Bestmed Pace 1:in-and-out of hospital benefits (2024)

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Bestmed Pace 1.

We also have information on: Dentistry, Optometry, Wellness and Preventative, Other, Maternity, Cancer, Mental Health and Prosthetics benefits.

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Monthly Costs:

Pace 1 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R5,061
  • R3,555
  • R1277
  • Only pay for 3 children
Savings:
  • R11,544
  • R8,100
  • R2,916
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R12,607
  • Main+1= R25,213
Children Rates:
  • Under 24 unless registered student, then under 26
  • Only pay for 3 children
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️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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In-hospital Procedures for 2024:

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

Bestmed: Pace 1
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • 100% scheme rate
non-Network GPs:
  • 100% scheme rate
network GPs:
  • 100% scheme rate
Hospital Choice:
  • Long stay:: Any hospital
  • Day Procedure: Day network
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.
Penalty for using other hospital:
  • non-DSP Day hospitals: R2,625 co-payment
Other Co-payments:
    Specialised Radiology:
    • MRI, CT scans, isotope studies: Scheme rate
    Supplementary Services: (Physio, etc)
    • 100% scheme rate
    Transplants:
    • PMBs only
    Dialysis:
    • Covered, in and out of hospital
    Exclusions:
    • Joint replacement surgery
    Alternatives to hospitals:
    • Alternatives to hospitalisation: 100% scheme rate
    • Palliative Care or at-home care, in lieu of hospitalisation: R83,239 per person
    Casualty:
    • PMBs only
    Other: .
    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
    ♦️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
    .
    .
    .

    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)

    Bestmed: Pace 1
    Assume scheme pays all these costs, unless otherwise stated
    Summary of day-to-day benefits:
    Main Member: Adult: Child:
    Savings:
    • R11,544
    • R8,100
    • R2,916
    Extended Fund:
    Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
    • Main= R12,607
    • Main+1= R25,213
    PMBs out of hospital:
    • 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.
    General info:
    • 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
    GP consultations:
    • From day-to-day benefit
    • R2,596 per person and R5,219 per family
    • Shared with Specialist benefit
    Childcare:
    • Ages 0-2 years: 3 baby growth and development assessments per year
    • Immunisations: Covered
    Specialists consultations:
    • Shared with GP benefits, see above
    Pathology:
    • R3,776 per person and R7,554 per family
    • From day-to-day benefit
    • Shared with standard radiology benefit
    General radiology:
    • Shared with pathology benefits, see above
    Specialised radiology:
    • MRI, CT Scan, isotope studies: R16,891 per family
    • Excludes PET scans
    Supplementary Services: (Physio, etc)
    • R5,095 per person and R10,575 per family
    • Fromday-to-day benefit
    General Appliances:
    • Out of hospital: R13,321 per family from day-to-day benefit
    • In-hospital: 100% scheme rate
    1.1. Hearing Aids:
    • R9,252 per family, every 24 months, paid by scheme
    1.2. Wheelchairs:
    • See above
    Note:
    • 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.

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    Medication Benefit for 2024:

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

    Bestmed: Pace 1
    Assume scheme pays all these costs, unless otherwise stated
    Summary of day-to-day benefits:
    Main Member: Adult: Child:
    Savings:
    • R11,544
    • R8,100
    • R2,916
    Extended Fund:
    Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
    • Main= R12,607
    • Main+1= R25,213
    Chronic:
    • An additional 7 non-PMB conditions are covered at 90% scheme rate, with an overall limit of R7,690 per person and R15,380 per family
    • If you voluntarily use medicine that is not on Bestmed's list (formulary), you pay a 25% co-payment
    Acute (presrcibed) medication:
    • R2,721 per person and R5,631 per family
    • From day-to-day benefit
    Over-the-counter:
    • R1,100 OR access to full savings for OTC purchases after R1,100 self payment.
    • Includes sunscreen, vitamins, minerals
    Birth Control:
    • R2,678 per person
    • IUD insertion: once every 5 years
    On Discharge:
    • 7 days
    Biological:
    • In-hospital: R33,296 per family
    • Out of hospital: PMB only
    Note:
    • 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.

    Also see these: