses = R982.50
      Lens enhancement = R750 covered
      In lieu of glasses members can opt for contact lenses, limited to R2 010

      Basic radiology and pathology

      Savings first.
      Limited to M = R3 596, M1+ = R7 194.
      (Subject to overall day-to-day limit)

      Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)

      MRI/CT scans: Maximum of 3 scans per beneficiary. PET scan: 1 scan per beneficiary. Subject to pre-authorisation.

      Oncology

      Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.

      HIV/AIDS

      100% Scheme tariff. Subject to pre-authorisation and DSPs.

      Peritoneal dialysis and haemodialysis

      100% Scheme tariff. Subject to pre-authorisation and DSPs.

      Rehabilitation services after trauma

      100% Scheme tariff.

      Medicines

      CDL and PMB chronic medicine

      100% Scheme tariff.
      Co-payment of 20% for non-formulary medicine.

      Non-CDL chronic medicine

      20 conditions. 90% Scheme tariff.
      Limited to M = R10 000 M1+ = R20 000. Co-payment of 20% for non-formulary medicine.

      Biological medicine

      Limited to R182 977 per beneficiary.

      Other high-cost medicine

      100% Scheme tariff.

      Acute medicine

      Savings first. Limited to M = R3 000, M1 + = R6 000.
      (Subject to overall day-to-day limit)

      Over-the-counter (OTC) medicine

      Member choice:
      1. R1 057 OTC limit per family OR
      2. Access to full savings for OTC purchases (after R1 057 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
      Subject to the available savings.

      Preventative care benefits

      Flu vaccines
      • All ages
      • 1 per beneficiary per year
      • Applicable to all active members and beneficiaries
      Pneumonia vaccines
      • Children <2 years
      • High-risk adult group

             Children:

      • As per schedule of Department of Health

             Adults:

      • Twice in a lifetime with booster above 65 years of age

             Adults:

      • The Scheme will identify certain high-risk individuals who will be advised to be immunised
      Travel vaccines
      • All ages
      • Quantity and frequency depending on product up to to the maximum allowed amount
      • Mandatory travel vaccines for typhoid, yellow fever, tetanus, meningitis, hepatitis and cholera from Scheme risk benefits
      Paediatric immunisation
      • Babies and children
      • Funding for all paediatric vaccines according to the state-recommended programme
      Baby growth and development assessments
      • 0-2 years
      • 3 assessments per year
      • Assessments are done at a Bestmed Network Pharmacy Clinic
      Female contraceptives
      • All females of child-bearing age
      • Quantity and frequency depending on product up to the maximum allowed amount.
      • Mirena device - 1 device every 60 months
      • Limited to R2 550 per beneficiary per year. Includes all items classified in the category of female contraceptives
      Intrauterine device (IUD) insertion
      • All females of child-bearing age
      • 1 device every 5 years.
      • Consultation and procedure by a gynaecologist or FP.
      HPV vaccinations
      • Females 9-26 years of age
      • 3 vaccinations per beneficiary
      • Vaccinations will be funded at Mediscor Reference Price (MRP)
      Back and neck preventative programme
      • All ages
      • Subject to pre-authorisation
      • Preferred providers (DBC/Workability Clinics)
      • This is a preventative programme with the objective of preventing back and neck surgery. The Scheme may identify appropriate participants
      • Based on the first assessment, a rehabilitation treatment plan is drawn up and initiated over an uninterrupted period that will be specified by the provider
      • Use of this programme is in lieu of surgery
        Mammogram (tariff code 34100)
        • Females 40 years and older
        • Once every 24 months
        • 100% Scheme tariff
        Bone Densitometry
        • All beneficiaries 45 years and older.
          Once every 24 months.
        Preventative dentistry
        PSA screening
        • Males 50 years and older
        • Once every 24 months
        • Can be done at a urologist or Family Practitioner (FP)
        • Consultation paid from the available savings account
        Pap smear
        • Females 18 years and older
        • Once every 24 months
        • Can be done at a gynaecologist or Family Practitioner (FP)
        • Consultation paid from the available savings account

         

        Maternity Benefits

        100% Scheme tariff. Subject to the following benefits:

        Consultations: 
        • 9 antenatal consultations at a Family Practitioner OR gynaecologist OR midwife
        • 1 post-natal consultation at a Family Practitioner OR gynaecologist OR midwife
        Ultrasounds:
        • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a Family Practitioner OR gynaecologist OR radiologist
        • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a Family Practitioner OR gynaecologist OR radiologist
        Supplements:
        • Any item categorised as a maternity supplement can be claimed up to a maximum of R127 per claim, once a month, for a maximum of 9 months

        From R 6562 per month*

        Add Dependants

        Adults
        0
        Children
        0

        Comprehensive cover with in- and out-of-hospital benefits.

