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24h Emergency: 084 124

Beat2

Plan Details

Hospital & Emergencies

Accommodation (hospital stay) and theatre fees

100% Scheme tariff.  DSP specialist network applicable if the network option is chosen.

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

PMBs only at DSP day hospitals.

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 limited to R14 106   • Pacemaker (dual chamber) R42 986   • Vascular R31 470   • Endovascular and catheter base procedures - no benefit   • Spinal R31 470   • Artificial disc - no benefit   • Drug-eluting stents - PMBs and DSP products only   • Mesh R11 044   • Gynaecology/Urology R9 025   • Lens implants R6 887 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 R33 130   • Knee replacement R40 848   • Other minor joints R12 706

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 Subject to co-payments

Oncology

100% Scheme tariff Subject to pre-authorisation. 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 abreast cancer patient.

Peritoneal dialysis and haemodialysis

100% Scheme tariff Subject to pre-authorisation and DSPs

Confinements (Birthing)

100% Scheme tariff.

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

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.

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

Emergency evacuation

Services rendered by ER24.

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 R3 800 on all endoscopic investigations and specialised diagnostic imaging
if done in a private hospital. Any other facility,
no co-payment. Co-payment for voluntary use of nonnetwork hospital R11 874 for network option.

Day-to-Day

Savings Account/ Day-to-day Benefits

Savings account available.
Limited day-to-day benefits are available.

Value Benefits
  • Preventative care benefits
  • Contraceptive benefit
  • Wound care benefit
  • Preventative dentistry
Over-the-counter

Savings account.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
Co-payment of 40% for non-formulary medicine.

Non-CDL chronic medicine

No benefit.

Biologicals and other high-cost medicine

PMBs only as per funding protocol.
Subject to pre-approval.

Acute medicine

Savings account.

Over-the-counter (OTC) medicine

Savings account.

Preventative care benefits

Flu vaccines
  • All ages
  • 1 per beneficiary per year
  • Applicable to all active members and beneficiaries
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:

  • The Scheme will identify certain high-risk individuals who will be advised 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 315 per beneficiary per year. Includes all items classified in the category of female contraceptives
HPV vaccinations
  • Females 9-26 years of age
  • 3 vaccinations per beneficiary
  • Vaccinations will be funded at Mediscor Reference Price (MRP)
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
  • Females 40 years and older
  • Once every 24 months
  • Scheme tariff is applicable
Preventative dentistry
PSA screening
  • Males 50 years and older
  • Once every 24 months
  • Can be done at a urologist or Family Practitioner (FP)
  • Consultation paid from the available savings account
Pap smear
  • Females 18 years and older
  • Once every 24 months
  • Can be done at a gynaecologist or Family Practitioner (FP)
  • Consultation paid from the available savings account

 

Maternity benefits

100% Scheme tariff. 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 2053 per month*

Add Dependants

Adults
0
Children
0

*You are able to reduce your premium to R1 847 by opting for the Beat2 Network option. Please ask a sales consultant for more information.

Beat 2 offers extensive hospital cover (at private hospitals) as well as access to a savings account for general day-to-day expenses.

Get personalised pricing call for more information

Beat3

Plan Details

Hospital & Emergencies

Accommodation (hospital stay) and theatre fees

100% Scheme tariff.  DSP specialist network applicable if the network option is chosen.

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. Limited to R12 944 per family

Dental and oral surgery (In- or out of hospital)

Limited to R8 075 per family.

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

100% Scheme tariff Limited too R79 678 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 limited to R14 107 • Pacemaker (dual chamber) R42 986 • Vascular R31 586 • Endovascular and catheter base procedures - no benefit • Spinal R31 586   • Artificial disc - no benefit • Drug-eluting stents - PMBs and DSP products only • Mesh R11 101 • Gynaecology/Urology R9 168  • Lens implants R6 887 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 R33 368   • Knee replacement R41 288   • Minor joints R12 706

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

100% Scheme tariff Subject to pre-authorisation. 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.

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 R8 312 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 R24 000 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

Emergency evacuation

Services rendered by ER24.

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 R3 800 on all endoscopic investigations and specialised diagnostic imaging
if done in a private hospital. Any other facility,
no co-payment. Co-payment for voluntary use of non-network hospital R11 874 for network option.

Day-to-Day

Savings Account/ Day-to-day Benefits

Savings account available.
Limited day-to-day benefits are available.

Value Benefits
  • Preventative care benefits
  • Optometry
  • Preventative dentistry
  • Maternity benefits
Over-the-counter

Savings account.

Medicines

CDL and PMB chronic medicine

100% Scheme tariff.
Co-payment of 40% for non-formulary medicine.

Non-CDL chronic medicine

5 conditions. 80% Scheme tariff.
Limited to M = R3 444, M1+ = R7 006.
Co-payment of 35% for non-formulary medicine.

Biologicals and other high-cost medicine

PMBs only as per funding protocol.
Subject to pre-approval.

Acute medicine

Savings account.

Over-the-counter (OTC) medicine

Savings account.

Preventative care benefits

Flu vaccines
  • All ages
  • 1 per beneficiary per year
  • Applicable to all active members
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:

  • The Scheme will identify certain high-risk individuals who will be advised to be immunise
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 contraceptive
  • 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 315 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
HPV vaccinations
  • Females 9-26 years of age
  • 3 vaccinations per beneficiary
  • Vaccinations will be funded at Mediscor Reference Price (MRP)
Mammogram
  • Females 40 years and older
  • Once every 24 months
  • Scheme tariff is applicable
Preventative dentistry
  • Refer to Preventative Dentistry section for details
PSA screening
  • Males 50 years and older
  • Once every 24 months
  • Can be done at a urologist or Family Practitioner (FP)
  • Consultation paid from the available savings account
Pap smear
  • Females 18 years and older
  • Once every 24 months
  • Can be done at a gynaecologist or Family Practitioner (FP)
  • Consultation paid from the available savings account

 

Maternity benefits

100% Scheme tariff. Subject to the following benefits:


Consultations: 
  • 9 antenatal consultations at a FP 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 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
Supplements:
  • Any item categorised as a maternity supplement can be claimed up to a maximum of R100 per claim, once a month, for a maximum of 9 months

From R 3117 per month*

Add Dependants

Adults
0
Children
0

*You are able to reduce your premium to R2 805 by opting for the Beat3 Network option. Please ask a sales consultant for more information.

Beat 3 offers extensive in-hospital cover with savings and additional benefits, including maternity benefits.

Get personalised pricing call for more information

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