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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

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 R32 299 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 062 per family

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

Limited to R8 075 per family.

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

100% Scheme tariff. Limited to R90 246 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 209   • Vascular R32 892   • Pacemaker (dual chamber) R56 167   • Endovascular and catheter-based procedures – no benefit   • Spinal R32 892   • Artificial disc - no benefit   • Drug-eluting stents - PMBs and DSP products only   • Mesh R12 349<   • Gynaecology/Urology R8 906   • Lens implants R6 769 a lens per eye

Prosthesis – External

DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Limited to R22 918 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 R33 486   • Knee replacement R44 530   • Minor joints R13 834

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

100% Scheme tariff. Subject to preauthorisation. DSP applies.

Peritoneal dialysis and haemodialysis

100% Scheme tariff Subject to pre-authorisation and DSPs

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.

Confinements (Birthing)

100% Scheme tariff.

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

100% Scheme tariff. Limited to R8 977 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 R30 000 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

Up to R10 million and a maximum of 90 days. Services rendered by Bryte Insurance and managed by ER24.

Emergency evacuation

Services rendered by ER24.

Day-to-Day

Savings Account/ Day-to-day Benefits

Savings account available.
Limited day-to-day benefits are available.

Value Benefits
  • No co-payment or automatic self-payment gaps
  • Family Practitioner (FP) and Specialist consultations
  • Optometry
  • Dentistry
  • Maternity benefits
Over-the-counter

Available.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
Co-payment of 35% for non-formulary medicine.

Non-CDL chronic medicine

7 conditions. 90% Scheme tariff.
Limited to M = R6 650, M1+ = R13 299.
Co-payment of 30% for non-formulary medicine.

Biologicals and other high-cost medicine

PMBs only.
Subject to pre-approval.

Acute medicine

Savings first.
Limited to M = R2 352, M1 + = R4 869. (Subject to overall day-to-day limit).

Over-the-counter (OTC) medicine

**Member choice:
1. R683 OTC limit OR

2. Access to full savings for OTC purchases (after R683 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
Subject to the available savings. 


**The default OTC choice is:
1. R683 OTC limit. Members wishing to choose the other option are welcome to contact Bestmed.

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
Female contraceptive
  • 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 315 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
HPV vaccinations
  • Females 9-26 years of age
  • 3 vaccinations per beneficiary
  • Vaccinations will be funded at Mediscore Reference Price (MRP)
Mammogram
  • Females 40 years and older
  • Once every 24 months
  • Scheme tariff is applicable
Preventative dentistry
  • Refer to Preventative Dentistry section for details
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 FP OR gynaecologist OR midwife
  • 1 post-natal consultation at a FP OR gynaecologist OR midwife
Ultrasounds:
  • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a FP OR gynaecologist OR radiologist
  • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a FP OR gynaecologist OR radiologist
Supplements:
  • Any item categorised as a maternity supplement can be claimed up to a maximum of R100 per claim, once a month, for a maximum of 9 months

From R 4083 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.

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

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 R32 299 per beneficiary. Subject to network facilities.

Consultations and procedures

100% Scheme tariff.

Surgical procedures and anaesthetics

100% Scheme tariff.

Organ transplants

100% Scheme tariff. (Only PMBs.)

Major medical maxillo-facial surgery strictly related to certain conditions

100% Scheme tariff. Limited to R13 181 per family

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

Limited to R10 094 per family.

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

100% Scheme tariff Limited to R97 260 per family.

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

Sub-limits per beneficiary:
• *Functional limited to R16 981   • Pacemaker (dual chamber) R56 285   • Vascular R33 605   • Endovascular and catheter-based procedures - no benefit   • Spinal R33 605   • Artificial disc - no benefit   • Drug-eluting stents R18 881   • Mesh R12 469   • Gynaecology/Urology R9 144   • Lens implants R7 125 a lens per eye

Prosthesis – External

Limited to R23 393 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 R34 555   • Knee replacement R45 907   • Minor joints R14 106

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

100% Scheme tariff Subject to preauthorisation. DSP applies.

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 abreast cancer patient.

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)

No benefit (PMBs only). Subject to pre-authorisation and protocols. Limited to R9 381 per eye.

HIV/AIDS

100% Scheme tariff. Subject to preauthorisation and DSPs

Midwife-assisted births

100% Scheme tariff Subject to preauthorisation and DSPs.

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 R30 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

Emergency evacuation

Services rendered by ER24.

International travel cover

Up to R10 million and a maximum of 90 days.  Services rendered by Bryte Insurance and managed by ER24.

Day-to-Day

Savings Account/ Day-to-day Benefits

Savings account available.
Limited day-to-day benefits are available.

