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24h Emergency: 084 124

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 R30 000 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 R33 655 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 R13 610 per family

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

Limited to R8 414 per family.

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

100% Scheme tariff. Limited to R94 036 per family.

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

• *Functional limited to R16 890  • Vascular R34 273   • Pacemaker (dual chamber) R58 526   • Endovascular and catheter-based procedures – no benefit   • Spinal R34 273   • Artificial disc - no benefit   • Drug-eluting stents - PMBs and DSP products only   • Mesh R12 868<   • Gynaecology/Urology R9 280   • Lens implants R7 053 a lens per eye

Prosthesis – External

DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Limited to R23 881 per family.

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 R34 892   • Knee replacement R46 400   • Minor joints R14 415

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 preauthorisation. 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 354 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 R75 000 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.

Day procedures at a day-hospital facility

100% Scheme tariff. Subject to pre-authorisation. DSPs apply for PMBs

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 R5 million for one member and R10 million for principal 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 R5 million for one member and R10 million for principal member and dependants.

Day-to-Day

Overall day-to-day limit

M = R11 359, M1+ = R22 717.

FP and Specialist consultations

Savings first. Limited to M = R2 339, M1+ = R4 702. (Subject to overall day-to-day limit)

Diabetes primary care consultation

100% of Scheme tariff subject to registration with Halocare. 2 primary care consultations at Dis-Chem Pharmacies. Paid first from the FP and specialist consultations day-to-day benefit, thereafter Scheme risk.

Basic and specialised dentistry

Savings and then from day-to-day limits. Orthodontic: Subject to pre-authorisation. Limited to M = R4 305, M1+ = R8 736. (Subject to overall day-to-day limit)

Medical aids, apparatus and appliances

100% Scheme tariff. Savings first. Limited to R12 003 per family. Includes repairs to artificial limbs. (Subject to overall day-to-day limit)

Wheelchairs

Subject to medical apparatus and appliance limits.

Hearing aids

Limited to R8 336 per family every 24 months. 100% Scheme tariff. Subject to pre-authorisation.

Supplementary services

Savings first. Limited to M = R4 590, M1+ = R9 528. (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 774 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 = R950 covered AND
100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR
Contact lenses = R1720

Non-network Provider
Consultation - R350 fee at non-network provider
Frame = R598 AND
Single vision lenses = R210 OR
Bifocal lenses = R445 OR
Multifocal lenses = R1 000
In lieu of glasses members can opt for contact lenses, limited to R1 720

Basic radiology and pathology

100% Scheme tariff. Savings first. Limited to M = R3 402, M1+ = R6 806. (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 R15 220 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 25% for non-formulary medicine.

Non-CDL chronic medicine

7 conditions. 90% Scheme tariff. Limited to M = R6 929, M1+ = R13 858. Co-payment of 25% for non-formulary medicine.

Biologicals and other high-cost medicine

PMBs only. Subject to pre-authorisation.

Acute medicine

Savings first. Limited to M = R2 451, M1 + = R5 074. (Subject to overall day-to-day limit)

Over-the-counter (OTC) medicine

Member choice:
1. R1 000 OTC limit per family OR
2. Access to full savings for OTC purchases (after R1 000 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 412 per beneficiary per year. Includes all items classified in the category of female contraceptives
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
    • 1 lactation consultation with a registered nurse or lactation specialist.
    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 R120 per claim, once a month, for a maximum of 9 months

    From R 4242 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 242
    Adult dependant: R2 980
    Child dependant: R1 071
    Maximum child dependants: 3

    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 R25 000 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 R33 655 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 R13 735 per family

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

    Limited to R10 518 per family.

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

    100% Scheme tariff. Limited to R101 345 per family.

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

    • *Functional limited to R17 694  • Vascular R35 017   • Pacemaker (dual chamber) R58 649   • Endovascular and catheter-based procedures – no benefit   • Spinal R35 017   • Artificial disc - no benefit   • Drug-eluting stents - R19 674   • Mesh R12 992<   • Gynaecology/Urology R9 528   • Lens implants R7 424 a lens per eye

    Prosthesis – External

    Limited to R24 376 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 R36 007   • Knee replacement R47 835   • Minor joints R14 698

    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 preauthorisation. DSP applies.

    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 R9 775 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 R90 000 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.

    Day procedures at a day-hospital facility

    Day procedures at a day-hospital facility funded at 100% Scheme tariff. Subject to pre-authorisation. DSPs apply for PMBs.

