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. *If claimed on the day of discharge. Limited to: A maximum of 7 days treatment if claimed as part of the hospital account, or R450 if claimed from a retail pharmacy on the date of discharge. No benefit if not claimed on the date of discharge
Biological medicine during hospitalisation
Approved PMBs at DSPs.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs, and 21 days’ stay for in-hospital management per beneficiary per annum.
Consultations and procedures
Approved PMBs at DSPs. Subject to pre-authorisation.
Surgical procedures and anaesthetics
Approved PMBs at DSPs. Subject to pre-authorisation. 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.)
Stem cell 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 R67 162 per family. Subject to PMBs at DSP network
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 per annum: *Functional R35 613. Vascular R57 441. Pacemaker (single and dual chamber) R54 390. Spinal including artificial disc R33 278. Drug-eluting stents – subject to Vascular prosthesis limit. DSPs apply. Mesh R12 171. Gynaecology/urology R10 053. Lens implants R6 988 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 R34 107. Knee and shoulder replacements R43 122. Other minor joints R16 151
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. PET scans - PMB only. Subject to pre-authorisation.
Oncology
Oncology benefits funded at PMB level of care only, subject to pre-authorisation, designated or preferred service providers and protocols. Essential ICON protocols apply.
Peritoneal dialysis and haemodialysis
Approved PMBs at DSPs.
Confinements (Birthing including midwife assisted births)
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.
Alternatives to hospitalisation
Approved PMBs at DSPs.
Advanced illness benefit
Approved PMBs. Subject to pre authorisation and treatment plan.
Day procedures
PMBs in network day-hospitals: Approved PMBs at DSPs. Subject to pre-authorisation, protocols and funding guidelines. Non-PMBs in network day-hospitals: 100% Scheme tariff. Subject to approved DSPs and pre-authorisation. Limited to R57 441 per family per annum for non-PMB day procedures. A co-payment of R2 872 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the procedure shall be paid in full if it is done in an acute hospital, if it is arranged with the Scheme before the time. The non-PMB conditions covered are: Circumcision, Colonoscopy - co-payment applicable, Gastroscopy - co-payment applicable, Myringotomy and grommet insertion, Sterilisation (male and female), Tonsillectomy and adenoidectomy.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Co-payments
Non-DSP hospital co-payment: Co-payment of R15 025 per event for voluntary use of a non-DSP hospital. Procedure-specific co-payments: The co-payment shall not apply to PMB conditions: Colonoscopies R2 000 and Gastroscopies R2 000.
General Practitioner (GP) consultations
Unlimited GP consultations. Subject to Rhythm GP network. Subject to pre approval after 10th visit. Applicable per family per annum.
Pharmacy clinic nurse consultation
100% of Scheme tariff. Unlimited primary care nurse consultations (NAPPI code 981078001) at preferred provider network pharmacy clinic.
Specialist consultations
100% Scheme tariff. Specialist consultations must be referred by a Rhythm Network Provider. Limited to a maximum of R2 670 per family per year. Subject to Rhythm Specialist DSP network.
Out-of-network and casualty visits
PMB only
Medical aids, apparatus and appliances including wheelchairs and hearing aids and appliances
Approved PMBs at DSPs
Supplementary services
PMB only.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
PMB only.
Basic Dentistry
Where clinically appropriate and subject to Rhythm1 protocols, Rhythm Dental Network Providers and Rhythm approved dental codes.
Optometry Services
Benefits available every 24 months from date of service. Network Provider (PPN): One (1) consultation (eye test) at optometrist network per beneficiary per annum. No benefit for spectacle frames, lenses or contact lenses. Non-network Provider: One (1) consultation per beneficiary = R420. No benefit for spectacle frames, lenses or contact lenses.
Basic pathology
100% Scheme tariff. Basic blood tests as requested by a Rhythm Network GP and network pathologists, subject to Rhythm1 protocols and Rhythm approved pathology codes.
Basic radiology
100% Scheme tariff. Basic X-rays as requested by your Rhythm Network GP and subject to Rhythm1 protocols and Rhythm approved radiology codes.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded).
Approved PMBs at DSPs. PET scans - PMB only. Subject to pre-authorisation.
Oncology
Oncology benefits funded at PMB level of care only, subject to pre-authorisation, designated or preferred service providers and protocols. Essential ICON protocols apply.
Peritoneal dialysis and haemodialysis
Approved PMBs at DSPs.
HIV/AIDS
Approved PMBs at 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.
Biological medicine
PMBs only.
Other high-cost medicine
PMBs only.
Acute medicine
100% Scheme tariff. Subject to Bestmed formulary only. As prescribed by Rhythm Network Provider and obtained from preferred provider pharmacy network.
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)Dependants under the age of 24 years are regarded as child dependants.
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. *If claimed on the day of discharge, as follows: Limited to a maximum of 7 days treatment if claimed as part of the hospital account, or limited to R450 if claimed from a retail pharmacy. Subject to MRP. No benefit if not claimed on the date of discharge.
