Bestmed's comprehensive plans offer excellent hospital and chronic benefits to young, middle-age and established families.
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.
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.
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.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
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 
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.
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.
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.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
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
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.
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.
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.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
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
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.
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.
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.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
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.
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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.
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.
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.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
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
