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. *If claimed on the day of discharge, as follows: Limited to a maximum of 7 days treatment if claimed as part of the hospital account or limited to R550 if claimed from a retail pharmacy. Subject to MRP. No benefit if not claimed on the date of discharge.
Biological medicine during hospitalisation
Limited to R36 430 per family per annum. Subject to preauthorisation and funding guidelines.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per annum in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per annum. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs and 21 days’ stay for in-hospital management per beneficiary per annum.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
Organ transplants
100% Scheme tariff. (PMBs only)
Stem cell transplants
100% Scheme tariff. (PMBs Only).
Major medical maxillo-facial surgery strictly related to certain conditions
100% Scheme tariff. Limited to R16 527 per family per annum.
Dental and oral surgery (In- or out of hospital)
Limited to R10 217 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R114 189 per family per annum.
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 per annum: *Functional R39 060. Vascular R74 674. Pacemaker (single and dual chamber) R71 068. Spinal including artificial disc R41 618. Drug-eluting stents - subject to Vascular prosthesis limit. Mesh R15 626. Gynaecology/urology R11 269. Lens implants R8 565 a lens per eye.
Prosthesis – External
Limited to R28 998 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
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 R42 369. Knee replacement R56 344. Other minor joints R17 505.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 690 per family per annum.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies)
100% Scheme tariff.
Limited to a combined in and out of hospital benefit of R41 840 per family per annum. Co-payment of R2 000 per scan, not applicable for PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Oncology
100% Scheme tariff. Subject to preauthorisation, designated or preferred service providers, and protocols. Essential ICON protocols apply.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs
Confinements (birthing, including midwife-assisted births)
100% Scheme tariff.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Subject to pre-authorisation and protocols. Limited to R11 359 per eye.
HIV/AIDS
100% Scheme tariff. Subject to preauthorisation and DSPs.
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff.
Limited to R91 073 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures
Day procedures performed in a day hospital by a DSP provider will be funded at 100% network or Scheme tariff, subject to pre-authorisation, protocols, funding guidelines. A co-payment of R2 872 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital if a DSP is used and the DSP does not work in a day hospital, the day procedure co-payment will not apply if done in an acute hospital, if it is arranged with the scheme before time.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Overall day-to-day limit
M = R13 794, M1+ = R27 586.
GP and Specialist consultations
Savings first. 100% Scheme tariff. Limited to M = R2 840, M1+ = R5 710. (Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings first. 100% Scheme tariff. Limited to M = R5 228, M1+ = R10 609. (Subject to overall day-to-day limit). Orthodontic services subject to pre-authorisation.
Medical aids, apparatus and appliances
Savings first. 100% Scheme tariff. Limited to R14 575 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 R10 123 per family every 24 months. 100% Scheme tariff. Subject to pre-authorisation, quotation, motivation and audiogram.
Supplementary services
Savings first. 100% Scheme tariff. Limited to M = R5 574, M1+ = R11 570. (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)
General wound care savings first. 100% Scheme tariff. Limited to R4 583 per family per annum. (Subject to overall day-to-day limit). NPWT treatment shall be at 100%. Scheme tariff, subject to preauthorisation.
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary. Frame = R1 270 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR Contact lenses = R2 085 OR Non-network Provider: Consultation - R420 fee at non network provider Frame = R953 AND Single vision lenses = R225 OR Bifocal lenses = R485 OR Multifocal lenses = R1 080 (consisting of R850 per base lens plus R230 per branded lens add-on) In lieu of glasses members can opt for contact lenses, limited to R2 085.
Basic radiology and pathology
100% Scheme tariff. Savings first. Limited to M = R4 132, M1+ = R 8 264. (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 a combined in- and out-of-hospital benefit of R41 840 per family per annum. Co-payment of R2 000 per scan, not applicable to confirmed PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Rehabilitation services after trauma
100% Scheme tariff.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs
Oncology
100% Scheme tariff. Subject to preauthorisation, designated or preferred service providers and protocols. Essential ICON protocols apply.
