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
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
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.
40% co-payment on non-formulary medicine at a preferred provider network pharmacy.
No benefit.
PMBs only - subject to pre-approval.
100% Scheme tariff.
Subject to Bestmed formulary only.
Limited to R387 per family.
Subject to preferred provider network pharmacy. Includes sunscreen, vitamins and minerals with NAPPI codes on Scheme formulary.
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.
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
• Preventative care
• Family Practitioner (FP) and specialist consultations
• Optometry
• Basic dentistry
Get personalised pricing
call for more information 
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 benefits are available.
No savings account available.
Available.
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.
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.
100% Scheme tariff.
Limited to R156 743 per beneficiary.
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.
Limited to R608 per family.
Subject to preferred provider network pharmacy.
Includes sunscreen, vitamins and minerals with nappi codes on Scheme formulary.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
Network option dedicated to those looking for comprehensive cover.
Get personalised pricing
call for more information