        You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.

        Contributions
        Member: R6 562
        Adult dependant: R6 435
        Child dependant: R1 447
        Maximum child dependants: 3

        Bestmed members pay for only three child dependants. The rest is covered at no extra cost. Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.

        Get personalised pricing call for more information

        Pace3

        Plan Details

        Hospital & Emergencies

        Accommodation (hospital stay) and theatre fees

        100% Scheme tariff.

        Take-home medicine

        100% Scheme tariff. Limited to 7 days’ medicine.

        Treatment in mental health clinic

        100% Scheme tariff. Limited to 21 days per beneficiary

        Treatment of chemical and substance abuse

        100% Scheme tariff. Limited to 21 days or R35 573 per beneficiary. Subject to network facilities.

        Consultations and procedures

        100% Scheme tariff.

        Surgical procedures and anaesthetics

        100% Scheme tariff.

        Organ transplants

        100% Scheme tariff. (PMBs only)

        Major medical maxillo-facial surgery strictly related to certain conditions

        100% Scheme tariff.

        Dental and oral surgery (In- or out of hospital)

        Limited to R18 571 per family.

        Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)

        100% Scheme tariff. Limited to R128 300 per family.

        Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Items utilised towards treating or supporting a bodily function.

        Sub-limits per beneficiary:
          *Functional R36 000   Pacemaker (dual chamber) R68 989   Vascular R69 000   Spinal incl. artificial disk R64 115   Drug-eluting stents R20 926   Mesh R20 926   Gynaecology/Urology R15 694   Lens implants R13 419 a lens per eye
        Joint replacements:   Hip replacement and other major joints R57 545   Knee replacement R67 027   Other minor joints R24 783

        Prosthesis – External

        Limited to R30 212 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.

        Orthopaedic and medical appliances

        100% Scheme tariff.

        Pathology

        100% Scheme tariff.

        Basic radiology

        100% Scheme tariff.

        Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)

        100% Scheme tariff

        Oncology programme

        100% Scheme tariff. DSP applies. Access to extended protocols.

        Peritoneal dialysis and haemodialysis

        100% Scheme tariff Subject to pre-authorisation and DSPs

        Confinements (Birthing)

        100% Scheme tariff.

        Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)

        100% Scheme tariff. Limited to R11 117 per eye.

        Mammary surgery on the unaffected (non-cancerous) breast of a breast cancer patient

        100% Scheme tariff for reconstructive surgery
        (which may include symmetrising, partial or total mastectomy etc.) on the unaffected (non-cancerous) breast of a breast cancer patient The benefit is limited to R40 476
        and is subject to pre-authorisation.

        HIV/AIDS

        100% Scheme tariff. Subject to preauthorisation and DSPs

        Midwife-assisted births

        100% Scheme tariff

        Supplementary services

        100% Scheme tariff.

        Alternatives to hospitalisation

        100% Scheme tariff

        Palliative care and Home-based care in lieu of hospitalisation

        100% Scheme tariff limited to R126 840 per annum. Subject to available benefit, pre-authorisation and treatment plan.

        International travel cover

        Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
        Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants. 

        Day procedures at a day-hospital facility

        Day procedures at DSPs and/or day-hospitals will be funded at 100%  network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.

        Day-to-Day

        Overall day-to-day limit

        M = R20 045, M1+ = R41 425.

        FP and Specialist consultations

        Savings first. 100% Scheme tariff.
        M = R4 840, M1+ = R9 809.
        (Subject to overall day-to-day limit)

        Basic and specialised dentistry

        Savings first and then from day-to-day limit.
        Limited to M = R8 219, M1+ = R15 323.
        (Subject to overall day-to-day limit)

        Orthodontic dentistry

        100% Scheme tariff. Subject to pre-authorisation.
        Limited to R9 513 per event for beneficiaries up to 18 years of age. Subject to overall day-to-day limit.