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 = R8 414, M1+ = R16 827. Co-payment of 25% for non-formulary medicine.
Biological medicine
PMBs only as per funding protocol.
Other high-cost medicine
100% Scheme tariff. Subject to pre-authorisation.
Acute medicine
Savings first. 100% Scheme tariff. Limited to M = R2 977, M1 + = R6 161. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Member choice: 100% Scheme tariff.
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: R5 934
Adult dependant: R4 289
Child dependant: R1 541
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years 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 If claimed on the day of discharge, as follows: Limited to a maximum of 7 days treatment if claimed as part of the hospital account, or limited to R550 if claimed from a retail pharmacy. Subject to MRP. No benefit if not claimed on the date of discharge.
Biological medicine during hospitalisation
100% Scheme tariff. Limited to R30 357 per family per annum. Subject to preauthorisation and funding guidelines.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per annum in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per annum. Subject to preauthorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs and 21 days’ stay for in-hospital management per beneficiary per annum.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
Organ transplants
100% Scheme tariff. (PMBs only)
Stem cell transplants
100% Scheme tariff. (PMBs Only).
Major medical maxillo-facial surgery strictly related to certain conditions
100% Scheme tariff. Limited to R16 678 per family per annum
Dental and oral surgery (In- or out of hospital)
Limited to R12 772 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R123 064 per family per annum
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 per annum: *Functional R39 060. Pacemaker (single and dual chamber) R71 218. Vascular R74 674. Spinal including artificial disc R42 522. Drug-eluting stents R23 890. Mesh R15 777. Gynaecology/urology R11 570. Lens implants R9 014 a lens per eye.
Prosthesis – External
100% Scheme tariff.
Limited to R29 599 per family. DSPs apply. Includes artificial limbs limited to one (1) limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
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 R43 723. Knee and shoulder replacements R58 086. Other minor joints R17 848.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 690 per family per annum.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies)
Limited to a combined in- and out-ofhospital benefit of R41 840 per family per annum. PET scans are limited to one (1) scan per beneficiary per annum, not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
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, including midwife-assited births)
100% Scheme tariff.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Subject to pre-authorisation and protocols. Limited to R11 871 per eye.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff.
Limited to R109 288 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures
Day procedures performed in a day hospital by a DSP provider will be funded at 100% network or Scheme tariff, subject to pre-authorisation, protocols, funding guidelines and DSPs.. A co-payment of R2 872 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital,the day procedure co-payment will not apply if done in acute hospital, if it is arranged with the Scheme before the time.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Cochlear and boneanchored hearing aid implants
100% Scheme tariff.
*Up to a maximum limit of R250 000 per beneficiary per annum. Subject to pre-authorisation and Preferred Providers or DSPs. Sound processor upgrades every 5 years.
Overall day-to-day limit
M = R16 227, M1+ = R32 452
GP and Specialist consultations
Savings first. Limited to M = R4 133, M1+ = R7 361. 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 = R7 149, M1+ = R14 359. (Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
Savings first. Limited to R14 575 per family. Includes repairs to artificial limbs. 100% Scheme tariff. (Subject to overall day-to-day limit).
Hearing aids
Subject to pre-authorisation. Limited to R13 357 per family every 24 months. 100% Scheme tariff. (Subject to quotation, motivation and audiogram)
Supplementary services
Savings first. Limited to M = R6 311, M1+ = R12 817. (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 R6 311 per family. (Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary; Frame = R1 270 covered AND; 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR; Contact lenses = R2 085 OR ... Non-network Provider: Consultation - R420 fee at non-network provider; Frame = R953 AND; Single vision lenses = R225 OR; Bifocal lenses = R485 OR; Multifocal lenses = R1 080 (consisting of R850 per base lens plus R230 per branded lens add-on) In lieu of glasses members can opt for contact lenses, limited to R2 085
Basic radiology and pathology
Savings first. Limited to M = R4 132, M1+ = R8 414. (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 a combined in- and out-of-hospital benefit of R41 840 per family per annum. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation, protocols 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 = R9 571, M1+ = R19 143. Co-payment of 20% for non-formulary medicine.Biologicals medicine
PMBs only as per funding protocol.