Biological medicine during hospitalisation
Limited to R18 215 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health clinics
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs, and 21 days’ stay for in-hospital management per beneficiary per annum.
Consultations and procedures
100% Scheme tariff. Subject to pre-authorisation and DSP network.
Surgical procedures and anaesthetics
100% Scheme tariff.
Subject to preauthorisation and DSP network. 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)
Stem cell 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 R67 162 per family per annum.
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 per annum: *Functional R35 613. Vascular R57 441. Pacemaker (singular and dual chamber) R54 390. Spinal including artificial disc R33 278. Drug-eluting stents – subject to Vascular prosthesis limit. DSPs apply. Mesh R12 171. Gynaecology/urology R10 053. Lens implants R6 988 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 R34 107. Knee replacement R43 122. Other minor joints R16 151. Functional nasal surgery and surgical procedures where CNS stimulators are used (e.g. epilepsy, Parkinson disease, etc.) will be excluded from benefits, except for PMB conditions.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R8 264 per family per annum.
Pathology
100% Scheme tariff.
Basic Radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies)
100% Scheme tariff.
Limited to a combined in- and out-of-hospital benefit of R18 828 per family per annum. Co-payment of R2 600 per scan, not applicable to confirmed PMBs. PET scans - PMB only.
Confinements (birthing, including midwife-assisted births)
100% Scheme tariff.
Oncology
100% Scheme tariff. Subject to pre-authorisation, designated or preferred service providers and protocols. Essential ICON protocols apply.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation, protocols and DSP.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
Approved PMBs at DSPs.
HIV/AIDS
Subject to pre-authorisation, protocols and DSP.
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff.
Advanced illness benefit
100% Scheme tariff. Limited to R72 858 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures
Day procedures performed in a day hospital by a DSP provider will be funded at 100% network or Scheme tariff subject to pre-authorisation, protocols, funding guidelines and DSPs. A co-payment of R2 872 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the day procedure co-payment will not apply if done in acute hospital, if it is arranged with the Scheme before the time.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Co-payments
Non-DSP hospital co-payment: Co-payment of R15 025 per event for voluntary use of a non-DSP hospital. Procedure-specific co-payments: The co-payment shall not apply to PMB conditions: Arthroscopic procedures R3 660. Back and neck surgery R3 660. Laparoscopic procedures R3 660. Colonoscopies R2 000. Cystoscopies R2 000. Gastroscopies R2 000. Hysteroscopies R2 000. Sigmoidoscopies R2 000.
General Practitioner (GP) consultations
Unlimited GP consultations.
Subject to Bestmed Rhythm GP network. Applicable per family per annum.
Specialist consultations
Specialist consultations (this includes minor procedures done in specialist rooms and all consumables used), must be referred by a Rhythm Network Provider. Limited to M = R1 822, M1+ = R3 037.
Out-of-network and casualty visits
Out-of-network visits to a GP and casualty visits are limited to a maximum of R1 802 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. 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.
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. Network Provider (PPN) Consultation - One (1) per beneficiary. Frame = R310 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR Contact lenses = R795 OR Non-network Provider: Consultation - R420 fee at non-network provider Frame = R233 AND Single vision lenses = R225 OR Bifocal lenses = R485 OR Multifocal lenses = R485 In lieu of glasses members can opt for contact lenses, limited to R795.
Basic pathology
100% Scheme tariff.
Basic blood tests as requested by a Bestmed Rhythm Network GP 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 GP 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).
100% Scheme tariff. Limited to a combined in- and out-of-hospital benefit of R18 828 per family per annum. Co-payment of R2 600 per scan, not applicable to confirmed PMBs. PET scans - PMB only. Subject to pre-authorisation
Oncology
100% Scheme tariff. Subject to preauthorisation, designated or preferred service providers and protocols. Essential ICON protocols apply.
Peritoneal dialysis and haemodialysis
Subject to pre-authorisation, protocols and DSP.
HIV/AIDS
Subject to pre-authorisation, protocols and DSP.
Back and neck preventative programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols 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 for non-formulary medicine at a preferred provider network pharmacy.
Biological medicine
PMBs only.
Other high-cost medicine
PMBs only.
Acute medicine
100% Scheme tariff. Subject to Bestmed formulary only. As prescribed by Rhythm Network Provider and obtained from preferred provider pharmacy network.
Over-the-counter (OTC) medicine
100% Scheme tariff. Limited to R366 per family per annum and to R122 per event.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
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: R2757
Adult dependant: R2 610
Child dependant: R1 653
Maximum child dependants: 3
Contributions (income level R5 501 - R8 500)
Member: R3 300
Adult dependant: R3 000
Child dependant: R1 759
Maximum child dependants: 3
Contributions (income level R8 501 and higher)
Member: R3 516
Adult dependant: R3 165
Child dependant: R1 759
Maximum child dependants: 3
Bestmed members pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years are regarded as child dependants.
Get personalised pricing
call for more information