    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 R5 million for one member and R10 million for principal 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 R5 million for one member and R10 million for principal member and dependants.

    Day-to-Day

    Overall day-to-day limit

    M = R13 363, M1+ = R26 726.

    FP and Specialist consultations

    Savings first.
    Limited to M = R3 403, M1+ = R6 063
    (Subject to overall day-to-day limit)

    Diabetes primary care consultation

    100% of Scheme tariff subject to registration with HaloCare.
    2 primary care consultations at Dis-Chem Pharmacies.
    Paid first from the FP and specialist consultations; day-to-day benefit, thereafter Scheme risk.

    Basic and specialised dentistry

    Savings and then from day-to-day limit.
    Orthodontics are subject to pre-authorisation.
    Limited to M = R5 887, M1+ = R11 825.
    (Subject to overall day-to-day limit)

    Medical aids, apparatus and appliances

    Savings first. 100% Scheme tariff. Limited to R12 003 per family. Includes repairs to artificial limbs. (Subject to overall day-to-day limit).

    Hearing aids

    Subject to pre-authorisation. Limited to R12 003 per family every 24 months. 100% Scheme tariff.

    Supplementary services

    Savings first.
    Limited to M = R5 197, M1+ = R10 555.
    (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 197 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 = R950 covered AND
    100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR
    Contact lenses = R1720

    Non-network Provider
    Consultation - R350 fee at non-network provider
    Frame = R598 AND
    Single vision lenses = R210 OR
    Bifocal lenses = R445 OR
    Multifocal lenses = R1 000
    In lieu of glasses members can opt for contact lenses, limited to R1 720

    Basic radiology and pathology

    Savings first.
    Limited to M = R3 402, M1+ = R6 929.
    (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 R17 694 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 = R7 882, M1+ = R15 764. Co-payment of 20% for non-formulary medicine.

    Biologicals and other high-cost medicine

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

    Acute medicine

    Savings first. Limited to M = R3 006, M1 + = R6 075 (Subject to overall day-to-day limit)

    Over-the-counter (OTC) medicine

    Member choice:
    1. R1 000 OTC limit per family OR
    2. Access to full savings for OTC purchases (after R1 000 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 412 per beneficiary per year. Includes all items classified in the category of female contraceptives
    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
      • 1 lactation consultation with a registered nurse or lactation specialist.
      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 R120 per claim, once a month, for a maximum of 9 months

      From R 5062 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 062
      Adult dependant: R4 181
      Child dependant: R1 251
      Maximum child dependants: 3

      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 R33 655 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 R13 982 per family.

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

      100% Scheme tariff. Limited to R120 762 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 limited to R18 374   • Vascular R45 286   • Pacemaker (dual chamber) R65 268   • Spinal including artificial disc R60 542   • Drug-eluting stents R19 797   • Mesh R19 797   • Gynaecology/Urology R14 786   • Lens implants s R12 695 a lens per eye   Joint replacements:
      • Hip replacements and other major joints R54 380   • Knee replacement R63 103   • Minor joints R23 447

      Prosthesis – External

      Limited to R28 458 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 R38 294
      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 R9 774 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 R120 000 per annum. Subject to available benefit, pre-authorisation and treatment plan.

      Day procedures at a day-hospital facility

      Day procedures at a day-hospital facility funded at 100% Scheme tariff. Subject to pre-authorisation. DSPs apply for PMBs

      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 R5 million for one member and R10 million for principal 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 R5 million for one member and R10 million for principal member and dependants.

      Day-to-Day

      Overall day-to-day limit

      M = R16 036, M1+ = R32 071.

      FP and Specialist consultations

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

      Diabetes primary care consultation

      100% of Scheme tariff subject to registration with HaloCare. 2 primary care consultations at Dis-Chem Pharmacies.
      Paid first from the “FP and specialist consultations” day-to-day benefit, thereafter Scheme risk.

      Basic and specialised dentistry

      Savings and then from day-to-day limit.
      Limited to M = R7 217, M1+ = R14 433.
      (Subject to overall day-to-day limit)

      Orthodontic dentistry

      100% Scheme tariff. Subject to preauthorisation.
      Limited to R7 000 per event for beneficiaries up to 18 years of age.

      Medical aids, apparatus and appliances

      Savings first. Limited to R10 888 per family.
      Includes repairs to artificial limbs.
      (Subject to overall day-to-day limit)

      Wheelchairs

      Limited to R14 725 per family every 48 months.

