Bestmed Pulse 2 medical aid plan: 2019

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Pulse 2
2019 Costs:
Total Cost pm:

Main member:

R5,298

Adult:

R5,298

Child: (Pay only for first 4)

R1,124
Savings (per year):
  • No savings option on this plan
Extended Fund: RM= R13,168
M1+= R26,176
R R
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IN HOSPITAL PROCEDURES:
Pulse 2
Scheme Benefits: Notes and Links:
Specialists:
  • Up to 100% scheme rate
  • You or gap cover pay the balance, if any
Gap Cover
  • 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.
Hospital Choice:
  • Choose from Network hospitals, or pay R10,750 co-payment if you voluntarily choose another hospital
Specialised Radiology:
  • 100% scheme rate
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
Co-payments:
  • None
Alternatives to hospitals:
  • Bestmed pays up to 100% scheme rate
  • You pay the balance, if any
Casualty:
  • Two casualty visits per family, limited to R1,300
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 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)
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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= R13,168
M1+= R26,176
R R
General info:
  • This plan has an "extra" fund ("day-to-day benefit"), so most out of hospital costs are paid by this, subject to sub-limits per benefit (see below)
GP consultations:
  • Contracted Pulse1 GPs: unlimited
  • Not-contracted GPs: R1,398 per family
Childcare:
  • No extra benefits
Specialists consultations:
  • Must be referred, pre-approved and only at Bestmed Specialist DSP
  • Limited to R2,903 per person and R5,590 per family, subject to day-to-day benefit
Pathology:
  • Paid by Bestmed if network is used, subject to protocols and day-to-day benefit
General radiology:
  • Paid by Bestmed if network is used, subject to protocols and day-to-day benefit
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)
  • R3,870 per person and R7,686 per family
  • From day-to-day benefit
What next?
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MATERNITY BENEFITS:
Pulse 2
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% scheme rate
Consultations:
    Paid by Bestmed:
  • 9 consults, at GP/gynae/midwife
  • 4 x 2D specific scans
  • Iron and folic acid supplements
  • Post natal consult with GP/gynae/midwife
Scans:
    Bestmed pays for:
  • 4 scans
What next?
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CANCER (ONCOLOGY):
Pulse 2
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • Oncology programme
  • Biological medicine: R141,900 per person
What next?
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DENTISTRY:
Pulse 2
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard dentistry: R6,611 per person and R8,385 per family, paid from day-to-day benefit
  • Benefit shared with specialised dentistry
Specialised Dentistry:
  • Specialised dentistry: R6,611 per person and R8,385 per family, paid from day-to-day benefit
  • Benefit shared with standard dentistry
In-Hospital Dentistry:
  • Dental and oral surgery: 100% scheme rate
Orthodontics: See above
Maxillo Facial Surgery:
  • Up to 100% scheme rate
What next?
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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 R6,235 per person and R12,470 per family
  • If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 25% co-payment
Acute (presrcibed) medication:
  • R4,139 per person and R8,385 per family
  • Paid by Bestmed only if on medicine list ("provider network formulary")
  • From day-to-day benefit
Over-the-counter:
  • R550 per family
Birth Control:
  • R2,097 per family per year, paid by Bestmed
On Discharge:
  • 7 days
Biological:
  • R141,900 per person
What next?
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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:R825
Single lenses100% cost
Bifocals:R175
MultifocalsR710
ContactsR1,435
Refractive Surgery:R8,546
Notes:Above benefits from network provider
What next?
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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 R29,240 per person
Out-of-hospital:
  • Out-of-hospital: PMBs always paid in full at DSP, and include consultations
  • Otherwise, limited to R2,700 per person and R5,200 per family, paid from day-to-day benfit and shared with GP and Specialist benefits
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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
What next?
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OTHER BENEFITS:
Pulse 2
Scheme Benefits Notes and Links:
General Appliances:
  • Out of hospital, R9,353 per family from day-to-day benefit
  • In-hospital, 100% scheme rate
  • No benefit
1.1. Hearing Aids:
  • R26,015 per family, every 2 years
1.2. Wheelchairs:
  • R12,040 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: R9,030 per family
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

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WELLNESS/PREVENTATIVE BENEFITS:
Pulse 2
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Twice in a lifetime, with a booster above 65yrs
Back Rehabilitation Programme:
  • 6 weeks, once a year
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • No benefit, unless PMB
Mammogram:
  • No benefit, unless PMB
PAS Test:
  • No benefit, unless PMB
HIV Test:
Other:
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.

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PROSTHETICS:
Pulse 2
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R96,213 per family
  • External: R23,220 per family
Sub-limits:
    (per person):
  • Functional (treating or supporting a bodily function): R15,964
  • Vascular: R37,195
  • Pacemaker, dual chamber: R50,418
  • Spinal: R37,195
  • Artificial disk: R16,340
  • Drug-eluting stents: R16,340
  • Mesh: R16,340
  • Gynaecology/Urology: R12,148
  • Lens implants: R10,428 per lens
  • Hip replacement and other major joints: R44,505
  • Knee prosthesis: R51,976
  • Minor joints: R19,350
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.


    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