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all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.
| Pace 4 |
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| Total Cost pm: |
R7,983 |
R7,983 |
R1,870 |
| Savings: |
R2880 |
R2880 |
R684 |
| Extended Fund: |
RM= R34,153
M1+= R55,075 |
R |
R |
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IN HOSPITAL PROCEDURES:
Pace 4 |
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Scheme Benefits: |
Notes and Links: |
| non-Network Specialists: |
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| network Specialists: |
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| non-Network GPs: |
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| network GPs: |
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| Hospital Choice: |
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| Penalty for using other hospital: |
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| Specialised Radiology: |
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| Supplementary Services: (Physio, etc) |
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- The Blue Plan gap cover will increase this to 500% scheme rate
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| Transplants: |
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| Co-payments: |
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| Alternatives to hospitals: |
- Bestmed pays up to 100% scheme rate
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| Casualty: |
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- Both the Blue Plan and Red Plan gap cover will pay up to R10,000 per person for unpaid casualty costs in event of emergency
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| Other: |
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| Note: |
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- Gap cover is an add-on to your medical aid, not a stand alone product
- Gap cover has a maximum benefit payout of R165,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R165,000 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):
Pace 4 |
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Scheme Benefits |
Notes and Links: |
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Main Member: |
Adult: |
Child: |
| Extended Fund: |
RM= R34,153
M1+= R55,075 |
R |
R |
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| General info: |
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- 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
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| GP consultations: |
- Subject to day-to-day benefit, savings first)
- M =R5,372 and M+ =R8,708
- Shared with specialist benefit
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- See Primary Health Care benefit above
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| Childcare: |
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| Specialists consultations: |
- Shared with GP benefits, see above
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- See Primary Health Care benefit above
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| Pathology: |
- Subject to day-to-day benefit, savings first)
- M =R5,372 and M+ =R10,574
- Shared with standard radiology benefit
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- See Primary Health Care benefit above
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| General radiology: |
- Shared with pathology benefits, see above
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- See Primary Health Care benefit above
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| Specialised radiology: |
- MRI/CT scans: Scheme pays for 3 scans per person
- PET scans: Scheme pays for 1 scan per person
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| Supplementary Services: (Physio, etc) |
- M =R5,372 and M+ =R10,574
- From day-to-day benefit, (savings first)
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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MATERNITY BENEFITS:
Pace 4 |
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Scheme Benefits |
Notes and Links: |
| Hospital stay: |
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- The Blue Plan gap cover will increase this to 500% scheme rate
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| Consultations: |
Paid by Bestmed:
- 9 consults, at GP/gynae/midwife
- Iron and folic acid supplements
- Post natal consult with GP/gynae/midwife
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| Scans: |
Bestmed pays for:
- 2 x 2D scans
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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CANCER (ONCOLOGY):
Pace 4 |
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Scheme Benefits |
Notes and Links: |
| Overall coverage (in and out of hospital): |
- Oncology programme
- Biological medicine: R468,645 per person
- Mammmary surgery (breast cancer): R35,000
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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DENTISTRY:
Pace 4 |
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Scheme Benefits |
Notes and Links: |
| Standard Dentistry: |
- From day-to-day benefit
- M =R11,861 and M+ =R20,020
- Benefit shared with specialised dentistry
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- 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
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| Specialised Dentistry: |
- From day-to-day benefit
- M =R11,861 and M+ =R20,020
- Benefit shared with standard dentistry
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| In-Hospital Dentistry: |
- Dental and oral surgery: R19,225 per family
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| Orthodontics: |
- Subject to pre-authorisation and overall dentistry limits as above
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| Maxillo Facial Surgery: |
- Up to 100% scheme rate
- PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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MEDICATION:
Pace 4 |
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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
- An additional 28 non-CDL conditions are covered at 90% scheme rate, with an overall limit of M= R18,942 and M+ =R38,055
- If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 15% - 20% co-payment
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| Acute (presrcibed) medication: |
- M =R8,482 and M+ =R13,175
- From day-to-day benefit, (savings first)
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- 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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| Over-the-counter: |
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| Birth Control: |
- R2,205 per family per year, paid by Bestmed
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| On Discharge: |
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| Biological: |
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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OPTOMETRY:
Pace 4 |
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Scheme Benefits: |
Notes and Links: |
| Optometry: |
| Limit: | Paid by scheme, every 24 months |
| Consult: | 1 per person |
| Frames: | R868 |
| Single lenses | 100% cost from network, or R184 |
| Bifocals: | 100% cost from network, or R431 |
| Multifocals | 100% cost from network, or R747 |
| Contacts | R1,510 |
| Refractive Surgery: | R9,613 per eye |
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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MENTAL HEALTH:
Pace 4 |
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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 R30,760 per person
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| Out-of-hospital: |
- PMBs always paid in full at DSP, and include consultations
- Otherwise, M =R5,372 and M+ =R8,708
- Shared with GP and specialist benefit
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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
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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OTHER BENEFITS:
Pace 4 |
|
Scheme Benefits |
Notes and Links: |
| General Appliances: |
- Out of hospital, R9,952 per family from day-to-day benefit (savings first)
- In-hospital, 100% scheme rate
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| 1.1. Hearing Aids: |
- R34,379 per person, every 2 years
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| 1.2. Wheelchairs: |
- R13,458 per family every 4 years
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| Dialysis: |
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| International Insurance: |
In brief (all subject to conditions of policy):
- Medical expenses up to R10 million and maximum 90 days
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| Other: |
- Wound care: R13,118 per family, from day-to-day benefit, savings first
- Insulin Pump: R40,000 per person
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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WELLNESS/PREVENTATIVE BENEFITS:
Pace 4 |
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Scheme Benefits: |
Notes and Links: |
| Flu vaccination: |
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| Pneumonia vaccines: |
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| Biometric Screening: |
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| Child Immunisation: |
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| Pap Smear: |
- Covered, 18yrs+ every 2 years
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| Mammogram: |
- Covered, women 40yrs+, every two years
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| PAS Test: |
- Covered, 50yrs+ every 2 years
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| HIV Test: |
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| Other: |
- HPV and HIB Vaccinations
- Bone densitometry
- Tempo Programme which includes bio screening, child assessments, nutrition assessments, fitness and nutritional interventions (biokineticist and dietician consults)
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
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PROSTHETICS:
Pace 4 |
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Scheme Benefits: |
Notes and Links: |
| Overal Limit: |
- Overall: R128,018 per family
- External: R29,517 per family
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| Sub-limits: |
(per person):
- Functional (treating or supporting a bodily function): R18,773
- Vascular: R47,498
- Pacemaker, dual chamber: R59,655
- Spinal, including artificial disk: R64,014
- Drug-eluting stent: R21,318
- Mesh: R18,773
- Gynaecology/Urology: R15,494
- Lens implants: R17,156 per lens
- Hip replacement/prosthesis and other major joints: R57,280
- Knee prosthesis: R66,328
- Minor joints: R21,318
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We’ll quote you on 2 similar plans too, so you can choose the best one for you!
Are you already on this plan, but need help? Get in touch!
|
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