        Medical aids, apparatus and appliances

        Savings first. Limited to R11 509 per family.
        Includes repairs to artificial limbs.
        (Subject to overall day-to-day limit)

        Wheelchairs

        Limited to R15 564 per family every 48 months.

        Hearing aids

        Limited to R35 705 per beneficiary every 24 months subject to pre-authorisation.

        Continuous/Flash Glucose Monitoring (CGM/FGM)

        100% Scheme tariff. Limited to R21 140 per family per annum. Subject to pre-authorisation.

        Supplementary services

        Savings first.
        Limited to M = R2 956, M1+ = R6 212.
        (Subject to overall day-to-day limit)

        Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)

        100% Scheme tariff. Savings first.
        Limited to R10 000 per family.
        (Subject to overall day-to-day limit)

        Optometry benefit

        Benefits available every 24 months from date of service.

        Network Provider (PPN)
        Consultation - 1 per beneficiary.
        Frame = R1 040 covered AND
        100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
        Lens enhancement = R750 covered OR
        Contact lenses = R2 010

        Non-network Provider
        Consultation - R365 fee at non-network provider
        Frame = R780 AND
        Single vision lenses = R215 OR
        Bifocal lenses = R460 OR
        Multifocal lenses = R982.50
        Lens enhancement = R750 covered 
        In lieu of glasses members can opt for contact lenses, limited to R2 010

        Basic radiology and pathology

        Savings first.
        Limited to M = R3 924, M1+ = R7 781.
        (Subject to overall day-to-day limit)

        Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)

        MRI/CT scans: Maximum of 3 scans per beneficiary. PET scan: 1 scan per beneficiary. Subject to pre-authorisation.

        Oncology

        Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.
        Access to extended protocols.

        HIV/AIDS

        100% Scheme tariff. Subject to pre-authorisation and DSPs.

        Peritoneal dialysis and haemodialysis

        100% Scheme tariff. Subject to pre-authorisation and DSPs.

        Rehabilitation services after trauma

        100% Scheme tariff.

        Medicines

        CDL and PMB chronic medicine

        100% Scheme tariff.
        Co-payment of 15% for non-formulary medicine.

        Non-CDL chronic medicine

        20 conditions. 90% Scheme tariff.
        Limited to M = R15 368, M1+ = R30 735. Co-payment of 15% for non-formulary medicine.

        Biological medicine

        Limited to R366 197 per beneficiary.

        Other high-cost medicine

        100% Scheme tariff.

        Acute medicine

        Savings first. Limited to M = R2 000, M1 + = R4 500.
        (Subject to overall day-to-day limit)

        Over-the-counter (OTC) medicine

        Member choice:
        1. R1 057 OTC limit per family OR
        2. Access to full savings for OTC purchases (after R1 057 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
        Subject to the available savings.

        Preventative care benefits

        Flu vaccines
        • All ages
        • 1 per beneficiary per year
        • Applicable to all active members and beneficiaries
        Pneumonia vaccines
        • Children <2 years
        • High-risk adult group

               Children:

        • As per schedule of Department of Health

               Adults:

        • Twice in a lifetime with booster above 65 years of age

               Adults:

        • The Scheme will identify certain high-risk individuals who will be advised to be immunised
        Travel vaccines
        • All ages
        • Quantity and frequency depending on product up to to the maximum allowed amount
        • Mandatory travel vaccines for typhoid, yellow fever, tetanus, meningitis, hepatitis and cholera from Scheme risk benefits
        Paediatric immunisation
        • Babies and children
        • Funding for all paediatric vaccines according to the state-recommended programme
        Baby growth and development assessments
        • 0-2 years
        • 3 assessments per year
        • Assessments are done at a Bestmed Network Pharmacy Clinic
        Female contraceptives
        • All females of child-bearing age
        • Quantity and frequency depending on product up to the maximum allowed amount.
        • Mirena device - 1 device every 60 months
        • Limited to R2 550 per beneficiary per year. Includes all items classified in the category of female contraceptives
        Intrauterine device (IUD) insertion
        • All females of child-bearing age
        • 1 device every 5 years.
        • Consultation and procedure by a gynaecologist or FP.
        HPV vaccinations
        • Females 9-26 years of age
        • 3 vaccinations per beneficiary
        • Vaccinations will be funded at Mediscor Reference Price (MRP)
        Back and neck preventative programme
        • All ages
        • Subject to pre-authorisation
        • Preferred providers (DBC/Workability Clinics)
        • This is a preventative programme with the objective of preventing back and neck surgery. The Scheme may identify appropriate participants
        • Based on the first assessment, a rehabilitation treatment plan is drawn up and initiated over an uninterrupted period that will be specified by the provider
        • Use of this programme is in lieu of surgery
          Mammogram (tariff code 34100)
          • Females 40 years and older
          • Once every 24 months
          • 100% Scheme tariff
          Bone Densitometry
          • All beneficiaries 45 years and older.
            Once every 24 months.
          Preventative dentistry
          PSA screening
          • Males 50 years and older
          • Once every 24 months
          • Can be done at a urologist or Family Practitioner (FP)
          • Consultation paid from the available savings account
          Pap smear
          • Females 18 years and older
          • Once every 24 months
          • Can be done at a gynaecologist or Family Practitioner (FP)
          • Consultation paid from the available savings account

           

          Maternity Benefits

          100% Scheme tariff. Subject to the following benefits:

          Consultations: 
          • 9 antenatal consultations at a Family Practitioner OR gynaecologist OR midwife
          • 1 post-natal consultation at a Family Practitioner OR gynaecologist OR midwife
          Ultrasounds:
          • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a Family Practitioner OR gynaecologist OR radiologist
          • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a Family Practitioner OR gynaecologist OR radiologist
          Supplements:
          • Any item categorised as a maternity supplement can be claimed up to a maximum of R127 per claim, once a month, for a maximum of 9 months

          From R 7534 per month*

          Add Dependants

          Adults
          0
          Children
          0

          Pace3 offers comprehensive cover for members that have diverse medical needs. It includes comprehensive chronic benefits and excellent hospital cover.

          You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.

          Contributions
          Member: R7 534
          Adult dependant: R6 065
          Child dependant: R1 296
          Maximum child dependants: 3

          Bestmed members pay for only three child dependants. The rest is covered at no extra cost. Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.

          Get personalised pricing call for more information

          Pace4

          Plan Details

          Hospital & Emergencies

          Accommodation (hospital stay) and theatre fees

          100% Scheme tariff.

          Take-home medicine

          100% Scheme tariff. Limited to 7 days’ medicine.

          Treatment in mental health clinic

          100% Scheme tariff. Limited to 21 days per beneficiary

          Treatment of chemical and substance abuse

          100% Scheme tariff. Limited to 21 days or R35 573 per beneficiary. Subject to network facilities.

          Consultations and procedures

          100% Scheme tariff.

          Surgical procedures and anaesthetics

          100% Scheme tariff.

          Organ transplants

          100% Scheme tariff.

          Major medical maxillo-facial surgery strictly related to certain conditions

          100% Scheme tariff.

          Dental and oral surgery (In- or out of hospital)

          Limited to R22 233 per family.

          Orthopaedic and medical appliances

          100% Scheme tariff.

          Pathology

          100% Scheme tariff.

          Basic radiology

          100% Scheme tariff.

          Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies).

          100% Scheme tariff

          Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)

          100% Scheme tariff. Limited to R148 048 per family.

          Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Items utilised towards treating or supporting a bodily function.

          Sub-limits per beneficiary:
            *Functional R40 000   Pacemaker (dual chamber) R68 989   Vascular R69 000   Spinal incl. artificial disk R74 030   Drug-eluting stents R24 653   Mesh R21 710   Gynaecology/Urology R17 918   Lens implants R19 840 per lens per eye
          Joint replacements:   Hip replacement and other major joints R66 243   Knee replacement R76 705   Other minor joints R24 653

          Prosthesis – External

          Limited to R34 135 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.

          Oncology

          Oncology programme. 100% of Scheme tariff.  Subject to pre-authorisation and DSP. Access to extended protocols.

