Bestmed Beat 2 medical aid plan: 2019

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Beat 2
2019 Costs:
Total Cost pm:

Main member:

R1,814

Adult:

R1,409

Child: (Pay only for first 4)

R764
Savings: R3,480 R2,700 R1,464
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IN HOSPITAL PROCEDURES:
Beat 2
Scheme Benefits: Notes and Links:
Specialists:
  • Up to 100% scheme rate
  • You or gap cover pay the balance, if any
Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Choose any hospital
Specialised Radiology:
  • You or your gap cover pay R3,200 co-payment if done in private hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
Co-payments:
  • Scopes: You or your gap cover pay R3,440co-payment if done in private hospital
  • Specialised radiology: You or your gap cover pay R3,440co-payment if done in private hospital
Alternatives to hospitals:
  • Bestmed pays up to 100% scheme rate
  • You pay the balance, if any
Casualty:
  • No benefit, unless PMB
Other:
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
What next?
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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Beat 2
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: R3,480 R2,700 R1,464
General info:
  • This plan has a small savings fund, so most out of hospital costs are paid by you
  • Remember, out of hospital costs authorised as part of PMB treatment (eg. cancer, asthma or stroke) are always paid by the scheme, even on this plan.
GP consultations:
  • From day-to-day benefit, unless PMB
Childcare:
  • No extra benefits
Specialists consultations:
  • From day-to-day benefit, unless PMB
Pathology:
  • From day-to-day benefit, unless PMB
General radiology:
  • From day-to-day benefit, then from out of pocket
Specialised radiology:
  • Bestmed pays up to R4,837 per family
  • You or your gap cover pay the balance
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
What next?
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MATERNITY BENEFITS:
Beat 2
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% scheme rate
Consultations:
  • From day-to-day benefit, unless PMB
Scans:
  • From day-to-day benefit, unless PMB
What next?
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CANCER (ONCOLOGY):
Beat 2
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, at DSP (designated service provider)
What next?
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DENTISTRY:
Beat 2
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Preventative dentistry: paid by Bestmed. Includes exam, radiographs, scaling and polishing, fissure sealing and space maintainers
  • Standard dentistry: from day-to-day benefit
Specialised Dentistry:
  • Speciallised dentistry: from day-to-day benefit
In-Hospital Dentistry:
  • No benefit, unless PMB
Orthodontics:
  • Subject to pre-authorisation
Maxillo Facial Surgery:
  • You pay this out of pocket, unless it's to treat a PMB (then, at DSP day hospitals only).
  • PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
What next?
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MEDICATION:
Beat 2
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary: 40%
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • From day-to-day benefit
Birth Control:
  • R2,097 per family per year, paid by Bestmed
On Discharge:
  • 7 days
Biological:
  • No benefit, unless PMB level of care
What next?
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OPTOMETRY:
Beat 2
Scheme Benefits: Notes and Links:
Optometry:
Limit:From day-to-day benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
What next?
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MENTAL HEALTH:
Beat 2
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: PMBs always paid in full at DSP, and include up to 21 days admission
  • Treatment of chemical or substance abuse: PMB level of care or R29,240 per person
Out-of-hospital:
  • Out-of-hospital: PMBs always paid in full at DSP, and include consultations
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Trauma:
  • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
What next?
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OTHER BENEFITS:
Beat 2
Scheme Benefits Notes and Links:
General Appliances:
  • Out of hospital, paid from day-to-day benefit
  • In-hospital, 100% scheme rate
  • No benefit
1.1. Hearing Aids:
  • From day-to-day benefit, unless PMB
1.2. Wheelchairs:
  • From day-to-day benefit, unless PMB
Dialysis:
  • Bestmed only pays for PMB cases, with a designated network provider
HIV:
  • Managed care programme, which includes pathology tests, doctor consults, medicine and hospital treatment]
Emergency Transport:
  • ER24
International Insurance:
    In brief (all subject to conditions of policy):
  • Available to all members between the age of 3 months and 84 years old
  • Medical expenses up to R10 million. Pre-existing conditions or sequelae thereof limited to R250,000
  • Cost of a visit by a family member when severe illness or injury has occurred
  • Return to South Africa, if deemed necessary
Other:
  • Wound care: R3,193 per family, paid by Bestmed
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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WELLNESS/PREVENTATIVE BENEFITS:
Beat 2
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Twice in a lifetime, with a booster above 65yrs
Back Rehabilitation Programme:
  • 6 weeks, once a year
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered, 18yrs+ every 2 years
Mammogram:
  • No benefit, unless PMB
PAS Test:
  • No benefit, unless PMB
HIV Test:
Other:
  • HPV Vaccinations
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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PROSTHETICS:
Beat 2
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R71,380 per family
  • External: no benefit
Sub-limits:
    (per person):
  • Functional (treating or supporting a bodily function): R12,770
  • Vascular: R28,490
  • Pacemaker, dual chamber: R38,915
  • Spinal: R28,490
  • Mesh: R9,998
  • Gynaecology/Urology: R8,170
  • Drug eluting stents: DSP products only
  • Lens implants: R6,235 per lens
    Exclusions:
  • Endovascular and catheter-based procedures
  • Artificial disk
  • Joint replacements, unless PMB
    PMB joint replacements - prothesis limits:
  • Hip replacement and other major joints: R29,993
  • Knee replacement: R36,980
  • Minor Joints: R11,503
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised