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.
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?
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.
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): Pace 4
Scheme Benefits
Notes and Links:
Main Member:
Adult:
Child:
Savings /yr:
R2640
R2640
R624
Extended Fund:
RM= R32,465
M1+= R52,353
R
R
General info:
This plan has a savings fund as well as an "extra" fund, so most out of hospital costs can be paid by this
Remember, out of hospital costs authorised as part of PMB treatment (eg. cancer, asthma or stroke) are always paid by the scheme, not out of savings.
GP consultations:
From day-to-day benefit, unless PMB, up to R5,106 per person and R8,278 per family
Shared with specialist benefit
Childcare:
No extra benefits
Specialists consultations:
Shared with GP benefits, see above
Pathology:
R5,106 per person and R10,051 per family
From savings first, then from extra fund
Shared with radiology benefit
General radiology:
Shared with pathology benefits, see above
Specialised radiology:
Bestmed pays for 3 MRI/CT scans and 1 PET scan per person
All else is paid by you out-of-pocket
Supplementary Services: (Physio, etc)
R5,106 per person and R10,051 per family
From day-to-day benefit
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.
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.
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.
Preventative dentistry: paid by Bestmed. Includes exam, radiographs, scaling and polishing, fissure sealing and space maintainers
Standard dentistry: from day-to-day benefit, up to R11,275 per person and R19,030 per family
Benefit shared with specialised dentistry
Specialised Dentistry:
Specialised dentistry: from day-to-day benefit, up to R11,275 per person and R19,030 per family
Benefit shared with standard dentistry
In-Hospital Dentistry:
Preventative dentistry: paid by Bestmed. Includes exam, radiographs, scaling and polishing, fissure sealing and space maintainers
Standard and specilaized dentistry: From day-to-day benefit (savings first), up to M= R11,275 and M1+ = R19,030
Dental and oral surgery: R18,275 per family
PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
Orthodontics:
Subject to pre-authorisation and overall dentistry limits as above
Maxillo Facial Surgery:
Up to 100% scheme rate
Other dental/oral surgery: R17,000 per family
PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
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.
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
An additional 26 non-CDL conditions are covered at 85% scheme rate, with an overall limit of R18,006 per person and R36,174 per family
If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 20% co-payment
Acute (presrcibed) medication:
Limited to R8,063 per person and R12,524 per family
10% co-payment
From day-to-day benefit
Over-the-counter:
From savings
Birth Control:
R2,097 per family per year, paid by Bestmed
On Discharge:
7 days
Biological:
R445,480 per person
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.
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.
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
Otherwise, limited to R4,750 per person and R7,700 per family, paid from day-to-day benfit and shared with GP and Specialist benefits
/td>
Trauma:
Up to 100% scheme rate
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.
Out of hospital, paid from savings first, then extra fund, up to R9,460 per family
In-hospital, 100% scheme rate
No benefit
1.1. Hearing Aids:
R32,680 per family, every 2 years
1.2. Wheelchairs:
R12,793 per family every 4 years
Dialysis:
Up to 100% scheme rate
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: R12,470 per family
From day-to-day benefit, unless PMB
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.
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.
Functional (treating or supporting a bodily function): R16,600
Vascular: R45,150
Pacemaker, dual chamber: R56,706
Spinal, including artificial disk: R60,850
Drug-eluting stent: R20,264
Mesh: R17,845
Gynaecology/Urology: R14,728
Lens implants: R16,308 per lens
Hip replacement/prosthesis and other major joints: R54,449
Knee prosthesis: R63,049
Minor joints: R20,264
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.
PMB Mental Health conditions
These PMB mental conditions must be covered by medical aids without charging the member out-of-pocket expenses, assuming that protocols and DSPs...
Chronic PMB conditions
PMB (Prescribed Minimum Benefits), including chronic PMB conditions, are conditions that any medical aid needs to pay for, regardless of what plan...
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