Other high-cost medicine
PMBs only as per funding protocol.
Acute medicine
Savings first. Limited to M = R3 652, M1 + = R7 376. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
*Member choice: R1 214 OTC limit per family OR Access to full savings for OTC purchases (after R1 214 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: R7 365
Adult dependant: R6 082
Child dependant: R1 821
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years 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. *If claimed on the day of discharge, as follows: Limited to a maximum of 7 days treatment if claimed as part of the hospital account or limited to R600 if claimed from a retail pharmacy. Subject to MRP. No benefit if not claimed on the date of discharge.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs, 21 days’ stay for in-hospital management per beneficiary per annum.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
Organ transplants
100% Scheme tariff. (PMBs only)
Stem cell 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 R16 979 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R146 642 per family per annum
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 per annum: *Functional R41 358. Vascular R74 674. Pacemaker (single and dual chamber) R79 255.Spinal including artificial disc R73 517. Drug-eluting stents R24 040. Mesh R24 040. Gynaecology/urology R17 954. Lens implants R15 416 a lens per eye. Joint replacements: - Hip replacement and other major joints R66 033. - Knee replacement R76 627. - Other minor joints R28 471.
Prosthesis – External
Limited to R34 557 per family per annum. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 690 per family per annum.
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. Limited to a combined in and out of hospital benefit of R43 932 per family per annum. Co-payment of R1 500 per scan, not applicable for PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Oncology
100% Scheme tariff. Subject to preauthorisation, designated or preferred service providers, and protocols. Essential ICON protocols apply.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs
Confinements (birthing, including midwife-assisted births)
100% Scheme tariff.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Subject to pre-authorisation and protocols. Limited to R11 869 per eye
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff.
Limited to R145 716 per beneficiary per annum. Subject to available benefit, pre authorisation and treatment plan
Day procedures
Day procedures performed in a day hospital by a DSP provider will be funded at 100% network or Scheme tariff, subject to pre-authorisation, protocols, funding guidelines. A co-payment of R2 872 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the day procedure co-payment will not apply if done in acute hospital, if it is arranged with the Scheme before the time
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Overall day-to-day limit
M = R17 233, M1+ = R34 465.
GP and Specialist consultations
Savings first. 100% Scheme tariff. Limited to M = R5 260, M1+ = R10 661. (Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings first. 100% Scheme tariff. Limited to M = R8 762, M1+ = R17 527. (Subject to overall day-to-day limit). Orthodontic services subject to preauthorisation
Orthodontic dentistry
Savings first. 100% Scheme tariff. Subject to pre-authorisation. Limited to R8 500 per event for beneficiaries up to 18 years of age. (Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
Savings first. 100% Scheme tariff. Limited to R13 221 per family. Includes repairs to artificial limbs. (Subject to overall day-to-day limit)
Wheelchairs
100% Scheme tariff. Limited to R17 880 per family every 48 months.
Hearing aids
100% Scheme tariff. Limit of R33 472 per beneficiary every 24 months. Subject to quotation, motivation and audiogram.
Supplementary services
Savings first. 100% Scheme tariff. Limited to M = R4 021, M1+ = R8 042. (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)
General wound care savings first. 100% Scheme tariff. Limited to R8 245 per family per annum. (Subject to overall day-to-day limit). NPWT treatment shall be at 100% Scheme tariff, subject to pre-authorisation.
