Bestmed's network options offer healthcare services and private hospital cover at designated service providers (DSPs).
Accommodation (hospital stay) and theatre fees
Approved PMBs at DSPs.
Take-home medicine
100% Scheme tariff. Limited to 3 days’ medicine.
Treatment in mental health clinic
Approved PMBs at DSPs. Subject to pre-authorisation. 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 pre-authorisation and DSP network.
Consultations and procedures
Approved PMBs at DSPs. Subject to pre-authorisation.
Surgical procedures and anaesthetics
Approved PMBs at DSPs. Subject to pre-authorisation.
Organ transplants
100% Scheme tariff. (Only PMBs.)
Major medical maxillo-facial surgery strictly related to certain conditions
Approved PMBs at DSPs.
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. Subject to PMBs at DSP network. Limited to R55 309 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 R11 755
• Vascular R27 406
• Pacemaker (dual chamber) R44 791
• Spinal R27 406
• Artificial disc - No benefit
• Drug-eluting stents - Subject to PMBs at DSP network
• Mesh R10 023
• Gynaecology/Urology R8 278
• Lens implants R5 755 a lens per eye
Prosthesis – External
Approved PMBs at DSPs.
Exclusions (Prosthesis sub-limit subject to preferred provider, otherwise limits and co-payments apply)
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
Hip replacement and other major joints R28 088.
Knee replacement R35 512.
Minor joints R13 301
Orthopaedic and medical appliances
Approved PMBs at DSPs.
Pathology
Approved PMBs at DSPs.
Basic radiology
Approved PMBs at DSPs.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. Excluding PET scans)
Approved PMBs at DSPs.
Oncology
Approved PMBs at DSPs.
Peritoneal dialysis and haemodialysis
Approved PMBs at DSPs.
Confinements (Birthing)
Approved PMBs at DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
Approved PMBs at DSPs.
HIV/AIDS
Approved PMBs at DSPs.
Midwife-assisted births (Protocols apply)
Approved PMBs at DSPs.
Supplementary services
Approved PMBs at DSPs.
Alternatives to hospitalisation
Approved PMBs at DSPs.
Palliative care and Home-based care in lieu of hospitalisation
Approved PMBs at DSPs.
Day procedures at a day-hospital facility
Approved PMBs at DSPs. Subject to pre-authorisation.
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 of up to R12 373 per event for voluntary use of a non-DSP hospital.
Family Practitioner (FP) consultations
Unlimited FP consultations. Subject to Bestmed Rhythm FP network.
Subject to pre-authorisation after 10th visit.
Pharmacy clinic nurse consultation
Benefit shall be at 100% of Scheme tariff/cost for unlimited primary care nurse consultations (nappi code 981078001) at network pharmacies.
Diabetes primary care consultation
100% of Scheme tariff subject to registration with Halocare. 2 primary care consultations at Dis-Chem Pharmacies.
Specialist consultations
Specialist consultations must be referred by a Rhythm Network Provider.
Limited to 2 consultations at a maximum of R1 100 per visit per family.
Subject to Rhythm Specialist Network.
Out-of-network and casualty visits
Approved PMB services only.
Medical aids, apparatus and appliances including wheelchairs and hearing aids and appliances
Approved PMB services only.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
Approved PMB services only.
Basic Dentistry
Where clinically appropriate and subject to Bestmed Rhythm1 protocols, Bestmed Rhythm Dental Network Providers and Rhythm approved dental codes.
Optometry Services
1 consultation per beneficiary.
No benefit for spectacle frames, lenses or contact lenses.
Benefits available every 24 months from date of service at PPN provider only.
Basic pathology
100% Scheme tariff.
Basic blood tests as requested by a Bestmed Rhythm Network FP and subject to Bestmed Rhythm1 protocols and Rhythm approved pathology codes.
Basic radiology
100% Scheme tariff.
Basic X-rays as requested by your Bestmed Rhythm Network FP and subject to Bestmed Rhythm1 protocols and Rhythm approved radiology codes.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded).
Approved PMB services only.
Oncology
Approved PMB services only. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
Approved PMB services only.
HIV/AIDS
Approved PMB services only.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff.
30% co-payment on non-formulary medicine at a preferred provider network pharmacy.
Biologicals and other high-cost medicine
PMBs only. Subject to pre-authorisation
Acute medicine
100% Scheme tariff. Subject to Bestmed formulary only. As prescribed by network provider and obtained from DSP pharmacy.
Children:
Adults:
Adults:
100% Scheme tariff at DSP network. Subject to the following benefits:
Add Dependants
*Your monthly contribution will be determined by the higher of the gross monthly income of the Main Member and Spouse/Partner on the membership upon submitting your application. Three months’ payslips will be required upon applying with Bestmed and proof of income will be requested annually to determine the correct income category for the membership. If your are unable to provide the requested, the highest income bracket being used.
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.
Contributions (income R0 - R9 000)
Member: R1200
Adult dependant: R1200
Child dependant: R495
Maximum child dependants: 3
Contributions (income R9 001 - R14 000)
Member: R1 400
Adult dependant: R1 400
Child dependant: R595
Maximum child dependants: 3
Contributions (income >R14 001)
Member: R2 500
Adult dependant: R2500
Child dependant: R1 295
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.
