Bestmed Beat 1 medical aid plan: 2020

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Always consult with your broker before making final decisions regarding your healthcare cover.

Beat 1
2020 Costs:
Total Cost pm:

Main member:

R1,617

Adult:

R1,255

Child:

R680
Savings (per year):
  • No savings option on this plan



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IN HOSPITAL PROCEDURES:
Beat 1
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • The Blue Plan gap cover will increase this to 500% scheme rate
network Specialists:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
non-Network GPs:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
network GPs:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Hospital Choice:
  • Choose from Network hospitals
Penalty for using other hospital:
  • n/a
Specialised Radiology:
  • You or your gap cover pay R3,619 co-payment if done in private hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
Co-payments:
  • Scopes: You or your gap cover pay R3,619 co-payment if done in private hospital
  • Specialised radiology: You or your gap cover pay R3,619 co-payment if done in private hospital
Alternatives to hospitals:
  • Scheme pays up to 100% scheme rate
Casualty:
  • No benefit, unless PMB
  • Both the Blue Plan and Red Plan gap cover will pay up to R20,000 per person for unpaid casualty costs in event of emergency
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 R157,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R157,000 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)



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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 1
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Consider getting Primary Health Care (PHC) (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
GP consultations:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Childcare:
  • No extra benefits
Specialists consultations:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Pathology:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
General radiology:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Specialised radiology:
  • Bestmed pays up to R5,089 per family
  • You or your gap cover pay the balance
  • Excludes PET scans
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB



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MATERNITY BENEFITS:
Beat 1
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
    Paid by scheme:
  • 6 consults with GP, gynaecologist or midwife
Scans:
  • 2 x 2D ultrasound scans



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CANCER (ONCOLOGY):
Beat 1
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, at DSP (designated service provider)



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DENTISTRY:
Beat 1
Scheme Benefits Notes and Links:
Standard Dentistry:
  • No benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Specialised Dentistry:
  • No benefit
In-Hospital Dentistry:
  • Dental and oral surgery: No benefit, unless PMB
Orthodontics:
  • No benefit
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



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MEDICATION:
Beat 1
Scheme Benefits: Notes and Links:
Chronic:
  • All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. Find out more
  • If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 40% co-payment
Acute (presrcibed) medication:
  • No benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Over-the-counter:
  • No benefit
Birth Control:
  • R2,205 per family per year, paid by Bestmed
On Discharge:
  • 7 days, paid by Bestmed
Biological:
  • No benefit, unless PMB level of care



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OPTOMETRY:
Beat 1
Scheme Benefits: Notes and Links:
Optometry:
Limit:No benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here



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MENTAL HEALTH:
Beat 1
Scheme Benefits Notes and Links:
In-hospital:
  • 21 days per person
  • Subject to PMBs and Designated Service Providers
  • Alcoholism/Drug Addiction: 21 days per person or R30,760 per person. Network facilities.
Out-of-hospital:
  • PMBs always paid in full at DSP, and include consultations
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



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OTHER BENEFITS:
Beat 1
Scheme Benefits Notes and Links:
General Appliances:
  • Out of hospital: you pay this out of pocket
  • In-hospital: 100% scheme rate
1.1. Hearing Aids:
  • See above
1.2. Wheelchairs:
  • See above
Dialysis:
  • PMB only, with a designated network provider
International Insurance:
    In brief (all subject to conditions of policy):
  • Medical expenses up to R10 million and maximum 90 days
Other:
  • Wound care: R3,359 per family, paid by Bestmed



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WELLNESS/PREVENTATIVE BENEFITS:
Beat 1
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered
Biometric Screening:
  • Covered
Child Immunisation:
  • No benefit
Pap Smear:
  • Covered, 18yrs+ every 2 years
Mammogram:
  • No benefit, unless PMB
PAS Test:
  • No benefit, unless PMB
HIV Test:
Other:
  • HPV Vaccinations
  • Tempo Programme which includes bio screening, child assessments, nutrition assessments, fitness and nutritional interventions (biokineticist and dietician consults)



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PROSTHETICS:
Beat 1
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R75,092 per family
  • External: PMBs only
Sub-limits:
    (per person):
  • Functional (treating or supporting a bodily function): R13,434
  • Vascular: R29,971
  • Pacemaker, dual chamber: R40,939
  • Spinal: R29,971
  • Mesh: R10,518
  • Gynaecology/Urology: R8,595
  • Drug eluting stents: PMBs and DSP products only
  • Lens implants: R6,559 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: R31,553
  • Knee replacement: R38,903
  • Minor Joints: R12,101



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    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