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary. Frame = R1 325 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND Lens enhancement = R750 covered OR Contact lenses = R2 280 OR Non-network Provider: Consultation - R420 fee at non-network provider Frame = R994 AND Single vision lenses = R225 OR Bifocal lenses = R485 OR Multifocal lenses = R1 080 (consisting of R850 per base lens plus R230 per branded lens add-on) AND Lens enhancement = R750 covered In lieu of glasses members can opt for contact lenses, limited to R2 280
Basic radiology and pathology
Savings first. 100% Scheme tariff. Limited to M = R4 132, M1+ = R 8 264. (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 a combined in- and out-of-hospital benefit of R43 932 per family per annum. Co-payment of R1 500 per scan, not applicable to confirmed PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSP.
Oncology
100% Scheme tariff. Subject to pre-authorisation, designated or preferred service providers and protocols. Essential ICON protocols apply.
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 = R11 488, M1+ = R22 976. Co-payment of 20% for non-formulary medicine.
Biological medicine
100% Scheme tariff. Limited to R210 208 per beneficiary.
Other high-cost medicine
100% Scheme tariff. Subject to pre-authorisation.
Acute medicine
Savings first. 100% Scheme tariff. Limited to M = R3 447, M1 + = R6 893. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
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: R8 766
Adult dependant: R8 596
Child dependant: R1 933
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years 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. *If claimed on the day of discharge, as follows: Limited to a maximum of 7 days treatment if claimed as part of the hospital account or limited to R600 if claimed from a retail pharmacy. Subject to MRP. No benefit if not claimed on the date of discharge.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs and 21 days’ stay for in-hospital management per beneficiary per annum.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
Organ transplants
100% Scheme tariff. (PMBs only)
Stem cell 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)
100% Scheme tariff. Limited to R21 335 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R147 394 per family per annum.
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 per annum: Functional R41 358. Vascular R79 269. Pacemaker (single and dual chamber) R79 255. Spinal including artificial disc R73 657. Drug-eluting stents R24 040. Mesh R24 040. Gynaecology/urology R18 030. Lens implants R15 416 a lens per eye. Joint replacements: - Hip replacement and other major joints R66 108. - Knee replacement R77 001. - Other minor joints R28 471.
Prosthesis – External
Limited to R34 708 per family per annum. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 690 per family per annum.
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. Limited to a combined in- and out-of-hospital benefit of R43 932 per family per annum. Co-payment of R1 500 per scan, not applicable to confirmed PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Oncology programme
100% Scheme tariff. Subject to pre authorisation, designated or preferred service providers and protocols. Essential, Core and Enhanced level ICON protocols apply. Additional access to biological / high cost medicine cover limited to the biological / high cost medicine benefit.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Confinements (birthing, including midwife-assisted births)
100% Scheme tariff.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Subject to pre-authorisation and protocols. Limited to R12 772 per eye.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff.
Limited to R145 716 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Biological medicine during hospitalisation
Biological medicine during Limited to the Biological medicine hospitalisation benefit per beneficiary per year as set out on page 8. Subject to pre-authorisation and funding guidelines.
Day procedures
Day procedures performed in a day hospital by a DSP provider will be funded at 100% network or Scheme tariff, subject to pre-authorisation, protocols, funding guidelines. A co-payment of R2 872 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the day procedure co-payment will not apply if done in acute hospital, if it is arranged with the Scheme before the time.
Medically necessary breast reduction surgery (including fees for all providers, hospital and procedure)
100% Scheme tariff.
Up to a maximum limit of R100 000 per family per annum. Subject to funding protocols and pre-authorisation.
Overall day-to-day limit
M = R23 028, M1+ = R47 590.
GP and Specialist consultations
Savings first. 100% Scheme tariff. M = R5 561, M1+ = R11 269. (Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings first. 100% Scheme tariff. Limited to M = R9 442, M1+ = R17 603. (Subject to overall day-to-day limit) Orthodontic services subject to pre-authorisation.