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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
Biological medicine during hospitalisation
Limited to R15 000 per family per annum. Subject to pre-authorisation and funding guidelines.
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
Approved PMBs at DSPs.
Dental and oral surgery (In- or out of hospital)
Approved PMBs at DSPs.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R55 309 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 755
Vascular R27 406
Pacemaker (dual chamber) R44 791
Endovascular and catheter-based procedures - no benefit
Spinal R27 406
Artificial disc - no benefit
Drug-eluting stents - PMBs and DSP products only
Mesh R10 023
Gynaecology/ Urology R8 278
Lens implants R5 755 a lens per eye
Prosthesis – External
Approved PMBs at DSPs.
Exclusions (Prosthesis sub-limit subject to preferred provider, otherwise limits and co-payments apply)
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
Hip replacement and other major joints R28 088.
Knee replacement R35 512.
Minor joints R13 301
Orthopaedic and medical appliances
100% Scheme tariff Limited to R6 806 per family.
Pathology
100% Scheme tariff.
Basic Radiology
100% Scheme tariff
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies)
100% Scheme tariff Subject to pre-authorisation.
Confinements (Birthing)
100% Scheme tariff.
Oncology
Oncology programme. 100% of Scheme tariff. DSP applies. Subject to pre-authorisation.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
Approved PMBs at DSPs.
HIV/AIDS
100% Scheme tariff Subject to pre-authorisation and DSPs.
Midwife-assisted births (Protocols apply)
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 of up to R12 373 per event for voluntary use of a non-DSP hospital.
Family Practitioner (FP) consultations
100% Scheme tariff.
Unlimited medically necessary consultations with a Bestmed Rhythm Network FP for basic primary care.
Diabetes primary care consultation
100% of Scheme tariff subject to registration with Halocare. 2 primary care consultations at Dis-Chem Pharmacies.
Specialist consultations
Specialist consultations (this includes minor procedures done in specialist rooms and all consumables used), must be referred by a Rhythm Network Provider and approved by Bestmed.
Limited to M = R1 500; M1+ = R2 500.
Subject to Rhythm Specialist DSP network.
Out-of-network and casualty visits
Out-of-network visits to an FP and casualty visits are limited to a maximum of R1 485 per family per year.
Basic radiology and pathology that falls within formulary when received as a result of the casualty visit will be paid from the out-of-network and casualty visits limit.
Once limit has been reached the costs will be for the member’s own account.
Emergency visits are unlimited at any State facility.
You will be required to pay for all treatment received at the point of service. The cost of these services may be claimed back by completing an Out-of-network claim form which can be downloaded from the Bestmed website or obtained from Bestmed.
Reimbursements are subject to Bestmed Rhythm2 protocols.
Medical aids, apparatus and appliances including wheelchairs and hearing aids and appliances
Approved PMB services only.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
Approved PMB services only.
Basic Dentistry
Where clinically appropriate and subject to Bestmed Rhythm1 protocols, Bestmed Rhythm Dental Network Providers and Rhythm approved dental codes.
Dentures
Limited to a maximum of 2 removable acrylic dentures (i.e. 2 single denture plates) per family every 24 months.
Optometry Services
1 Consultation per beneficiary.
Frame = R235 covered (Frame refund value after network discount R176) AND Standard lenses
Single vision lenses = R210 OR
Bifocal lenses = R445
In lieu of glasses members can opt for contact lenses, limited to R655
Benefits available every 24 months from date of service at PPN provider only.
Basic pathology
100% Scheme tariff.
Basic blood tests as requested by a Bestmed Rhythm Network FP and subject to Bestmed Rhythm1 protocols and Rhythm approved pathology codes.
Basic radiology
100% Scheme tariff.
Basic X-rays as requested by your Bestmed Rhythm Network FP and subject to Bestmed Rhythm2 protocols and Rhythm approved radiology codes.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded).
Approved PMB services only.
Oncology
Oncology programme. 100% of Scheme tariff. Subject to pre-authorisation and DSPs.
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.
CDL and PMB chronic medicine
100% Scheme tariff.
30% co-payment on non-formulary medicine at a preferred provider network pharmacy.
Biologicals and other high-cost medicine
PMBs only. Subject to pre-authorisation
Acute medicine
100% Scheme tariff. Subject to Bestmed formulary only. As prescribed by network provider and obtained from DSP pharmacy.
Over-the-counter (OTC) medicine
Limited to R600 per family.
Subject to preferred provider network pharmacy.
Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
*Your monthly contribution will be determined by the higher of the gross monthly income of the Main Member and Spouse/Partner on the membership upon submitting your application. Three months’ payslips will be required upon applying with Bestmed and proof of income will be requested annually to determine the correct income category for the membership. If your are unable to provide the requested, the highest income bracket being used.
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.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions (income R0 - R5 500)
Member: R1 760
Adult dependant: R1 673
Child dependant: R1 059
Maximum child dependants: 3
Contributions (income R5 501 - R8 500)
Member: R2 114
Adult dependant: R2 009
Child dependant: R1 269
Maximum child dependants: 3
Contributions (income >R8 501)
Member: R2 537
Adult dependant: R2 284
Child dependant: R1 269
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
