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24h Emergency: 084 124

Pulse1

Plan Details

Hospital & Emergencies

Accommodation (hospital stay) and theatre fees

100% Scheme tariff at a designated service provider (DSP) hospital.

Take-home medicine

100% Scheme tariff.  Limited to 3 days’ medicine

Treatment in mental health clinics

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

Treatment of chemical and substance abuse

100% Scheme tariff (only PMBs). .  Limited to 21 days per beneficiary subject to network facilities.

Consultations and procedures

100% Scheme tariff.

Surgical procedures and anaesthetics

100% Scheme tariff.
Excluded from benefits: functional nasal surgery, surgery for medical conditions, e.g. Epilepsy, Parkinson’s disease, etc., and procedures where stimulators are used.

Organ transplants

100% Scheme tariff. (PMBs only)

Major medical maxillo-facial surgery strictly related to certain conditions

No benefit.
 

 

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

No benefit

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: Item utilised towards treating or supporting a bodily function.

Sub-limits per beneficiary:
Functional R11 281   Vascular R26 302   Pacemaker (dual chamber) R42 986   Endovascular and catheter-based procedures - no benefit   Spinal R26 302   Artificial disc - no benefit   Drug-eluting stents - PMBs and DSP products only   Mesh R9 619   Gynaecology/ Urology R7 944   Lens implants R5 523 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 R26 956.   Knee replacement R34 080.   Minor joints R12 765

Orthopaedic and medical appliances

100% Scheme tariff Limited to R6 531 per family.

Pathology

100% Scheme tariff.

Basic Radiology

100% Scheme tariff

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

100% Scheme tariff

Oncology

Oncology programme. 100% of Scheme tariff. 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 a breast cancer patient.

Peritoneal dialysis and haemodialysis

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

Confinements (Birthing)

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

HIV/AIDS

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

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

No benefit (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 where procedure has been clinically approved:
R3 800 on all laparoscopic procedures   R3 800 on prostate procedures   R3 800 on procedures for prolapse/ incontinence   R3 800 on arthroscopy other than acute trauma   R3 800 on endoscopy investigations done primarily in hospital   Co-payment of up to R11 874 per event

Day-to-Day

Medical Savings

Basic and Specialised Dentistry

Where clinically appropriate and subject to Bestmed Pulse1 protocols. Includes consultations, primary extractions, fillings, fluoride treatment, scaling and polishing. Limited to 2 consultations for a full mouth examination per beneficiary per year. Bestmed Pulse1 dental network providers and Bestmed Pulse1 list of approved dental codes. Dentures limited to a maximum of 2 removable acrylic dentures (i.e. 2 single denture plates) per family every 24 months. Co-payment of 20% of total fee which the member must pay directly to the provider.

Optometry Services

Benefits available every 24 months from date of service at PPN provider only.

  • Consultation - only PPN providers
  • Frame = R225 covered AND Standard lenses
  • Single vision lenses = R210 OR 
  • Bifocal lenses = R445
  • In lieu of glasses members can opt for contact lenses, limited to R630

Over-the-counter medicine

Pathology

100% Scheme tariff. Basic blood tests as requested by a Bestmed Pulse1 Network FP and subject to Bestmed Pulse1 Network protocols and approved pathology list of codes.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
40% co-payment on non-formulary medicine at a preferred provider network pharmacy.

Non-CDL chronic medicine

No benefit.

Biologicals and other high-cost medicine 

PMBs only - subject to pre-approval.

Acute medicine 

100% Scheme tariff.
Subject to Bestmed formulary only.

Over-the-counter (OTC) medicine 

Limited to R387 per family.
Subject to preferred provider network pharmacy. Includes sunscreen, vitamins and minerals with NAPPI codes on Scheme formulary.

Preventative care benefits

Flu vaccines
  • All ages
  • 1 per beneficiary per year
  • Flu vaccine via Bestmed Network Pharmacy or FP
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:

  • Bestmed will identify certain high-risk individuals who will be advised by the Scheme 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  (tariff code 34100)
  • Females 40 years and older
  • Once every 24 months
  • Must be referred by Family Practitioner (FP) or Pulse Specialist DSP

From R 2442 per month*

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*Depending on your income bracket, you may be eligible for a reduced premium. Please ask a sales consultant for more information

Our network options offer you unlimited in-hospital cover with either limited essential day-to-today benefits, or comprehensive savings for your consultations with designated healthcare providers.

The Pulse range is ideally suitable for you if:

• You are seeking a plan option that is based on your income (Pulse1)
• You are comfortable with making use of designated service providers (DSPs) within our Pulse network
• You are looking for unlimited comprehensive cover for hospitalisation and the added benefit of preventative care

Value benefits

• Preventative care
• Family Practitioner (FP) and specialist consultations
• Optometry
• Basic dentistry

Get personalised pricing call for more information

Pulse2

Plan Details

Hospital & Emergencies

Accommodation (hospital stay) and theatre fees

100% Scheme tariff at a Designated Service Provider (DSP) hospital.

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.

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

100% Scheme tariff

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

100% Scheme tariff Limited too o R106 277 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 R17 634   • Vascular R41 086   • Pacemaker (dual chamber) R55 692   • Spinal R41 086   • Artificial disc R18 049   • Drug-eluting stents R18 049   • Mesh R18 049   • Gynaecology/Urology R13 419   • Lens implants R11 519 a lens per eye   Joint replacements:
• Hip replacement and other major joints R49 160.   • Minor joints R21 374.   • Knee replacement R57 413

Prosthesis – External

Limit of R25 649 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.
Subject to pre-authorisation and protocols. Limited to R9 440 per eye.

HIV/AIDS

100% Scheme tariff. Subject to pre-authorisation 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.

Emergency evacuation

Services rendered by ER24.

Day procedures at a dayhospital 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 up to R11 874 per event for voluntary use of a non-DSP hospital.

Day-to-Day

Savings Account/ Day-to-day Benefits

Day-to-day benefits are available.
No savings account available.

Value Benefits
  • Preventative care
  • Family Practitioner (FP) and Specialist consultations
  • Optometry
  • Dentistry 
Over-the-counter medicine

Available.

 

Medicines

CDL and PMB chronic medicine* 

100% Scheme tariff.
Unlimited.
Must be prescribed by a network provider and obtained from a network pharmacy.
Co-payment of 25% for non-formulary medicine. 

Non-CDL chronic medicine*

16 conditions. 90% of Scheme tariff.
Limited to M = R6 887, M1+ = R13 774.
Must be prescribed by a network provider and obtained from a network pharmacy.
Co-payment of 20% for non-formulary medicine.

Biologicals and other high-cost medicine

100% Scheme tariff.
Limited to R156 743 per beneficiary.

Acute medicine

100% Scheme tariff.
Limited M = R4 572, M1+ = R9 262.
(Subject to overall day-to-day limit) Must be prescribed by a network provider and obtained from a network pharmacy.

Over-the-counter (OTC) medicine

Limited to R608 per family.
Subject to preferred provider network pharmacy.
Includes sunscreen, vitamins and minerals with nappi codes on Scheme formulary.

Preventative care benefits

Flu vaccines
  • All ages
  • 1 per beneficiary per year
  • Flu vaccine via Bestmed Network Pharmacy or FP
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:

  • Bestmed will identify certain high-risk individuals who will be advised by the Scheme 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  (tariff code 34100)
  • Females 40 years and older
  • Once every 24 months
  • Must be referred by Family Practitioner (FP) or Pulse Specialist DSP

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 6012 per month*

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Children
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