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24h Emergency: 084 124

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 000 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 R33 655 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 R82 158 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 698 Pacemaker (dual chamber) R44 791   Vascular R32 792   Endovascular and catheter-based procedures - no benefit   Spinal R32 792   Artificial disc - no benefit   Drug-eluting stents - PMBs and DSP products only   Mesh R11 508  Gynaecology/Urology R9 404  Lens implants R7 176 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 R34 522   Knee replacement R42 564   Minor joints R13 240  

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. DSP applies.

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 preauthorisation 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 R60 000 per beneficiary 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

Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R5 million for one member and R10 million for principal 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 R5 million for one member and R10 million for principal member and dependants.

Co-payments

Co-payment for voluntary use of non-network hospital R12 373 for Beat1 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.

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.

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 567 per family.

Oncology

Oncology programme at 100% of Scheme tariff.

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.

Biologicals and other high-cost medicine

PMBs only as per funding protocol.

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 412 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
  • 1 lactation consultation with a registered nurse or lactation specialist.
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 1570 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 570
Adult dependant: R1 220
Child dependant: R661
Maximum child dependants: 3

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 000 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 R33 655 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 R82 158 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 698 Pacemaker (dual chamber) R44 791   Vascular R32 792   Endovascular and catheter-based procedures - no benefit   Spinal R32 792   Artificial disc - no benefit   Drug-eluting stents - PMBs and DSP products only   Mesh R11 508  Gynaecology/Urology R9 404  Lens implants R7 176 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 R34 522   Knee replacement R42 564   Minor joints R13 240  

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 DSP.

Confinements (Birthing)

100% Scheme tariff.

HIV and AIDS

100% Scheme tariff. Subject to preauthorisation 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 R60 000 per beneficiary 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

Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R5 million for one member and R10 million for principal 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 R5 million for one member and R10 million for principal member and dependants.

Co-payments

Co-payment for voluntary use of non-network hospital R12 373 for the Beat1 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.

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 3 675 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 567 per family.

Oncology

Oncology programme at 100% of Scheme tariff.

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.

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.

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 412 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
  • 1 lactation consultation with a registered nurse or lactation specialist.
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 1746 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 746
Adult dependant: R1 354
Child dependant: R734
Maximum child dependants: 3

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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