This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Bestmed Beat 4.
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:: 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. Otherwise, see Penalties, above.
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| Penalty for using other hospital: |
- 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: R40,000 per family with a R2,000 co-payment
- PET Scans: 1 per person
- 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: R104,482 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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- Main= R15,513
- Main+1= R31,025
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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
- R3,951 per person and R7,037 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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- From day-to-day benefit
- R3,951 per person and R7,037 per family
- Shared with GP benefit
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- R3,950 per person and R8,044 per family
- From day-to-day benefit
- Shared with general radiology benefit
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- R3,950 per person and R8,044 per family
- From day-to-day benefit
- Shared with pathology benefit
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- MRI, CT scans, isotope studies: R40,000 per family with a R2,o00 co-payment
- PET Scans: 1 per person
- In and out of hospital
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| Scopes: |
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- R6,033 per person and R12,253 per family
- Fromday-to-day benefit
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- Out of hospital: R13,934 per family
- In-hospital: R15,000 per family
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- R12,770 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
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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.
|
| . |
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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- Main= R15,513
- Main+1= R31,025
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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 R9,150 per person and R18,301 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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- R3,491 per person and R7,052 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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- 7 days if part of hospital account
- R150 if from pharmacy, on day of discharge
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- In-hospital: R29,022 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:
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.
|
