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.
Accommodation (hospital stay) and theatre fees
100% Scheme tariff.
Take-home medicine
100% Scheme tariff. Only if claimed on the day of discharge. Limited to a maximum of 7 days treatment if claimed as part of the hospital account, or limited to R450 if claimed from a retail pharmacy. Subject to MRP. No benefit if not claimed within 3 days from the date of discharge.
Biological medicine during hospitalisation
Limited to R12 144 per family per annum.
Subject to pre-authorisation and funding guidelines.
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
No benefit. (PMBs only).
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 R99 764 per family per annum.
Prosthesis – Internal Note: Sub-limits subject to availability of overall prosthesis limit. DSPs apply *Functional: Items used to replace or augment an impaired bodily function.
Sub-limits per beneficiary per annum:
*Functional R35 613. Pacemaker (single and dual chamber) R54 390. Vascular R57 441. Spinal including artificial disc R39 819. Drug-eluting stents - subject to Vascular prosthesis limit. Mesh R13 975. Gynaecology / urology R11 419. Lens implants R8 713 a lens per eye.
Prosthesis – External
No benefit. (PMBs only).
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
Exclusions (Limits and co-payments apply. Preferred provider network available.)
Joint replacement surgery (except for PMBs).
PMBs subject to prosthesis limits: Hip replacement and other major joints R41 918. Knee and shoulder replacements R51 686. Other minor joints R16 078.
Orthopaedic and medical appliances *Note: Appliances directly relating to the hospital admission and/or procedure
100% Scheme tariff. Limited to R15 690 per family per annum
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging and nuclear medicine - in- and/or out-of-hospital (including MRI scans, CT scans and nuclear/isotope studies). PET scans are excluded, not applicable to PMBs.
100% Scheme tariff. Limited to a combined in- and out-of-hospital benefit of R20 920 per family per annum. PET scans - PMB only. Subject to benefit confirmation and reference number received from the Contact Centre.
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.
HIV and AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
PMBs only
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff.
Advanced illness benefit
100% Scheme tariff. Limited to R72 858 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan
Day procedures
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.
Co-payments
Non-network hospital co-payment. Co-payment for voluntary use of non-network hospital R15 025 applicable to network options. Procedure-specific co-payments: The co-payment shall not apply to PMB conditions: Arthroscopic procedures R3 660. Back and neck surgery R3 660. Functional nasal and sinus procedures R2 000. Laparoscopic procedures R3 660. Colonoscopies R2 000. Cystoscopies R2 000. Gastroscopies R2 000. Hysteroscopies R2 000. Sigmoidoscopies R2 000. A co-payment of R2 872, as described in the Day procedures benefit, will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital.
General Practitioner (GP) and specialist consultations
None.
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. Limited to R4 463 per family.
Basic and Specialised Dentistry
None.
Optometry Services
None.
Basic radiology and pathology
None.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded)
100% Scheme tariff.
Limited to a combined in- and out-of-hospital benefit of R20 920 per family per annum. PET scans - PMB only. Subject to benefit confirmation and reference number received from the Contact Centre.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation, protocols and DSP.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
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.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff. Co-payment of 30% for non-formulary medicine.
Non-CDL chronic medicine
No benefit.
Biological medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Other high-cost medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Acute medicine
No benefit.
Over-the-counter (OTC) medicine
No benefit.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
No matter your age, if you are looking to be covered for life's unexpected tumbles, our hospital plans give unlimited cover at any of our network hospitals for planned and unplanned hospital stays.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R2 269
Adult dependant: R1 764
Child dependant: R956
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children join as beneficiaries on 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. Only if claimed on the day of discharge. Limited to a maximum of 7 days treatment if claimed as part of the hospital account, or limited to R450 if claimed from a retail pharmacy. Subject to MRP. No benefit if not claimed within 3 days from the date of discharge.
Biological medicine during hospitalisation
Limited to R12 144 per family per annum.
Subject to pre-authorisation and funding guidelines.
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
No benefit. (PMBs only).
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 R99 764 per family per annum.
Prosthesis – Internal Note: Sub-limits subject to availability of overall prosthesis limit. DSPs apply *Functional: Items used to replace or augment an impaired bodily function.
Sub-limits per beneficiary per annum:
*Functional R35 613. Pacemaker (single and dual chamber) R54 390. Vascular R57 441. Spinal including artificial disc R39 819. Drug-eluting stents - subject to Vascular prosthesis limit. Mesh R13 975. Gynaecology / urology R11 419. Lens implants R8 713 a lens per eye.
Prosthesis – External
No benefit. (PMBs only).
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
Exclusions (Limits and co-payments apply. Preferred provider network available.)
Joint replacement surgery (except for PMBs).
PMBs subject to prosthesis limits: Hip replacement and other major joints R41 918. Knee and shoulder replacements R51 686. Other minor joints R16 078.
Orthopaedic and medical appliances *Note: Appliances directly relating to the hospital admission and/or procedure
100% Scheme tariff. Limited to R15 690 per family per annum
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging and nuclear medicine - in- and/or out-of-hospital (including MRI scans, CT scans and nuclear/isotope studies). PET scans are excluded, not applicable to PMBs.
100% Scheme tariff. Limited to a combined in- and out-of-hospital benefit of R20 920 per family per annum. PET scans - PMB only. Subject to benefit confirmation and reference number received from the Contact Centre.
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.
HIV and AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
PMBs only
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff.
Advanced illness benefit
100% Scheme tariff. Limited to R72 858 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan
Day procedures
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.
Co-payments
Non-network hospital co-payment. Co-payment for voluntary use of non-network hospital R15 025 applicable to network options. Procedure-specific co-payments: The co-payment shall not apply to PMB conditions: Arthroscopic procedures R3 660. Back and neck surgery R3 660. Functional nasal and sinus procedures R2 000. Laparoscopic procedures R3 660. Colonoscopies R2 000. Cystoscopies R2 000. Gastroscopies R2 000. Hysteroscopies R2 000. Sigmoidoscopies R2 000. A co-payment of R2 872, as described in the Day procedures benefit, will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital.
General Practitioner (GP) and specialist consultations
None.
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. Limited to R4 463 per family.
Basic and Specialised Dentistry
None.
Optometry Services
None.
Basic radiology and pathology
None.
Specialised diagnostic imaging and nuclear medicine - in- and/or out-of-hospital (including MRI scans, CT scans and nuclear/isotope studies). PET scans are excluded, not applicable to PMBs.
100% Scheme tariff. Limited to a combined in- and out-of-hospital benefit of R20 920 per family per annum. PET scans - PMB only. Subject to benefit confirmation and reference number received from the Contact Centre.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation, protocols and DSP.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
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.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff. Co-payment of 30% for non-formulary medicine.
Non-CDL chronic medicine
No benefit.
Biological medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Other high-cost medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Acute medicine
No benefit.
Over-the-counter (OTC) medicine
No benefit.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
No matter your age, if you are looking to be covered for life's unexpected tumbles, this hospital plan gives unlimited cover for unplanned hospital stays.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R2 523
Adult dependant: R1 959
Child dependant: R1 061
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children join as beneficiaries on 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
