Bestmed Beat 3:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Bestmed Beat 3. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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Terminology:

• 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
• All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

In-hospital Procedures (2026):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Bestmed: Beat 3
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	100% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Any hospital Day Procedure: Any day hospital
Penalty for using other hospital:	Voluntary use of long stay hospital instead of a day hospital: R2,872 penalty If your DSP does not work in a day hospital, the scheme will cover full cost for acute hospital, if authorised first	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	Arthroscopic procedures: R3,660 co-payment Back and neck surgery: R3,660 co-payment Functional nasal and sinus procedures: R2,000 co-payment Laparoscopic procedures: R3,660 co-payment Colonoscopies: R2,000 co-payment Cystoscopies: R2,000 co-payment Gastroscopies: R2,000 co-payment Hysteroscopies: R2,000 co-payment Sigmoidoscopies: R2,000 co-payment Extraction of wisdom teeth: R2,500 co-payment Specialised radiology: R2,000 co-payment Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI, CT scans, isotope studies: R33,472 per family with a R2,000 co-payment unless PMB PET Scans: PMBs only In and out of hospital	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:	R2,000 co-payment, unless PMB	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	100% scheme rate
Transplants:	PMBs only
Dialysis:	Covered, in and out of hospital
Exclusions:	Joint replacement surgery NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Alternatives to hospitalisation: 100% scheme rate Palliative Care or at-home care, in lieu of hospitalisation: R72,858 per person
Casualty/ER:	PMBs only	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2026):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Bestmed: Beat 3
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings: R7,560 R5,388 R2,664 Other Day-to-Day Funds:
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
GP consultations:	From day-to-day benefit
Childcare:	Ages 0-2 years: 3 baby growth and development assessments per year Immunisations: Covered	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	From day-to-day benefit
Pathology:	From day-to-day benefit
General radiology:	From day-to-day benefit
Specialised radiology:	MRI, CT scans, isotope studies: R33,472 per family with a R2,000 co-payment unless PMB PET Scans: PMBs only In and out of hospital	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Scopes:	R2,000 co-payment, unless PMB	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	From day-to-day benefit
General Appliances:	Out of hospital: No benefit In-hospital: R15,690 per family
1.1. Hearing Aids:	From day-to-day benefit
1.2. Wheelchairs:	From day-to-day benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2026):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Bestmed: Beat 3
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings: R7,560 R5,388 R2,664 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. An additional 5 non-PMB conditions are covered at 80% scheme rate, with an overall limit of R4,358 per person and R8,865 per family If you voluntarily use medicine that is not on Bestmed's list (formulary), you pay a 30% co-payment
Acute (prescribed) medication:	From day-to-day benefit
Over-the-counter:	From day-to-day benefit
Birth Control:	Oral/Injectable/Implantable: R2,510 per person IUD: R3,795 per person, every 5 years
On Discharge:	7 days if part of hospital account R500 if from pharmacy, on day of discharge
Biological:	In-hospital: R24,286 per family Out-of-hospital: PMBs only
View other benefits for this plan: In-hospital | 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. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider