Bestmed's network options offer healthcare services and private hospital cover at designated service providers (DSPs).
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
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 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
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 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. Subject to pre-authorisation and DSPs.
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)
No benefit (PMBs only).
HIV/AIDS
100% Scheme tariff Subject to pre-authorisation and DSPs.
Midwife-assisted births
100% Scheme tariff. Protocols apply
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.
Medical Savings
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.
Benefits available every 24 months from date of service at PPN provider only.
Over-the-counter medicine
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.
100% Scheme tariff.
30% co-payment on non-formulary medicine at a preferred provider network pharmacy.
No benefit.
PMBs only - subject to pre-authorisation.
100% Scheme tariff.
Subject to Bestmed formulary only.
Limited to R600 per family.
Subject to preferred provider network pharmacy. Includes sunscreen, vitamins and minerals with NAPPI codes on Scheme formulary.
100% Scheme tariff. Subject to the following benefits
Children:
Adults:
Adults:
Add Dependants
*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.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions (income bracket R0 - R5 500)
Member: R1 760
Adult dependant: R1 673
Child dependant: R1 059
Maximum child dependants: 3
Contributions (income bracket R5 501 - R8 500)
Member: R2 114
Adult dependant: R2 009
Child dependant: R1 269
Maximum child dependants: 3
Contributions (income bracket >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.
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