Value Benefits
  • No automatic self-payment gaps
  • Preventative care benefits
  • Family Practitioner (FP) and specialist consultations
Over-the-counter
  • Optometry
  • Dentistry
  • Maternity benefits
Over-the-counter medicine

Available.

 

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
Co-payment of 30% for non-formulary medicine.

Non-CDL chronic medicine

9 conditions. 90% Scheme tariff.
Limited to M = R7 564, M1+ = R15 129.
Co-payment of 25% for non-formulary medicine. 

Biologicals and other high-cost medicine

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

Acute medicine

Savings first.
Limited to M = R2 885, M1 + = R5 830 (Subject to overall day-to-day limit) .

Over-the-counter (OTC) medicine

**Member choice: 1. R683 OTC limit OR 2. Access to full savings for OTC purchases (after R683 limit) = self-payment gap accumulation.
Includes sunscreen, 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
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
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 315 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
HPV vaccinations
  • Females 9-26 years of age
  • 3 vaccinations per beneficiary
  • Vaccinations will be funded at Mediscor Reference Price (MRP)
Mammogram
  • Females 40 years and older
  • Once every 24 months
  • Scheme tariff is applicable 
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 FP OR gynaecologist OR midwife
  • 1 post-natal consultation at a FP OR gynaecologist OR midwife
Ultrasounds:
  • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a FP OR gynaecologist OR radiologist
  • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a FP OR gynaecologist OR radiologist
Supplements:
  • Any item categorised as a maternity supplement can be claimed up to a maximum of R100 per claim, once a month, for a maximum of 9 months

From R 4872 per month*

Add Dependants

Adults
0
Children
0

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

 

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 R32 299 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 419 per family.

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

100% Scheme tariff. Limited to R115 895 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 R17 634   • Vascular R43 460   • Pacemaker (dual chamber) R62 637   • Spinal including artificial disc R58 102   • Drug-eluting stents R18 999   • Mesh R18 999   • Gynaecology/Urology R14 190   • Lens implants s R12 184 a lens per eye   Joint replacements:
• Hip replacements and other major joints R52 188   • Knee replacement R60 560   • Minor joinst R22 502

Prosthesis – External

Limited to R27 311 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. DSP applies.

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 R36 750
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 380 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 R45 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

Up to R10 million and a maximum of 90 days.  Services rendered by Bryte Insurance and managed by ER24.

Emergency evacuation

Services rendered by ER24.

Day-to-Day

Savings Account/ Day-to-day Benefits

Savings account available.
Limited day-to-day benefits are available.

Value Benefits
  • No co-payment or automatic self-payment gaps
  • Family Practitioner (FP) and Specialist consultations
  • Optometry
  • Dentistry
  • Maternity benefits
Over-the-counter

Available.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
Co-payment of 30% for non-formulary medicine.

Non-CDL chronic medicine

18 conditions. 90% Scheme tariff.
Limited to M = R9 144 M1+ = R18 287. 
Co-payment of 25% for non-formulary medicine.

Biologicals and other high-cost medicine

Limited to R166 132 per beneficiary.

Acute medicine

Savings first. Limited to M = R4 869, M1 + = R9 737.
(Subject to overall day-to-day limit).

Over-the-counter (OTC) medicine

**Member choice: 1. R683 OTC limit OR 2. Access to full savings for OTC purchases (after R683 limit) = self-payment gap accumulation.
Includes sunscreen, 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
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 315 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
Mammogram
  • Females 40 years and older
  • Once every 24 months
  • Scheme tariff is applicable
Preventative dentistry
  • Refer to Preventative Dentistry section for details
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
HPV vaccinations
  • Females 9-26 years of age
  • 3 vaccinations per beneficiary
  • Vaccinations will be funded at Mediscore Reference Price (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 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 FP OR gynaecologist OR midwife
  • 1 post-natal consultation at a FP OR gynaecologist OR midwife
Ultrasounds:
  • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a FP OR gynaecologist OR radiologist
  • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a FP OR gynaecologist OR radiologist
Supplements:
  • Any item categorised as a maternity supplement can be claimed up to a maximum of R100 per claim, once a month, for a maximum of 9 months

From R 5800 per month*

Add Dependants

Adults
0
Children
0

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 R32 299 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 R16 862 per family.

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

100% Scheme tariff. Limited to R116 489 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 999   • Vascular R43 580   • Pacemaker (dual chamber)R62 637   • Spinal including artificial disc R58 212   • Drug-eluting stents R18 999   • Mesh R18 999   • Gynaecology/Urology R14 249   • Lens implants R12 184 a lens per eye   Joint replacements:
• Hip replacement and other major joints R52 248   • Knee replacement R60 857   • Minor joints R22 502

Prosthesis – External

Limited to R27 431 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 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 094 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 R36 750
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 R45 000 per annum. Subject to available benefit, pre-authorisation and treatment plan.

