This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Bestmed Beat 3 Network.
In-hospital Procedures (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
| 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:: Network 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. Otherwise, see Penalties, above.
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| Penalty for using other hospital: |
- Use of non--Network hospital: R14,364 penalty
- Use of non--DSP Day hospitals: R2,746 penalty
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| Other 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
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| Specialised Radiology: |
- MRI, CT scans, isotope studies: R32,000 per family with a R2,000 co-payment
- PET Scans: PMBs only
- In and out of hospital
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| Scopes: |
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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: |
Exclusions:
- Joint replacement surgery
- Note: All schemes have extensive exclusions. We've tried to list the major ones here, but please consult your scheme or broker to get the full list.
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| Alternatives to hospitals: |
- Alternatives to hospitalisation: 100% scheme rate
- Palliative Care or at-home care, in lieu of hospitalisation: R69,654 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:
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.
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Out-of-hospital Procedures (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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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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- This plan has a savings fund. When this is finished, most out of hospital costs are paid by you.
- You can access the free Tempo program and unlock some out of hospital benefits
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- Ages 0-2 years: 3 baby growth and development assessments per year
- Immunisations: Covered
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- MRI, CT scans, isotope studies: R32,000 per family with a R2,000 co-payment
- PET Scans: PMBs only
- In and out of hospital
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| Scopes: |
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- Out of hospital: No benefit
- In-hospital: R15,000 per family
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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
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View all the 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.
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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 (2025):
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
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Assume scheme pays all these costs, unless otherwise stated |
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Main Member: |
Adult: |
Child: |
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| Chronic: |
- An additional 5 non-PMB conditions are covered at 80% scheme rate, with an overall limit of R4,166 per person and R8,475 per family
- If you voluntarily use medicine that is not on Bestmed's list (formulary), you pay a 30% co-payment
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- R2,400 per person
- IUD insertion: once every 5 years
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- 7 days if part of hospital account
- R150 if from pharmacy, on day of discharge
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- In-hospital: R23,218 per family, unless part of PMB-protocol
- Out-of-hospital: PMBs only
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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:
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.
|
| . |
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.
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