• Bestmed

Bestmed Beat 4:
in-and-out of hospital benefits (2026)

Contents:

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Bestmed Beat 4. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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 Providers. Where stipulated, you must use 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.

Monthly Costs (2026)

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

Bestmed: Beat 4 (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R7,365
  • R6,082
  • R1,821
Savings:
  • R12,372
  • R10,212
  • R3,060
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R16,227
  • Main+1= R32,452
Children Rates:
  • Under 24yrs.
  • Only pay for 3 children
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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 4
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:
  • Long procedure: 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:
  • 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, especially if you don't use a DSP for a PMB or when buying medicine.
 Gap Cover:
Can cover most co-payments
(Plans coming soon)
Specialised Radiology:
  • MRI, CT scans, isotope studies: R41,840 per family with a R2,000 co-payment
  • PET Scans: 1 per person, not part of above limit or co-payment
  • 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: R109,288 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 4
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R12,372
  • R10,212
  • R3,060
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R16,227
  • Main+1= R32,452
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
  • R4,133 per person and R7,361 per family
  • Shared with Specialist 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)
Specialist consultations:
  • From day-to-day benefit
  • R4,133 per person and R7,361 per family
  • Shared with GP benefit
Pathology:
  • R3,950 per person and R8,044 per family
  • From day-to-day benefit
  • Shared with general radiology benefit
General radiology:
  • R4,130 per person and R8,414 per family
  • From day-to-day benefit
  • Shared with pathology benefit
Specialised radiology:
  • MRI, CT scans, isotope studies: R41,840 per family with a R2,000 co-payment
  • PET Scans: 1 per person, not part of above limit or co-payment
  • 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)
  • R6,311 per person and R12,817 per family
  • From day-to-day benefit
General Appliances:
  • Out of hospital: R14,575 per family
  • In-hospital: R15,690 per family
1.1. Hearing Aids:
  • R13,357 per family, every 24 months, paid by scheme
1.2. Wheelchairs:
  • See above
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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 (2026):

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

Bestmed: Beat 4
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child:
Savings:
  • R12,372
  • R10,212
  • R3,060
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R16,227
  • Main+1= R32,452
Other Day-to-Day Funds:
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 R9,571 per person and R19,143 per family
  • If you voluntarily use medicine that is not on Bestmed's list (formulary), you pay a 20% co-payment
Acute (prescribed) medication:
  • R3,652 per person and R7,376 per family
  • From day-to-day benefit
Over-the-counter:
  • R1,214
Birth Control:
  • Oral/Injectable/Implantable: R2,801 per person
  • IUD: R4,225 per person, every 5 years
On Discharge:
  • 7 days if part of hospital account
  • R550 if from pharmacy, on day of discharge
Biological:
  • In-hospital: R30,357 per family
  • Out-of-hospital: PMBs only
PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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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