Bestmed Pace 4 medical aid plan: 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

Pace 4
2018 Costs:
Total Cost pm:

Main member:

R6,608

Adult:

R6,608

Child: (Pay only for first 4)

R1,548
Savings Account (yr): R2376 R2376 R552
Extended Fund: RM= R30,200
M1+= R48,700		 R R
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child: (Pay only for first 4)

R
In brief (2018):
  • Scheme rate is 100%, (gap increases this to 500%)
  • Most day-to-day expenses are paid by scheme, or from savings or from out of pocket, unless PMBs
  • Bestmed supplements your savings for some out of hospital claims with an extra fund
  • Bestmed pays for maternity consults and scans
  • Cancer cover includes biological medicine (limit increased with gap cover)
  • Bestmed pays for refractive surgery
  • Treatment and medicine for 52 chronic conditions covered by scheme
  • There is a benefit for out-of-hospital specialised radiology (gap increases the limit)
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

IN HOSPITAL PROCEDURES:
Pace 4
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
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Hospital Choice:
  • Choose any hospital
  • No extra benefit necessary
Specialised Radiology:
  • 100% scheme rate
  • No extra benefit necessary
Supplementary Services: (Physio, etc)
  • Bestmed pays up to 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Transplants:
  • Bestmed pays up to 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Co-payments:
  • None
  • No extra benefit necessary
Alternatives to hospitals:
  • Bestmed pays up to 100% scheme rate
  • You pay the balance, if any
  • No extra benefit available
Casualty:
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other:
  • N/A
  • N/A
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)

No phone calls!
Our quote will include the right gap cover for this plan

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 Gap benefits
Main: Adult: Child:
Savings /yr: R2376 R2376 R552
Extended Fund: RM= R30,200
M1+= R48,700		 R R
General info:
  • This plan has a savings fund as well as an "extra" fund, so most out of hospital costs are 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.
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • Bestmed pays up to R4,750 per person and R7,700 per family. All else is paid out of pocket
  • It is paid from savings first, then from extra fund
  • Shared with specialist benefit
    • No extra benefit available
    Childcare:
    • No extra benefits
    • No extra benefit available
    Specialists consultations:
    • Shared with GP benefits, see above
    • No extra benefit available
    Pathology:
    • R4,750 per person and R9,350 per family
    • Paid from savings first, then from extra fund
    • Shared with radiology benefit
    • No extra benefit available
    General radiology:
    • Shared with pathology benefits, see above
    • No extra benefit available
    Specialised radiology:
    • Bestmed pays for 3 MRI/CT scans and 1 PET scan per family
    • All else is paid by you out-of-pocket
    • No extra benefit available
    Supplementary Services: (Physio, etc)
    • R4,750 per person and R9,350 per family
    • Paid from day-to-day benefit
    • No extra benefit available

    No phone calls!
    Our quote will include the right gap cover for this plan
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    MATERNITY BENEFITS:
    Pace 4
    Scheme Benefits Gap benefits
    Hospital stay:
    • Bestmed pays up to its scheme rate, includiing for births with midwife
    • You or gap cover pay the balance, if any
    • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
    Consultations:
    • 12 consults, paid by Bestmed
    • No extra benefit available
    Scans:
    • 2 scans, paid by Bestmed
    • No extra benefit available

    No phone calls!
    Our quote will include the right gap cover for this plan
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    CANCER (ONCOLOGY):
    Pace 4
    Scheme Benefits Gap benefits
    Overall coverage (in and out of hospital):
    • Oncology program
    • Biological medicine: R414,000 per person
    • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, the gap cancer benefit will cover costs authorised but not paid by your medical scheme (up to the R150,000 per person per year gap cover limit). This includes extra cover for biological medicine short-payments or co-payments. More info

    No phone calls!
    Our quote will include the right gap cover for this plan
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    DENTISTRY:
    Pace 4
    Scheme Benefits Gap benefits
    Dentistry:
    • R10,250 per person and R17,300 per family, subject to day-to-day benefit
    • PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
    • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)
    Orthodontics:
    • Subject to pre-authorisation and overall dentistry limits as above
    • No extra benefit available
    Maxillo Facial Surgery:
    • 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
    • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