          Peritoneal dialysis and haemodialysis

          100% Scheme tariff Subject to pre-authorisation and DSPs

          Confinements (Birthing)

          100% Scheme tariff.

          Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)

          100% Scheme tariff. Limited to R11 117 per eye.

          Mammary surgery on the unaffected (non-cancerous) breast of a breast cancer patient

          100% Scheme tariff for reconstructive surgery
          (which may include symmetrising, partial or total mastectomy etc.) on the unaffected (non-cancerous) breast of a breast cancer patient.
          The benefit is limited to R40 476 and is subject to pre-authorisation.

          Medically necessary breast reduction surgery (Including fees for the surgeon and anaesthetist)

          100% Scheme tariff. R52 850 per family per annum (for surgeon and anaesthetist). Theatre and hospital cost will be funded from Scheme risk. Subject to funding protocols, pre-authorisation.

          HIV/AIDS

          100% Scheme tariff. Subject to pre-authorisation and DSPs

          Midwife-assisted births

          100% Scheme tariff

          Supplementary services

          100% Scheme tariff.

          Alternatives to hospitalisation

          100% Scheme tariff

          Palliative care and Home-based care in lieu of hospitalisation

          100% Scheme tariff Limited to R126 840 per annum. Subject to available benefit, pre-authorisation and treatment plan.

          Day procedures at a day-hospital facility

          Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.

          International travel cover

          Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
          Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants.

          Day-to-Day

          Overall day-to-day limit

          M = R39 497, M1+ = R63 693.

          FP and Specialist consultations

          Limited to M = R6 212, M1+ = R10 071.
          (Subject to overall day-to-day limit)

          Basic and specialised dentistry

          Limited to M = R13 717, M1+ = R23 152.
          (Subject to overall day-to-day limit)

          Orthodontic dentistry

          100% Scheme tariff. Subject to preauthorisation.
          Limited to R11 627 per event for beneficiaries up to 18 years of age.

          Medical aids, apparatus and appliances

          Limited to R11 509 per family. 
          Includes repairs to artificial limbs. 
          (Subject to overall day-to-day limit)

          Wheelchairs

          Limited to R15 564 per family every 48 months.

          Hearing aids

          Limited to R39 758 per beneficiary every 24 months subject to pre-authorisation.

          Insulin pump (excluding consumables)

          100% Scheme tariff.
          Limited to R46 259 per beneficiary every 24 months.
          Subject to pre-authorisation.

          Continuous/Flash Glucose Monitoring (CGM/FGM)

          100% Scheme tariff. Limited to R26 425 per family per annum. Subject to pre-authorisation.

          Supplementary services

          Limited to M = R6 212, M1+ = R12 228.
          (Subject to day-to-day overall limit)

          Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)

          Limited to R15 171 per family.
          (Subject to overall day-to-day limit)

          Optometry benefit

          Benefits available every 24 months from date of service.

          Network Provider (PPN)
          Consultation - 1 per beneficiary.
          Frame = R1 040 covered AND
          100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
          Lens enhancement = R750 covered OR
          Contact lenses = R2 375

          Non-network Provider
          Consultation - R365 fee at non-network provider
          Frame = R780 AND
          Single vision lenses = R215 OR
          Bifocal lenses = R460 OR
          Multifocal lenses = R982.50
          Lens enhancement = R750 covered
          In lieu of glasses members can opt for contact lenses, limited to R2 375

          Basic radiology and pathology

          Limited to M = R6 212, M1+ = R12 228.
          (Subject to overall day-to-day limit)

          Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)

          MRI/CT scans: Maximum of 3 scans per beneficiary. PET scan: 1 scan per beneficiary. Subject to pre-authorisation.

          Oncology

          Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.
          Access to extended protocols.

          HIV/AIDS

          100% Scheme tariff. Subject to pre-authorisation and DSPs.

          Peritoneal dialysis and haemodialysis

          100% Scheme tariff. Subject to pre-authorisation and DSPs.

          Rehabilitation services after trauma

          100% Scheme tariff.

          Medicines

          CDL and PMB chronic medicine

          100% Scheme tariff.
          Co-payment of 10% for non-formulary medicine.

          Non-CDL chronic medicine

          29 conditions. 100% Scheme tariff.
          Limited to M = R21 905, M1+ = R44 009. Co-payment of 10% for non-formulary medicine.

