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In-hospital Procedures for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated
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non-Network Specialists: |
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network Specialists: |
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non-Network GPs: |
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network GPs: |
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Hospital Choice: |
- Long stay:: Any hospital
- Day Procedure: Day network
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Day Hospitals: |
- Day procedures at DSP: scheme rate.
- If the provider is a DSP and does not work in a day hospital, the procedure will be Covered in full if it is done in an acute hospital.
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Penalty for using other hospital: |
- non-DSP Day hospitals: R2,625 co-payment
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Other Co-payments: |
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Specialised Radiology: |
- MRI, CT scans, isotope studies: Scheme rate
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Supplementary Services: (Physio, etc) |
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Transplants: |
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Dialysis: |
- Covered, in and out of hospital
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Exclusions: |
- Joint replacement surgery
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Alternatives to hospitals: |
- Alternatives to hospitalisation: 100% scheme rate
- Palliative Care or at-home care, in lieu of hospitalisation: R99,887 per person
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Casualty: |
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Other: |
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Note: |
- PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
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♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Bestmed plans, with costs and brief summary
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Out-of-hospital Procedures for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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- Main= R14,831
- Main+1= R29,661
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- All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
- This can include consults with specialists, blood or other tests, radiology and medicine
- The benefit is paid by the scheme, and not out of your savings account
- If you have no day-to-day funds, you still have cover for PMBs
- Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
- See our Guide to PMBs for more information.
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- The "day-to-day benefit" consists of a savings fund, and an "extra" fund.
- Claims paid from day-to-day benefit are usually paid from savings first, then the "extra fund". Once this is finished they are paid out-of pocket, unless they are for a PMB.
- You can access the free Tempo program and unlock some out of hospital benefits
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- From day-to-day benefit
- R3,777 per person and R6,728 per family
- Shared with Specialist benefit
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- Ages 0-2 years: 3 baby growth and development assessments per year
- Immunisations: Covered
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- Shared with GP benefits, see above
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- R3,776 per person and R7,690 per family
- From day-to-day benefit
- Shared with general radiology benefit
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- Shared with pathology benefits, see above
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- MRI, CT Scan, isotope studies, PT Scans: R19,638 per family
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- R5,768 per person and R11,714 per family
- Fromday-to-day benefit
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- Out of hospital> R13,321 per family from day-to-day benefit
- In-hospital: 100% scheme rate
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- R12,208 per family, every 24 months, paid by scheme
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- PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
|
♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Bestmed plans, with costs and brief summary
|
. |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
Medication Benefit for 2024:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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- Main= R14,831
- Main+1= R29,661
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Chronic: |
- If you voluntarily use medicine that is not on Bestmed's list (formulary), you pay a 30% co-payment
- An additional 9 non-PMB conditions are covered at 90% scheme rate, with an overall limit of R8,748 per person and R17,496 per family
- If you voluntarily use medicine that is not on Bestmed's list (formulary), you pay a 20% co-payment
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- R3,337 per person and R6,742 per family
- From day-to-day benefit
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- R2,678 per person
- IUD insertion: once every 5 years
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- In-hospital: R27,746 per family, unless part of PMB-protocol
- Out-of-hospital: Subject to authorisation
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- Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
- Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
- PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
|
♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Bestmed plans, with costs and brief summary
|
. |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
|