      Hearing aids

      Limited to R30 005 per beneficiary every 24 months subject to pre-authorisation.

      Supplementary services

      Savings first.
      Limited to M = R5 755, M1+ = R11 569.
      (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 = R990 covered AND
      100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
      Lens enhancement = R750 covered OR
      Contact lenses = R1 880

      Non-network Provider
      Consultation - R350 fee at non-network provider
      Frame = R598 AND
      Single vision lenses = R210 OR
      Bifocal lenses = R445 OR
      Multifocal lenses = R1 000
      In lieu of glasses members can opt for contact lenses, limited to R1 880

      Basic radiology and pathology

      Savings first.
      Limited to M = R3 402, M1+ = R6 806.
      (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 = R9 528 M1+ = R19 055. Co-payment of 20% for non-formulary medicine.

      Biologicals and other high-cost medicine

      Limited to R173 110 per beneficiary.

      Acute medicine

      Savings first. Limited to M = R5 074, M1 + = R10 146.
      (Subject to overall day-to-day limit)

      Over-the-counter (OTC) medicine

      Member choice:
      1. R1 000 OTC limit per family OR
      2. Access to full savings for OTC purchases (after R1 000 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 412 per beneficiary per year. Includes all items classified in the category of female contraceptives
      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
        • 1 lactation consultation with a registered nurse or lactation specialist.
        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 R120 per claim, once a month, for a maximum of 9 months

        From R 6026 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 026
        Adult dependant: R5 909
        Child dependant: R1 329
        Maximum child dependants: 3

        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 R33 655 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 R17 570 per family.

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

        100% Scheme tariff. Limited to R121 381 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 limited to R19 797   • Vascular R45 410   • Pacemaker (dual chamber)R65 268   • Spinal including artificial disc R60 657   • Drug-eluting stents R19 797   • Mesh R19 797   • Gynaecology/Urology R14 848   • Lens implants R12 695 a lens per eye   Joint replacements:
        • Hip replacement and other major joints R54 442   • Knee replacement R63 413   • Minor joints R23 447

        Prosthesis – External

        Limited to R28 583 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 R10 518 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 R38 294
        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 R120 000 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 R5 million for one member and R10 million for principal 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 R5 million for one member and R10 million for principal member and dependants.

        Day procedures at a day-hospital facility

        Day procedures at a day-hospital facility funded at 100% Scheme tariff. Subject to pre-authorisation. DSPs apply for PMBs

        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 579, M1+ = R9 280.
        (Subject to overall day-to-day limit)

        Diabetes primary care consultation

        100% of Scheme tariff subject to registration with HaloCare. 2 primary care consultations at Dis-Chem Pharmacies.
        Paid first from the “FP and specialist consultations” day-to-day benefit, thereafter Scheme risk.

        Basic and specialised dentistry

        Savings first and then from day-to-day limit.
        Limited to M = R7 776, M1+ = R14 497.
        (Subject to overall day-to-day limit)

        Orthodontic dentistry

        100% Scheme tariff. Subject to pre-authorisation.
        Limited to R9 000 per event for beneficiaries up to 18 years of age.

        Medical aids, apparatus and appliances

        Savings first. Limited to R10 888 per family.
        Includes repairs to artificial limbs.
        (Subject to overall day-to-day limit)

        Wheelchairs

        Limited to R14 725 per family every 48 months.

        Hearing aids

        Limited to R33 779 per beneficiary every 24 months subject to pre-authorisation.

        Continuous/Flash Glucose Monitoring (CGM/FGM)

        100% Scheme tariff. Limited to R20 000 per family per annum. Subject to pre-authorisation.

        Supplementary services

        Savings first.
        Limited to M = R2 797, M1+ = R5 877.
        (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 R11 136 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 = R990 covered AND
        100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
        Lens enhancement = R750 covered OR
        Contact lenses = R1 880

        Non-network Provider
        Consultation - R350 fee at non-network provider
        Frame = R598 AND
        Single vision lenses = R210 OR
        Bifocal lenses = R445 OR
        Multifocal lenses = R1 000
        In lieu of glasses members can opt for contact lenses, limited to R1 880

        Basic radiology and pathology

        Savings first.
        Limited to M = R3 712, M1+ = R7 362.
        (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.

        Biologicals and other high-cost medicine

        100% Scheme tariff. Limited to R346 449 per beneficiary.

