Bestmed Beat 1 medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
Beat 1
Quick Overview
Main: Adult: Child:
Total Cost pm: R1,363 R1,058 R573

(Pay only for first 4)

Savings (per year):
  • No savings option on this plan
Gap (optional):
  • Varies. See below for specific recommendation for this plan.
In brief:
  • Scheme rate is 100%, (gap increases this to 500%)
  • Most day-to-day expenses are paid from out of pocket, unless PMBs
  • Treatment and medicine for 27 chronic conditions covered by scheme
  • Cancer (PMB only) is treated in state hospitals, but you can upgrade to higher plan on cancer diagnosis to receive private hospital treatment
  • There are co-payments for in-hospital MRIs and CT Scans (gap cover pays this co-payment)
  • There is a benefit for out-of-hospital specialised radiology (paid in full with gap cover)
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

IN HOSPITAL PROCEDURES:
Beat 1
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice:
  • Choose any hospital
  • No extra benefit necessary
Specialised Radiology:
  • You or your gap cover pay R3,200 co-payment if done in private hospital
  • Gap co-payment benefit pays the co-payments
Supplementary Services: (Physio, etc)
  • Bestmed pays up to 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Transplants:
  • No extra benefit available (PMB benefits are paid in full by medical aid)
Co-payments:
  • Scopes: You or your gap cover pay R3,200 co-payment if done in private hospital
  • Specialised radiology: You or your gap cover pay R3,200 co-payment if done in private hospital
  • Gap cover pays co-payments for procedures approved by medical aid
Alternatives to hospitals:
  • Bestmed pays up to 100% scheme rate
  • You pay the balance, if any
  • No extra benefit available
Casualty:
  • Only PMB cases are paid
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other:
  • N/A
  • N/A
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

No phone calls!
Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Beat 1
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • This plan has no savings fund, so most out of hospital costs are paid by you
  • Remember, out of hospital costs authorised as part of PMB treatment (eg. cancer, asthma or stroke) are always paid by the scheme, even on this plan.
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • You pay this from out of pocket
  • No extra benefit available
Childcare:
  • No extra benefits
  • No extra benefit available
Specialists consultations:
  • You pay this from out of pocket
  • No extra benefit available
Pathology:
  • You pay this from out of pocket
  • No extra benefit available
General radiology:
  • You pay this from out of pocket
  • No extra benefit available
Specialised radiology:
  • Bestmed pays up to R4,500 per family
  • You or your gap cover pay the balance
  • Sublimit increased as necessary for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • You pay this from out of pocket
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Beat 1
Scheme Benefits Gap benefits
Hospital stay:
  • Bestmed pays up to 100% scheme rate, including for births with midwife
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Consultations:
  • You pay this out of pocket
  • No extra benefit available
Scans:
  • You pay this out of pocket
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Beat 1
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • Bestmed will pay for cancer treatment in a state hospital only, and only for PMBs. What does this mean?
  • If you are diagnosed with cancer while on this plan, you can upgrade your plan immediately to receive cover at private hospital
  • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, the gap cancer benefit will cover costs authorised but not paid by your medical scheme (up to the R150,000 per person per year gap limit) More info

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
Beat 1
Scheme Benefits Gap benefits
Dentistry:
  • You pay all dentistry out of pocket
  • PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use the required service provider)
Orthodontics:
  • You pay this out of pocket
  • No extra benefit available
Maxillo Facial Surgery:
  • You pay this out of pocket, unless it's to treat a PMB.
  • PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
Beat 1
Scheme Benefits Gap benefits
Chronic:
  • All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. Find out more
  • If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 40% co-payment
  • No extra benefit available
Acute (presrcibed) medication:
  • You pay this out of pocket
  • No extra benefit available
Over-the-counter:
  • You pay this out of pocket
  • No extra benefit available
Birth Control:
  • R1,950 per family per year, paid by Bestmed
  • No extra benefit available
On Discharge:
  • 7 days, paid by Bestmed
  • No extra benefit available
Biological:
  • You pay this out of pocket
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

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OPTOMETRY:
Beat 1
Scheme Benefits Gap benefits
Optometry:
  • You pay this out of pocket, unless for an approved in-hospital or day clinic procedure
  • PMB conditions are always paid by schemes. More info on PMBs
  • Refractive surgery: No benefit
    • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

    No phone calls!
    Our quote will include the right gap cover for this plan

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    MENTAL HEALTH:
    Beat 1
    Scheme Benefits Gap benefits
    In-hospital:
    • Bestmed will pay for up to 21 days per person at 100% scheme rate, and may require use of specific providers
    • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
    • No extra benefit available
    • (PMBs are paid in full by scheme if you use DSP)
    Out-of-hospital:
    • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
    • For non-PMB conditions, you pay this out of pocket
    • No extra benefit available
    • (PMBs are paid in full by scheme if you use DSP)
    Trauma:
    • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
    • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
    • No extra benefit available
    • (PMBs are paid in full by scheme if you use DSP)

    No phone calls!
    Our quote will include the right gap cover for this plan

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    OTHER BENEFITS:
    Beat 1
    Scheme Benefits Gap benefits
    General Appliances:
      Out of hospital, you pay this out of pocket
    • No benefit
    1.1. Hearing Aids:
    • You pay this out of pocket
    • No benefit
    1.2. Wheelchairs:
    • You pay this out of pocket
    • No benefit
    Dialysis:
    • Bestmed only pays for PMB cases, with a designated network provider
    • No extra benefit available
    • (PMBs are paid in full by scheme if you use DSP)
    HIV:
    • Managed care programme
    • No benefit
    Emergency Transport:
    • ER24
    • No benefit
    International Insurance:
    • TBC
    • No benefit
    Other:
    • Wound care: R2,970 per family, paid by Bestmed
    • No extra benefit available

    No phone calls!
    Our quote will include the right gap cover for this plan

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    WELLNESS/PREVENTATIVE BENEFITS:
    Beat 1
    Scheme Benefits Gap benefits
    Flu vaccination:
    • Covered
    • No benefit
    Pneumonia vaccines:
    • Covered
    • No benefit
    Back Rehabilitation Programme:
    • Covered
    • No benefit
    Biometric Screening:
    • Covered
    • No benefit
    Child Immunisation: .
    • No benefit
    Pap Smear:
    • Covered, 18yrs+ every 2 years
    • No benefit
    Mammogram:
    • No benefit
    • No benefit
    PAS Test:
    • No benefit
    • No benefit
    HIV Test: TBC
    • No benefit
    Other:
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan

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    PROSTHETICS:
    Beat 1
    Scheme Benefits Gap benefits
    Overal Limit:
    • Internal: R66,400 per family
    • External: no benefit
    • Sublimit increased by up to R150,000 per person
    • No benefit for procedures excluded by Bestmed
    Sub-limits:
    • Functional (treating or supporting a bodily function): R11,880
    • Vascular: R26,500
    • Pacemaker, dual chamber: R36,200
    • Spinal: R26,500
    • Mesh: R9,300
    • Gynaecology/Urology: R7,600
    • Lens implants: R5,800 per lens
      Exclusions:
    • Endovascular and catheter-based procedures
    • Artificial disk
    • Drug eluting stents
    • Joint replacements, unless PMB
      PMB joint replacements:
    • Hip replacement and other major joints: R27,900
    • Knee replacement: R34,400
    • Minor Joints: R10,700
    • Sublimit increased by up to R150,000 per person
    • No benefit for procedures excluded by Bestmed

    No phone calls!
    Our quote will include the right gap cover for this plan


      Important!
    • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
    • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
    • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
    • Assume that all benefits need to be pre-authorised