International travel cover

Up to R10 million and a maximum of 90 days.  Services rendered by Bryte Insurance and managed by ER24.

Emergency evacuation

Services rendered by ER24.

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

Savings Account/ Day-to-day Benefits

Savings account available.
Limited day-to-day benefits are available.

Value Benefits
  • No co-payment or automatic self-payment gaps
  • Family Practitioner (FP) and Specialist consultations
  • Optometry
  • Dentistry
  • Maternity benefits
Over-the-counter

Available.

Medicines

CDL and PMB chronic medicine

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

Non-CDL chronic medicine

19 conditions. 90% Scheme tariff.
Limited to M = R14 749, M1+ = R29 496.
Co-payment of 20% for non-formulary medicine.

Biologicals and other high-cost medicine

100% Scheme tariff.
Limited to R332 485 per beneficiary.

Acute medicine

Savings first. Limited to M = R1 544, M1 + = R3 800.
(Subject to overall day-to-day limit)

Over-the-counter (OTC) medicine

**Member choice:
1. R683 OTC limit OR
2. Access to full savings for OTC
purchases (after R683 limit) = self-payment gap accumulation. Includes sunscreen, vitamins and minerals with nappi codes on Scheme formulary.
Subject to the available savings.

 

**The default OTC choice is:
1. R683 OTC limit. Members wishing to choose the other option are welcome to contact Bestmed.

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
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 315 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
  • Females 40 years and older
  • Once every 24 months
  • Scheme tariff is applicable
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
HPV vaccinations
  • Females 9-26 years of age
  • 3 vaccinations per beneficiary
  • Vaccinations will be funded at Mediscore Reference Price (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 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 FP OR gynaecologist OR midwife
  • 1 post-natal consultation at a FP OR gynaecologist OR midwife
Ultrasounds:
  • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a FP OR gynaecologist OR radiologist
  • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a FP OR gynaecologist OR radiologist
Supplements:
  • Any item categorised as a maternity supplement can be claimed up to a maximum of R100 per claim, once a month, for a maximum of 9 months

From R 6658 per month*

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Adults
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Pace 3 offers comprehensive cover for members that have diverse medical needs. It includes comprehensive chronic benefits and excellent hospital cover.

 

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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 R32 299 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 R20 187  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. PET scans only included as indicated per option)

100% Scheme tariff

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

100% Scheme tariff. Limited to R134 419 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 712   • Vascular R49 873   • Pacemaker (dual chamber) R62 637   • Spinal including artificial disc R67 215   • Drug-eluting stents R22 384   • Mesh R19 712   • Gynaecology/Urology R16 269   • Lens implants R18 014 a lens per eye   Joint replacements:
• Hip replacement and other major joints R60 144   • Knee replacement R69 644   • Minor joints R22 384

Prosthesis – External

Limited to R30 993 per family.
DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.

Oncology

Oncology programme. 100% of 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 094 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 R36 750
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 R45 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

Up to R10 million and a maximum of 90 days.  Services rendered by Bryte Insurance and managed by ER24.

Emergency evacuation

Services rendered by ER24.

Day-to-Day

Savings Account/ Day-to-day Benefits

Savings account available.
Day-to-day benefits are available.

Value Benefits
  • No co-payment or automatic self-payment gaps
  • Family Practitioner (FP) and Specialist consultations
  • Optometry
  • Dentistry
  • Maternity benefits
Over-the-counter

Savings account.

Medicines

CDL and PMB chronic medicine

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

Non-CDL chronic medicine

28 conditions. 90% Scheme tariff. Limited to M = R19 889, M1+ = R39 958.
Co-payment of 15% for non-formulary medicine.

Biologicals and other high-cost medicine

Limited to R492 077 per beneficiary.

Acute medicine

Limited to M = R8 906, M1+ = R13 834.
10% co-payment.
(Subject to overall day-to-day limit)

Over-the-counter (OTC) medicine

Savings account.

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
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 315 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
  • Females 40 years and older
  • Once every 24 months
  • Scheme tariff is applicable
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
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 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 FP OR gynaecologist OR midwife
  • 1 post-natal consultation at a FP OR gynaecologist OR midwife
Ultrasounds:
  • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a FP OR gynaecologist OR radiologist
  • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a FP OR gynaecologist OR radiologist
Supplements:
  • Any item categorised as a maternity supplement can be claimed up to a maximum of R100 per claim, once a month, for a maximum of 9 months

From R 8318 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.


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