        Acute medicine

        Savings first. Limited to M = R1 609, M1 + = R3 960.
        (Subject to overall day-to-day limit)

        Over-the-counter (OTC) medicine

        Member choice:
        1. R1 000 OTC limit per family OR
        2. Access to full savings for OTC purchases (after R1 000 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 412 per beneficiary per year. Includes all items classified in the category of female contraceptives
        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
          • 1 lactation consultation with a registered nurse or lactation specialist.
          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 R120 per claim, once a month, for a maximum of 9 months

          From R 6918 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: R6 918
          Adult dependant: R5 569
          Child dependant: R1 190
          Maximum child dependants: 3

           

          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 R33 655 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 R21 034  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 R140 064 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 limited to R20 539   • Vascular R51 967   • Pacemaker (dual chamber)R65 268   • Spinal including artificial disc R70 038   • Drug-eluting stents R23 324   • Mesh R20 539   • Gynaecology/Urology R16 952   • Lens implants R18 770 a lens per eye   Joint replacements:
          • Hip replacement and other major joints R62 670   • Knee replacement R72 569   • Minor joints R23 324

          Prosthesis – External

          Limited to R32 295 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 R10 518 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 R38 294 and is subject to pre-authorisation.

          Breast reduction surgery

          100% Scheme tariff. R50 000 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 R120 000 per annum. Subject to available benefit, pre-authorisation and treatment plan.

          Day procedures at a day-hospital facility

          Day procedures at a day-hospital facility funded at 100% Scheme tariff. Subject to pre-authorisation. DSPs apply for PMBs

          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 R5 million for one member and R10 million for principal 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 R5 million for one member and R10 million for principal member and dependants.

          Day-to-Day

          Overall day-to-day limit

          M = R37 367, M1+ = R60 258.

          FP and Specialist consultations

          Limited to M = R5 877, M1+ = R9 528.
          (Subject to overall day-to-day limit)

          Diabetes primary care consultation

          100% of Scheme tariff subject to registration with HaloCare. 2 primary care consultations at Dis-Chem Pharmacies.
          Paid first from the “FP and specialist consultations” day-to-day benefit, thereafter Scheme risk.

          Basic and specialised dentistry

          Limited to M = R12 977, M1+ = R21 903.
          (Subject to overall day-to-day limit)

          Orthodontic dentistry

          100% Scheme tariff. Subject to preauthorisation.
          Limited to R11 000 per event for beneficiaries up to 18 years of age.

          Medical aids, apparatus and appliances

          Limited to R10 888 per family. 
          Includes repairs to artificial limbs. 
          (Subject to overall day-to-day limit)

          Wheelchairs

          Limited to R14 725 per family every 48 months.

          Hearing aids

          Limited to R37 614 per beneficiary every 24 months subject to pre-authorisation.

          Insulin pump (excluding consumables)

          100% Scheme tariff.
          Limited to R43 764 per beneficiary every 24 months.
          Subject to pre-authorisation.

          Continuous/Flash Glucose Monitoring (CGM/FGM)

          100% Scheme tariff. Limited to R25 000 per family per annum. Subject to pre-authorisation.

          Supplementary services

          Limited to M = R5 877, M1+ = R11 569.
          (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 R14 353 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 = R990 covered AND
          100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
          Lens enhancement = R750 covered OR
          Contact lenses = R2 220

          Non-network Provider
          Consultation - R350 fee at non-network provider
          Frame = R598 AND
          Single vision lenses = R210 OR
          Bifocal lenses = R445 OR
          Multifocal lenses = R1 000
          In lieu of glasses members can opt for contact lenses, limited to R2 220

          Basic radiology and pathology

          Limited to M = R5 877, M1+ = R11 569.
          (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 = R20 724, M1+ = R41 636. Co-payment of 10% for non-formulary medicine.

          Biologicals and other high-cost medicine

          Limited to R512 744 per beneficiary.

          Acute medicine

          Limited to M = R9 280, M1+ = R14 415.
          10% co-payment.
          (Subject to overall day-to-day limit)

          Over-the-counter (OTC) medicine

          Member choice:
          1. R1 000 OTC limit per family OR
          2. Access to full savings for OTC purchases (after R1 000 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
          Subject to the 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 412 per beneficiary per year. Includes all items classified in the category of female contraceptives
          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
          • 1 lactation consultation with a registered nurse or lactation specialist.
          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 R120 per claim, once a month, for a maximum of 9 months.

          From R 8642 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: R8 642
          Adult dependant: R8 642
          Child dependant: R2 025
          Maximum child dependants: 3


          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?