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Beat1

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

No benefit.
(PMBs only at DSP day hospitals).

 

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

PMBs only at DSP day hospitals.

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

100% Scheme tariff. Limited to R78 846 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 R14 106   Pacemaker (dual chamber) R42 986   Vascular R231 470   Endovascular and catheter-based procedures - no benefit   Spinal R31 470   Artificial disc - no benefit   Drug-eluting stents - PMBs and DSP products only   Mesh R11 044   Gynaecology/Urology R9 025   Lens implants R6 887 a lens per eye  

Prosthesis – External

No benefit. (PMBs only).

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 130   Knee replacement R40 848   Minor joints R12 706  

Orthopaedic and medical appliances

100% Scheme tariff.

Pathology

100% Scheme tariff.

Basic radiology

100% Scheme tariff.

Specialised diagnostic imaging

100% Scheme tariff.

Oncology

100% Scheme tariff.

Mammary surgery

100% Scheme tariff.

Peritoneal dialysis and haemodialysis

100% Scheme tariff.

Confinements

100% Scheme tariff.

HIV and AIDS

100% Scheme tariff. Subject to preauthorisation and DSPs.

Refractive surgery and stabilise vision

PMBs only

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 R24 000 per annum. Subject to available benefit, pre-authorisation and treatment plan.

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

International travel cover

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

Co-payments

Co-payment of R3 800 on all endoscopic investigations and specialised diagnostic imaging if done in a private hospital.
  Any other facility, no co-payment.
  Co-payment for voluntary use of non-network hospital R11 874 for network option.

Day-to-Day

Family Practitioner (FP) and specialist consultations

None.

Diabetes primary care consultation

100% of Scheme tariff subject to registration with Halocare.

2 primary care consultations at Dis-Chem Pharmacies limited to R359 per consultation.

Medical Savings

None.

Medical aids, apparatus and appliances including wheelchairs and hearing aids (Hearing aids are subject to pre-authorisation)

None.

Supplementary services

None.

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

100% Scheme tariff.

Basic and Specialised Dentistry

None.

Optometry Services

None.

Over-the-counter medicine

None.

Basic radiology and pathology

None.

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

100% Scheme tariff. Limited to R5 343 per family, (excluding PET scans).

Oncology

Oncology programme at 100% of Scheme tariff. DSP applies.

Peritoneal dialysis and haemodialysis

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

HIV & AIDS

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

Rehabilitation services after trauma

None.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
Co-payment of 40% for non-formulary medicine.

CDL and PMB chronic medicine

No benefit.

Biologicals and other high-cost medicine

PMBs only as per funding protocol.

Subject to pre-approval

No benefit.

Over-the-counter (OTC) medicine

No benefit.

Managed Healthcare

Diabetes primary care consultation

100% of Scheme tariff subject to registration with Halocare.
2 primary care consultations. 

Wound care benefit

100% Scheme tariff.
Limited to R3 527 per family.

Oncology

Oncology programme at 100% of Scheme tariff.
Subject to preauthorisation. DSP applies.

Peritoneal dialysis and haemodialysis

100% Scheme tariff. 

HIV/AIDS

100% Scheme tariff.

Preventative care benefits

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

      Children:

  • As per schedule of Department of Health

       Adults:

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

       Adults:

  • The Scheme will identify certain high-risk individuals who will be advised to be immunised
Travel vaccines
  • All ages
  • Quantity and frequency depending on product up to to the maximum allowed amount
  • Mandatory travel vaccines for typhoid, yellow fever, tetanus, meningitis, hepatitis and cholera from Scheme risk benefits
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
HPV vaccinations
  • Females 9-26 years of age
  • 3 vaccinations per beneficiary
  • Vaccinations will be funded at Mediscor Rerference Price (MRP)
Back and neck preventative programme
  • All ages
  • Subject to pre-authorisation
  • Preferred providers (DBC/Workability Clinics)
  • This is a preventative programme with the objective of preventing back and neck surgery. The Scheme may identify appropriate participants.
  • Based on the first assessment, a rehabilitation treatment plan is drawn up and initiated over an uninterrupted period that will be specified by the provider.
  • Use of this programme is in lieu of surgery
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

100% Scheme tariff. Subject to the following benefits


Consultations
  • 6 antenatal consultations 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

From R 1680 per month*

Add Dependants

Adults
0
Children
0

* You are able to reduce your premium to R1 511 by opting for the Beat1 Network option. Please ask a sales consultant for more information.

No matter your age, if you are looking to be covered for life's unexpected tumbles, our hospital plans give unlimited cover for planned and unplanned hospital stays.

Value benefits
Preventative care benefits
Contraceptive benefit
Wound care benefit
International travel cover

Additional information
In-hospital benefits are paid.
Some preventative care benefits are available.
Out-of-hospital benefits are paid from your own pocket.

Contributions
Member: R1 680
Adult dependant: R1 303
Child dependant: R706
Maximum child dependants: 4

Child dependants under the age of 21 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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