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24h Emergency: 084 124 | General Contact: 0860 002 378

Beat1 Network

Plan Details

Hospital & Emergencies

Accommodation (hospital stay) and theatre fees

100% Scheme tariff.

Take-home medicine

100% Scheme tariff. Limited to 7 days' medicine

Biological medicine during hospitalisation

Limited to R10 570 per family per annum.  Subject to pre-authorisation and funding guidelines.

Treatment in mental health clinic

100% Scheme tariff. Limited to 21 days' per beneficiary

Treatment of chemical and substance abuse

100% Scheme tariff. Limited to 21 days or R35 573 per beneficiary. Subject to network facilities.

Consultations and procedures

100% Scheme tariff.

Surgical procedures and anaesthetics

100% Scheme tariff.

Organ transplants

100% Scheme tariff. (PMBs only)

Major medical maxillo-facial surgery strictly related to certain conditions

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 R86 841 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 R31 000   Pacemaker (dual chamber) R47 344   Vascular R50 000   Endovascular and catheter-based procedures - no benefit   Spinal incl. artificial disk R34 661   Drug-eluting stents - PMBs and DSP products only   Mesh R12 164   Gynaecology/Urology R9 940   Lens implants R7 585 a lens per eye

Prosthesis – External

No benefit. (PMBs only).

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 R36 489   Knee replacement R44 990   Minor joints R13 995  

Orthopaedic and medical appliances

100% Scheme tariff.

Pathology

100% Scheme tariff.

Basic radiology

100% Scheme tariff.

Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies).

100% Scheme tariff.

Oncology

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

Peritoneal dialysis and haemodialysis

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

Confinements (Birthing)

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

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 R63 420 per beneficiary per annum.  Subject to available benefit, pre-authorisation and treatment plan.

Day procedures at a day-hospital facility

Day procedures at DSPs and/or day hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.

International travel cover

Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants.

Co-payments

Co-payment for voluntary use of non-network hospital R13 078 for Beat1 Network option.

Day-to-Day

Family Practitioner (FP) 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 R 3 885 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 R5 885 per family.

Oncology

Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.

Peritoneal dialysis and haemodialysis

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

HIV/AIDS

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

Rehabilitation services after trauma

PMBs only. Subject to pre-authorisation and DSPs.

Medicines

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.

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
Baby growth and development assessments
  • 0-2 years
  • 3 assessments per year
  • Assessments are done at a Bestmed Network Pharmacy Clinic
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 550 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 Reference Price (MRP)
Mammogram (tariff code 34100)
  • Females 40 years and older 
  • Once every 24 months
  • 100% Scheme tariff
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 members own account

 

Maternity

100% Scheme tariff. Subject to the following benefits


Consultations
  • 6 antenatal consultations at a family practitioner OR gynaecologist OR midwife
Ultrasounds
  • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a family practitioner OR gynaecologist OR radiologist
  • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a family practitioner OR gynaecologist OR radiologist

From R 1710 per month*

Add Dependants

Adults
0
Children
0

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: R1 710
Adult dependant: R1 329
Child dependant: R720
Maximum child dependants: 3

Bestmed members pay for only three child dependants. The rest is covered at no extra cost. Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.

Get personalised pricing call for more information

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

Biological medicine during hospitalisation

Limited to R10 570 per family per annum.  Subject to pre-authorisation and funding guidelines.

Treatment in mental health clinic

100% Scheme tariff. Limited to 21 days' per beneficiary

Treatment of chemical and substance abuse

100% Scheme tariff. Limited to 21 days or R35 573 per beneficiary. Subject to network facilities.

Consultations and procedures

100% Scheme tariff.

Surgical procedures and anaesthetics

100% Scheme tariff.

Organ transplants

100% Scheme tariff. (PMBs only)

Major medical maxillo-facial surgery strictly related to certain conditions

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 R86 841 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 R31 000   Pacemaker (dual chamber) R47 344   Vascular R50 000   Endovascular and catheter-based procedures - no benefit   Spinal incl. artificial disk R34 661   Drug-eluting stents - PMBs and DSP products only   Mesh R12 164   Gynaecology/Urology R9 940   Lens implants R7 585 a lens per eye

Prosthesis – External

No benefit. (PMBs only).

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 R36 489   Knee replacement R44 990   Minor joints R13 995  

Orthopaedic and medical appliances

100% Scheme tariff.

Pathology

100% Scheme tariff.

Basic radiology

100% Scheme tariff.

Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies).

100% Scheme tariff.

Oncology

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

Peritoneal dialysis and haemodialysis

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

Confinements (Birthing)

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

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 R63 420 per beneficiary per annum.  Subject to available benefit, pre-authorisation and treatment plan.

Day procedures at a day-hospital facility

Day procedures at DSPs and/or day hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 500.

International travel cover

Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants.

Co-payments

Co-payment for voluntary use of non-network hospital R13 078 for Beat1 Network option.

Day-to-Day

Family Practitioner (FP) 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 R 3 885 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 R5 885 per family.

Oncology

Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.

Peritoneal dialysis and haemodialysis

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

HIV/AIDS

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

Rehabilitation services after trauma

PMBs only. Subject to pre-authorisation and DSPs.

Medicines

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.

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
Baby growth and development assessments
  • 0-2 years
  • 3 assessments per year
  • Assessments are done at a Bestmed Network Pharmacy Clinic
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 550 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 Reference Price (MRP)
Mammogram (tariff code 34100)
  • Females 40 years and older 
  • Once every 24 months
  • 100% Scheme tariff
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 members own account

 

Maternity

100% Scheme tariff. Subject to the following benefits


Consultations
  • 6 antenatal consultations at a family practitioner OR gynaecologist OR midwife
Ultrasounds
  • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a family practitioner OR gynaecologist OR radiologist
  • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a family practitioner OR gynaecologist OR radiologist

From R 1901 per month*

Add Dependants

Adults
0
Children
0

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: R1 901
Adult dependant: R1 475
Child dependant: R799
Maximum child dependants: 3

Bestmed members pay for only three child dependants. The rest is covered at no extra cost. Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.

Get personalised pricing call for more information

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