Orthodontic dentistry
Savings first. 100% Scheme tariff. Subject to pre-authorisation. Limited to R10 929 per event for beneficiaries up to 18 years of age. (Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
Savings first. 100% Scheme tariff. Limited to R13 221 per family. Includes repairs to artificial limbs. (Subject to overall day-to-day limit)
Wheelchairs
100% Scheme tariff. Limited to R17 880 per family every 48 months.
Hearing aids
100% Scheme tariff. Limit of R33 472 per beneficiary every 24 months. Subject to quotation, motivation and audiogram.
Continuous/Flash Glucose Monitoring (CGM/FGM)
100% Scheme tariff. Limited to R24 286 per family per annum. Subject to pre-authorisation.
Supplementary services
Savings first. 100% Scheme tariff. Limited to M = R3 396, M1+ = R7 137. (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)
General wound care savings first. 100% Scheme tariff. Limited to R11 488 per family per annum. (Subject to overall day-to-day limit). NPWT treatment shall be at 100% Scheme tariff, subject to pre-authorisation.
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary. Frame = R1 325 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND Lens enhancement = R750 covered OR Contact lenses = R2 280 OR Non-network Provider: Consultation - R420 fee at non-network provider. Frame = R994 AND Single vision lenses = R225 OR Bifocal lenses = R485 OR Multifocal lenses at R1 080 (consisting of R850 per base lens plus R225 per branded lens add-on) AND Lens enhancement = R750 covered In lieu of glasses members can opt for contact lenses, limited to R2 280
Basic radiology and pathology
Savings first. 100% Scheme tariff. Limited to M = R4 508, M1+ = R8 939. (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 a combined in- and out-of-hospital benefit of R43 932 per family per annum. Co-payment of R1 500 per scan, not applicable to confirmed PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs.
Oncology
100% of Scheme tariff. Subject to preauthorisation, designated or preferred service providers and protocols. Essential, Core and Enhanced level ICON protocols apply. Additional access to biological / high cost medicine cover limited to the biological / high cost medicine limit.
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 = R17 654, M1+ = R35 310. Co-payment of 15% for non-formulary medicine.
Biological medicine
100% Scheme tariff. Limited to R420 695 per beneficiary.
Other high-cost medicine
100% Scheme tariff. Subject to pre-authorisation.
Acute medicine
Savings first. 100% Scheme tariff. Limited to M = R2 298, M1+ = R5 169. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
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: R10 064
Adult dependant: R8 101
Child dependant: R1 731
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years 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. If claimed on the day of discharge, as follows: Limited to a maximum of 7 days treatment if claimed as part of the hospital account, or limited to R700 if claimed from a retail pharmacy. Subject to MRP. No benefit if not claimed on the date of discharge.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per annum in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per annum. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs and 21 days’ stay for in-hospital management per beneficiary per annum.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
Organ transplants
100% Scheme tariff.
Stem cell 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)
100% Scheme tariff. Limited to R25 542 per family per annum.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 690 per family per annum.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies).
100% Scheme tariff.
Limited to a combined in- and out-of-hospital benefit of R47 070 per family per annum. Co-payment of R1 500 per scan, not applicable to confirmed PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R170 081 per family per annum.
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 per annum: *Functional R45 953 Vascular R79 269. Pacemaker (single and dual chamber) R79 255. Spinal including artificial disc R85 048. Drug-eluting stents R28 323. Mesh R24 942. Gynaecology/urology R20 584. Lens implants R22 792 a lens per eye. Joint replacements: - Hip replacement and other major joints R76 102. - Knee replacement R88 120. - Other minor joints R28 323.
Prosthesis – External
100% Scheme tariff. Limited to R39 216 per family per annum. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
Oncology
100% Scheme tariff. Subject to preauthorisation, designated or preferred service providers and protocols. Essential, Core and Enhanced level ICON protocols apply. Additional access to biological / high cost medicine cover limited to the biological / high cost medicine limit.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Confinements (birthing including midwife-assisted births)
100% Scheme tariff.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Subject to pre-authorisation and protocols. Limited to R12 772 per eye.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
Medically necessary breast reduction surgery (Including fees for the surgeon and anaesthetist)
100% Scheme tariff.