          Biological medicine

          Limited to R541 971 per beneficiary.

          Other high-cost medicine

          100% Scheme tariff.

          Acute medicine

          Limited to M = R9 809, M1+ = R15 237.
          10% co-payment.
          (Subject to overall day-to-day limit)

          Over-the-counter (OTC) medicine

          Subject to available savings.

          Preventative Care

          Flu vaccines
          • All ages
          • 1 per beneficiary per year
          • Applicable to all active members and beneficiaries
          Pneumonia vaccines
          • Children <2 years
          • High-risk adult group

                 Children:

          • As per schedule of Department of Health

                 Adults:

          • Twice in a lifetime with booster above 65 years of age

                 Adults:

          • The Scheme will identify certain high-risk individuals who will be advised to be immunised
          Travel vaccines
          • All ages
          • Quantity and frequency depending on product up to to the maximum allowed amount
          • Mandatory travel vaccines for typhoid, yellow fever, tetanus, meningitis, hepatitis and cholera from Scheme risk benefits
          Paediatric immunisation
          • Babies and children
          • Funding for all paediatric vaccines according to the state-recommended programme
          Baby growth and development assessments
          • 0-2 years
          • 3 assessments per year
          • Assessments are done at a Bestmed Network Pharmacy Clinic
          Female contraceptives
          • All females of child-bearing age
          • Quantity and frequency depending on product up to the maximum allowed amount. Mirena device - 1 device every 60 months
          • Limited to R2 550 per beneficiary per year. Includes all items classified in the category of female contraceptives
          Intrauterine device (IUD) insertion
          • All females of child-bearing age
          • 1 device every 5 years.
          • Consultation and procedure by a gynaecologist or FP.
          Back and neck preventative programme
          • All ages
          • Subject to pre-authorisation
          • Preferred providers (DBC/Workability Clinics)
          • This is a preventative programme with the objective of preventing back and neck surgery. The Scheme may identify appropriate participants.
          • Based on the first assessment, a rehabilitation treatment plan is drawn up and initiated over an uninterrupted period that will be specified by the provider.
          • Use of this programme is in lieu of surgery
          Preventative dentistry
          • Refer to Preventative Dentistry section for details
          Mammogram (tariff code 34100)
          • Females 40 years and older
          • Once every 24 months
          • 100% Scheme tariff
          PSA screening
          • Males 50 years and older
          • Once every 24 months
          • Can be done at a urologist or Family Practitioner (FP)
          • Consultation paid from the available consultation benefit/savings account
          HPV vaccinations
          • Females 9-26 years of age
          • 3 vaccinations per beneficiary
          • Vaccinations will be funded at MRP
          Bone densitometry
          • All beneficiaries 45 years and older
          • Once every 24 months
          Pap smear
          • Females 18 years and older
          • Once every 24 months
          • Can be done at a gynaecologist, Family Practitioner (FP) or pharmacy clinic
          • Consultation paid from the available consultation benefit/savings account

           

          Maternity Benefits

          100% Scheme tariff. Subject to the following benefits

          Consultations: 
          • 9 antenatal consultations at a Family Practitioner OR gynaecologist OR midwife
          • 1 post-natal consultation at a Family Practitioner OR gynaecologist OR midwife
          Ultrasounds:
          • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a Family Practitioner OR gynaecologist OR radiologist
          • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a Family Practitioner OR gynaecologist OR radiologist
          Supplements:
          • Any item categorised as a maternity supplement can be claimed up to a maximum of R127 per claim, once a month, for a maximum of 9 months.

          From R 9411 per month*

          Add Dependants

          Adults
          0
          Children
          0

          You may have above-average medical costs, or would like the maximum cover available. You need the comfort of extensive benefits and cover for hospital expenses.

          In addition, there is an individual medical savings account which offer further payment flexibility. With the exclusivity that Pace4 offers, you have the greatest cover with complete peace of mind.

          You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.

          Contributions
          Member: R9 411
          Adult dependant: R9 411
          Child dependant: R2 205
          Maximum child dependants: 3

          Bestmed members pay for only three child dependants. The rest is covered at no extra cost. Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.

          Get personalised pricing call for more information

          Want the full plan information sent to your inbox?