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24h Emergency: 084 124 | General Contact: 0860 002 378

Rhythm1

Plan Details

Hospital & Emergencies

Accommodation (hospital stay) and theatre fees

Approved PMBs at DSPs.

Take-home medicine

100% Scheme tariff.  Limited to 3 days’ medicine.

Biological medicine during hospitalisation

Approved PMBs at DSPs.

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)

Approved PMBs at DSPs.

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

100% Scheme tariff. Subject to PMBs at DSP network. Limited to R58 461 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 R31 000   Pacemaker (dual chamber) R47 344   Vascular R50 000   Endovascular and catheter-based procedures – no benefit   Spinal incl. artificial disk R28 968   Drug-eluting stents – PMBs and DSP products only   Mesh R10 594   Gynaecology/Urology R8 750   Lens implants R6 083 per 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 R29 689.   Knee replacement R37 536.   Minor joints R14 059.

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)

100% Scheme tariff.

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

PMBs in network day-hospitals: 
Approved PMBs at DSPs. Subject to pre-authorisation. 
Non-PMBs in network day-hospitals:
100% Scheme tariff. Subject to approved DSPs and pre-authorisation. Limited to R50 000 per family per annum for the 9 non-PMB day procedures. Voluntary use of a non-network hospital will result in a co-payment of R2 500. The nine non-PMB conditions covered are:
  Breast biopsy - lumpectomy  Circumcision  Colonoscopy  Dilatation and curettage (D & C)  Female sterilisation  Gastroscopy  Grommet insertion and myringotomy  Male sterilisation  Tonsillectomy
Subject to the Managed Healthcare (MHC) protocols and funding guidelines. 

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 R3 million for a family i.e. 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 R3 million for a family i.e. member and dependants.

Co-payments

Co-payment of up to R13 078 per event for voluntary use of a non-DSP hospital.

Day-to-Day

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.

Specialist consultations

Specialist consultations must be referred by a Rhythm Network Provider.
100% Scheme tariff. Limited to a maximum of R2 325 per family per year. 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

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

Consultation - 1 per beneficiary
Consultation fee of R365 at non-network provider.
No benefit for spectacle frames, lenses or contact lenses.

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.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
30% co-payment on non-formulary medicine at a preferred provider network pharmacy.

Biological medicine

PMBs only. Subject to pre-authorisation

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.

Preventative care benefits

Flu vaccines
  • All ages
  • 1 per beneficiary per year
  • At a Bestmed Rhythm Network FP or preferred provider network pharmacy.
  • Subject to Bestmed Rhythm1 protocols and where clinically necessary.
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 550 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
Baby growth and development assessments
  • 0-2 years
  • 3 assessments per year
  • Assessments are done at a Bestmed Network Pharmacy Clinic

Maternity benefits

100% Scheme tariff at DSP network. Subject to the following benefits:


Consultations: 
  • 6 antenatal consultations 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

From R 1307 per month*

Add Dependants

Adults
0
Children
0

*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: R1 307
Adult dependant: R1 307
Child dependant: R539

Contributions (income R9 001 - R14 000)
Member: R1 525
Adult dependant: R1 525
Child dependant: R648

Contributions (income >R14 001)
Member: R2 723
Adult dependant: R2 723
Child dependant: R1 410

 

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

Rhythm2

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

Biological medicine during hospitalisation

Limited to R15 855 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. Subject to pre-authorisation and DSP network.

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 R58 461 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 R31 000   Pacemaker (dual chamber) R47 344   Vascular R50 000   Endovascular and catheter-based procedures – no benefit   Spinal incl. artificial disk R28 968   Drug-eluting stents – PMBs and DSP products only   Mesh R10 594   Gynaecology/Urology R8 750   Lens implants R6 083 per 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 R29 689.   Knee replacement R37 536.   Minor joints R14 059

Orthopaedic and medical appliances

100% Scheme tariff. Limited to R7 194 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. Subject to pre-authorisation and DSPs or preferred providers.

Palliative care and Home-based care in lieu of hospitalisation

100% Scheme tariff, limited to R63 420 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. Co-payment of R2 500 if procedure is done in a private hospital.

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 R3 million for a family i.e. 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 R3 million for a family i.e. member and dependants.

Co-payments

Co-payment of up to R13 078 per event for voluntary use of a non-DSP hospital.

Day-to-Day

Family Practitioner (FP) consultations

100% Scheme tariff.
Unlimited medically necessary consultations with a Bestmed Rhythm Network FP for basic primary care.

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 586; M1+ = R2 643. 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 569 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.

Supplementary services

Approved PMB services only.

Includes services rendered by: 

dieticians
chiropractors
homeopaths
orthoptists 
acupuncturists
speech therapists
audiologists
occupational therapists
podiatrists
biokineticists
psychologists and
social workers

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

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

Consultation - 1 per beneficiary
Frame = R245 covered (Frame refund value after network discount R184) AND standard lenses
Single vision lenses = R215 OR
Bifocal lenses = R460
Multifocal lenses = R460
In lieu of glasses members can opt for contact lenses, limited to R700

Consultation fee of R365 at non-network provider.

Basic pathology

100% Scheme tariff.
Basic blood tests as requested by a Bestmed Rhythm Network FP and subject to Bestmed Rhythm2 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% 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.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
30% co-payment on non-formulary medicine at a preferred provider network pharmacy.

Biological medicine

PMBs only. Subject to pre-authorisation

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 R634 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
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 550 per beneficiary per year. Includes all items classified in the category of female contraceptives
Pap smear
  • Females 18 years and older. Once every 24 months.
  • Can be done at a Rhythm Specialist DSP gynaecologist, Bestmed Rhythm2 Network FP or network pharmacy clinic.
  • Consultation paid from the available consultation benefit.
Baby growth and development assessments
  • 0-2 years.
  • 3 assessments per year.
  • Assessments are done at a Bestmed Network Pharmacy Clinic.
Paediatric immunisation
  • Babies and children
  • Funding for all paediatric vaccines according to the state-recommended programme.
HPV vaccinations
  • Females 9-26 years of age.
  • 3 vaccinations per beneficiary.
  • Vaccinations will be funded at MRP.
PSA screening
  • Males 50 years and older.
  • Once every 24 months. Can be done at a Rhythm Specialist DSP urologist or Bestmed Rhythm Network FP.
  • Can be done at a urologist, FP or network pharmacy clinic. Consultation paid from the available consultation benefits
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 a Rhythm Family Practitioner (FP) or Rhythm Specialist DSP

Maternity benefits

100% Scheme tariff. Subject to the following benefits

Consultations: 
  • 9 antenatal consultations at a Family Practitioner 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 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
Supplements:
  • Any item categorised as a maternity supplement can be claimed up to a maximum of R127 per claim, once a month, for a maximum of 9 months.

From R 1917 per month*

Add Dependants

Adults
0
Children
0

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. This option is income level dependant.

You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.

Contributions (income level R0 - R5 500)
Member: R1 917
Adult dependant: R1 822
Child dependant: R1 154
Maximum child dependants: 3

Contributions (income level R5 501 - R8 500)
Member: R2 303
Adult dependant: R2 188
Child dependant: R1 382
Maximum child dependants: 3

Contributions (income level R8 501 and higher)
Member: R2 763
Adult dependant: R2 488
Child dependant: R1 382
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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