Up to a maximum limit of R100 000 per family per annum. Subject to funding protocols and preauthorisation.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff.
Advanced illness benefit
100% Scheme tariff.
Limited to R145 716 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Biological medicine during hospitalisation
Biological medicine during Limited to the Biological medicine hospitalisation benefit per beneficiary per year as set out on page 8. Subject to pre-authorisation and funding guidelines.
Day procedures
Day procedures performed in a day hospital by a DSP provider will be funded at 100% network or Scheme tariff, subject to pre-authorisation, protocols, funding guidelines. A co-payment of R2 872 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the day procedure co-payment will not apply if done in acute hospital, if it is arranged with the Scheme before the time.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Overall day-to-day limit
M = R45 375, M1+ = R73 172.
GP and Specialist consultations
100% Scheme tariff. Limited to M = R7 137, M1+ = R11 570. (Subject to overall day-to-day limit)
Basic and specialised dentistry
100% Scheme tariff. Limited to M = R15 759, M1+ = R26 598. (Subject to overall day-to-day limit). Orthodontic services subject to pre-authorisation.
Orthodontic dentistry
100% Scheme tariff. Subject to pre-authorisation. Limited to R13 357 per event for beneficiaries up to 18 years of age. (Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
100% Scheme tariff. Limited to R13 221 per family. Includes repairs to artificial limbs and insulin pump consumables. (Subject to overall day-to-day limit)
Wheelchairs
100% Scheme tariff. Limited to R17 880 per family every 48 months.
Hearing aids
100% Scheme tariff. Limited to R36 610 per beneficiary every 24 months. Subject to quotation, motivation and audiogram.
Insulin pump (excluding consumables)
100% Scheme tariff. Limited to R53 143 per beneficiary every 24 months. Subject to pre-authorisation.
Continuous/Flash Glucose Monitoring (CGM/FGM)
100% Scheme tariff. Limited to R30 357 per family per annum. Subject to pre-authorisation.
Supplementary services
100% Scheme tariff. Limited to M = R7 137, M1+ = R14 048. (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)
General wound care shall be at 100% of Scheme tariff. Limited to R17 429 per family per annum. (Subject to overall day-to-day limit). NPWT treatment shall be at 100% Scheme tariff, subject to pre-authorisation.
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary. Frame = R1 325 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND Lens enhancement = R750 covered OR Contact lenses = R2 700 OR Non-network Provider: Consultation - R420 fee at non-network provider. Frame = R994 AND Single vision lenses = R225 OR Bifocal lenses = R485 OR Multifocal lenses = R1 080 (consisting of R850 per base lens plus R230 per branded lens add-on) AND Lens enhancement = R750 covered In lieu of glasses members can opt for contact lenses, limited to R2 700.
Basic radiology and pathology
100% Scheme tariff. Limited to M = R7 137, M1+ = R14 048. (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 a combined in- and out-of-hospital benefit of R47 070 per family per annum. Co-payment of R1 500 per scan, not applicable to confirmed PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs.
Oncology
100% of Scheme tariff. Subject to preauthorisation, designated or preferred service providers and protocols. Essential, Core and Enhanced level ICON protocols apply. Additional access to biological / high cost medicine cover limited to the biological / high cost medicine limit.
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 = R25 165, M1+ = R50 558. Co-payment of 10% for non-formulary medicine.
Biological medicine
100% Scheme tariff. Limited to R622 628 per beneficiary.
Other high-cost medicine
100% Scheme tariff. Subject to pre-authorisation.
Acute medicine
Limited to M = R10 732, M1+ = R16 671. Co-payment of 10%. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
100% Scheme tariff. 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: R12 572
Adult dependant: R12 572
Child dependant: R2 945
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years are regarded as child dependant.
Get personalised pricing
call for more information
