Bestmed Pace 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 Pace 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: Pace 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:	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:	Specialised radiology: R1,500 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: R43,932 per family with a R1,500 co-payment PET Scans: 1 per person In and out of hospital	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:	In day hospital, by DSP provider: 100% scheme rate Otherwise, R2,625 co-payment	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:	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: R145,716 per person
Casualty/ER:	PMBs only or from day-to-day benefit	Gap Cover: Can cover ER claims (Plans coming soon)
Other:	Breast reduction: R100,000 per family
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: Pace 3
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
Main Member: Adult: Child: Savings: R15,684 R12,624 R2,688 Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account Main= R22,015 Main+1= R45,497 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 R5,561 per person and R11,269 per family GP and Specialist benefit is shared
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 R5,561 per person and R11,269 per family GP and Specialist benefit is shared
Pathology:	R4,508 per person and R8,939 per family From day-to-day benefit Standard radiology and pathology benefit is shared
General radiology:	R4,508 per person and R8,939 per family From day-to-day benefit Standard radiology and pathology benefit is shared
Specialised radiology:	MRI, CT scans, isotope studies: R43,932 per family with a R1,500 co-payment PET Scans: 1 per person In and out of hospital	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Scopes:	In day hospital, by DSP provider: 100% scheme rate Otherwise, R2,625 co-payment	Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	R3,396 per person and R7,137 per family From day-to-day benefit
General Appliances:	Out of hospital: R13,221 per family In-hospital: R15,690 per family
1.1. Hearing Aids:	R33,472 per person, every 24 months, paid by scheme
1.2. Wheelchairs:	R17,880 per family every 48 months
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: Pace 3
Assume scheme pays all these costs, unless otherwise stated
Main Member: Adult: Child: Savings: R15,684 R12,624 R2,688 Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account Main= R22,015 Main+1= R45,497 Other Day-to-Day Funds:
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. An additional 20 non-PMB conditions are covered at 90% scheme rate, with an overall limit of R17,654 per person and R35,310 per family If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 20% co-payment
Acute (prescribed) medication:	R2,298 per person and R5,169 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 R600 if from pharmacy, on day of discharge
Biological:	Biological Medicine: R420,695 per person Other high-cost medicine: scheme rate
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