Bestmed Pulse 2 medical aid plan: 2020

View all plans in this scheme.
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Pulse 2
2020 Costs:
Total Cost pm:

Main member:

R5,770

Adult:

R5,770

Child:

R1,371
Savings (per year):
  • No savings option on this plan
Extended Fund: RM= R13,854
M1+= R27,537
R R



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IN HOSPITAL PROCEDURES:
Pulse 2
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:
  • 100% scheme rate
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
Co-payments:
  • None
Alternatives to hospitals:
  • Bestmed pays up to 100% scheme rate
Casualty:
  • R1,471 per family, shared with out-of-network GP visits
  • 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):
Pulse 2
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: RM= R13,854
M1+= R27,537
R R
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • Network Pulse1 GPs: unlimited
  • Not-contracted GPs: R1,471 per family, shared with casualty benefit
Childcare:
  • No extra benefits
Specialists consultations:
  • Must be referred and from Pulse Specialist DSP network
  • M =R3,054 and M+ =R5,881
Pathology:
  • Must use Provider network and referral from Pulse1 network provider
  • From day-to-day benefit
General radiology:
  • Must use Provider network and referral from Pulse1 network provider
  • From day-to-day benefit
Specialised radiology:
  • MRI/CT scans: Scheme pays for 3 scans per person
  • PET scans: Scheme pays for 1 scan per person
  • No extra benefit available
Supplementary Services: (Physio, etc)
  • M =R4,071 and M+ =R8,086 per family
  • From day-to-day benefit



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MATERNITY BENEFITS:
Pulse 2
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 Bestmed:
  • 9 consults, at GP/gynae/midwife
  • Iron and folic acid supplements
  • Post natal consult with GP/gynae/midwife
Scans:
    Bestmed pays for:
  • 2 x 2D scans



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CANCER (ONCOLOGY):
Pulse 2
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • Oncology programme
  • Biological medicine: R149,279 per person



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DENTISTRY:
Pulse 2
Scheme Benefits Notes and Links:
Standard Dentistry:
  • M= R6,955 and M+= R8,821
  • From day-to-day benefit
  • Benefit shared with specialised dentistry
  • 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:
  • M= R6,955 and M+= R8,821
  • From day-to-day benefit
  • Benefit shared with standard dentistry
In-Hospital Dentistry:
  • Dental and oral surgery: 100% scheme rate
Orthodontics:
  • See specialized dentistry benefit, above
Maxillo Facial Surgery:
  • Up to 100% scheme rate



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MEDICATION:
Pulse 2
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 16 non-CDL conditions are covered at 85% scheme rate, with an overall limit of M =R6,559 and M+ =R13,118
  • If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 20%-25% co-payment
Acute (presrcibed) medication:
  • M= R4,354 and M+ =R8,821
  • From day-to-day benefit
Over-the-counter:
  • R579 per family
Birth Control:
  • R2,205 per family per year, paid by Bestmed
On Discharge:
  • 7 days
Biological:
  • R149,279 per person



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OPTOMETRY:
Pulse 2
Scheme Benefits: Notes and Links:
Optometry:
Limit:Paid by scheme, every 24 months
Consult:1 per person
Frames:R868
Single lenses100% cost from provider, or R184 from non-provider
Bifocals:100% cost from provider, or R431 from non-provider
Multifocals100% cost from provider, or R747 from non-provider
ContactsR1,510
Refractive Surgery:R8,990



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MENTAL HEALTH:
Pulse 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 R30,760 per person
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:
Pulse 2
Scheme Benefits Notes and Links:
General Appliances:
  • Out of hospital: R9,839 per family
  • In-hospital: 100% scheme rate
1.1. Hearing Aids:
  • R27,368 per family, every 2 years
1.2. Wheelchairs:
  • R12,666 per family every 4 years
Dialysis:
  • Up to 100% scheme rate
International Insurance:
    In brief (all subject to conditions of policy):
  • Medical expenses up to R10 million and maximum 90 days
Other:
  • Wound care: R9,500 per family



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WELLNESS/PREVENTATIVE BENEFITS:
Pulse 2
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered
Biometric Screening:
  • Covered
Child Immunisation:
  • No benefit
Pap Smear:
  • No benefit, unless PMB
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:
Pulse 2
Scheme Benefits: Notes and Links:
Overal Limit:
  • Overall: R101,216 per family
  • External: R24,427 per family
Sub-limits:
    (per person):
  • Functional (treating or supporting a bodily function): R16,794
  • Vascular: R39,129
  • Pacemaker, dual chamber: R53,040
  • Spinal: R39,129
  • Artificial disk: R17,190
  • Drug-eluting stents: R17,190
  • Mesh: R17,190
  • Gynaecology/Urology: R12,780
  • Lens implants: R10,970 per lens
  • Hip replacement and other major joints: R46,819
  • Knee prosthesis: R54,679
  • Minor joints: R20,356



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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