    No phone calls!
    Our quote will include the right gap cover for this plan
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    MEDICATION:
    Pace 4
    Scheme Benefits Gap benefits
    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
    • An additional 26 non-CDL conditions are covered at 85% scheme rate, with an overall limit of R16,750 per person and R33,650 per family
    • If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 20% co-payment
    • No extra benefit available
    Acute (presrcibed) medication:
    • Limited to R7,500 per person and R11,650 per family
    • 10% co-payment
    • Paid from day-to-day benefits
    • No extra benefit available
    Over-the-counter:
    • Paid from day-to-day benefit
    • No extra benefit available
    Birth Control:
    • R1,950 per family per year, paid by Bestmed
    • No extra benefit available
    On Discharge:
    • 7 days
    • No extra benefit available
    Biological:
    • R414,400 per person
    • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, the gap cancer benefit will cover costs authorised but not paid by your medical scheme (up to the R150,000 /person /year gap cover limit). This includes extra cover for biological medicine short-payments or co-payments. More info

    No phone calls!
    Our quote will include the right gap cover for this plan
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    OPTOMETRY:
    Pace 4
    Scheme Benefits Gap benefits
    Optometry:
    • Paid at cost if obtained from PPN provider (Torga or Specsavers included), every 24 months
    • Paid from day-to-day limit
    • Refractive surgery: R8,500 per eye, paid by scheme
    • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

    No phone calls!
    Our quote will include the right gap cover for this plan
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    MENTAL HEALTH:
    Pace 4
    Scheme Benefits Gap benefits
    In-hospital:
    • Bestmed will pay for up to 21 days per person at 100% scheme rate, and may require use of specific providers
    • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
    • No extra benefit available
    • (PMBs are paid in full by scheme if you use DSP)
    Out-of-hospital:
    • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
    • Otherwise, limited to R4,750 per person and R7,700 per family, paid from day-to-day benefit
    • Shared with GP and specialist benefit
    • No extra benefit available
    • (PMBs are paid in full by scheme if you use DSP)
    Trauma:
    • 100% scheme rate
    • No extra benefit available

    No phone calls!
    Our quote will include the right gap cover for this plan
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    OTHER BENEFITS:
    Pace 4
    Scheme Benefits Gap benefits
    General Appliances:
    • R8,800 per family
    • Paid from day-to-day benefits
    • No benefit
    1.1. Hearing Aids:
    • R30,400 per family, every 2 years
    • No benefit
    1.2. Wheelchairs:
      R11,900 per family every 4 years
    • No benefit
    Dialysis:
    • 100% scheme rate
    • Gap cover will pay shortfall for authorised in and out-of-hospital treatment
    • Note that gap does not pay penalties, for example if you have a co-payment because you voluntarily opted to use a non-DSP
    HIV:
    • Managed care programme
    • No benefit
    Emergency Transport:
    • ER24
    • No benefit
    International Insurance: TBC
    • No benefit
    Other:
    • Wound care: R11,600 per family
    • From day-to-day benefit
    • No extra benefit available

    No phone calls!
    Our quote will include the right gap cover for this plan
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    WELLNESS/PREVENTATIVE BENEFITS:
    Pace 4
    Scheme Benefits Gap benefits
    Flu vaccination:
    • Covered
    • No benefit
    Pneumonia vaccines:
    • Covered
    • No benefit
    Back Rehabilitation Programme:
    • Covered
    • No benefit
    Biometric Screening:
    • Covered
    • No benefit
    Child Immunisation:
    • Covered
    • No benefit
    Pap Smear:
    • Covered, 18yrs+ every 2 years
    • No benefit
    Mammogram:
    • Covered
    • No benefit
    PAS Test:
    • Covered
    • No benefit
    HIV Test: TBC
    • No benefit
    Other:
    • HPV and HIB Vaccinations
    • Bone densitometry
    • No benefit

    No phone calls!
    Our quote will include the right gap cover for this plan
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    PROSTHETICS:
    Pace 4
    Scheme Benefits Gap benefits
    Overal Limit:
    • Internal: R113,200 per family
    • External: R26,100 per family
    • Sublimit increased by up to R150,000 per person
    • No benefit for procedures excluded by medical aid
    Sub-limits:
    • Functional (treating or supporting a bodily function): R16,600
    • Vascular: R42,000
    • Pacemaker, dual chamber: R52,750
    • Spinal: R42,000
    • Artificial disk: R18,850
    • Drug-eluting stent: R18,850
    • Mesh: R16,600
    • Gynaecology/Urology: R13,700
    • Lens implants: R15,170 per lens
    • Hip replacement and other major joints: R50,650
    • Knee replacement: R58,650
    • Minor joints: R18,850
    • Sublimit increased by up to R150,000 per person
    • No benefit for procedures excluded by medical aid

    No phone calls!
    Our quote will include the right gap cover for this plan

      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