Bestmed Beat 3 Network medical aid plan: 2017 vs 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.

COSTS and OVERVIEW:
Beat 3 Network
2018 costs Gap
In brief: On Beat 3 Network in 2018:
  • Scheme rate is 100%, and most day-to-day expenses are paid by scheme, or from savings or from out of pocket, unless PMBs
  • You must use a network hospital
  • Bestmed pays for some optometry, out of hospital MRIs, maternity consults, and some preventative benefits
  • Cover for 32 chronic conditions
  • Cancer is treated in State hospitals, and PMB only
See full benefits below
For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims to 500% scheme rate
  • pays for ER treatment,
  • covers the 20% co-payment for cancer claims and
  • covers other in-hospital co-payments
See more benefits below, or full benefits here.
What’s new in 2018?
  • There are no major changes to this plan in 2018, other than the usual monetary increases in premiums, benefits and co-payments

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Contributions:
Main: Adult: Child:
Cost 2018: R2,301 R1,636 R889
Cost 2017: (R2,123) (R1,509) (R820)
Overal Limit: Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: R4,704 R3,336 R1,812
Children: Pay for maximum 4 children
2018 Gap prices are to be confirmed, will be about R300 per family of under 65yrs, and R400 per family with a member who is 65yrs+.
Find out more
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IN HOSPITAL PROCEDURES:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 100% scheme rate
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Network hospitals, or up to R10,000 co-payment if you voluntarily choose another hospital
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology:
  • 100% scheme rate
  • N/A
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Up to 500% of scheme rate for service providers
Transplants:
  • PMBs only
  • Up to 500% of scheme rate for service providers
Co-payments:
  • Scopes: R3,200 co-payment if in private hospital
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • 100% scheme rate
  • No benefit
Casualty: TBC
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit
  • No benefit
Pathology:
  • Paid from day-to-day benefit
  • No benefit
General radiology:
  • Paid from day-to-day benefit
  • No benefit
Specialised radiology:
  • R9,450 per family paid by scheme
  • Sublimit increased by R40,000
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • No benefit
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MATERNITY BENEFITS:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • Midwife births: covered
  • Up to additional 500% of medical aid rate
  • Premature birth (more than 6 weeks before due date): R12,000 lump sum
  • Premature birth (more than 6 weeks before due date):R300 per day, for days 1-13; R600 per day for days 14-20; R1,200 per day for days 21-30
Consultations:
  • 12 consults, paid by scheme
  • No benefit
Scans:
  • 2 scans, paid by scheme
  • No benefit
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CANCER (ONCOLOGY):
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • PMBs only, at State hospitals
  • No benefit
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • Preventative dentistry: paid by scheme. Includes exam, radiographs, scaling and polishing, fissure sealing and space maintainers
  • Otherwise, from day-to-day benefit
  • Dental and oral surgery: R6,800 per family
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Other sublimits increased by R40,000
Orthodontics:
  • Subject to pre-authorisation
  • No benefit
Maxillo Facial Surgery:
  • R10,900 per family paid by scheme
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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MEDICATION:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27CDLs plus 5 conditions covered at 75% scheme rate
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: R2,900 per person and R5,450 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
  • No benefit
Acute (presrcibed) medication:
  • Paid from day-to-day benefit
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefit, limited to R525
  • No benefit
Birth Control:
  • R1,950 per family per year, paid by scheme
  • No benefit
On Discharge:
  • 7 days
  • Up to 500% of scheme rate for service providers
Biological:
  • No benefit
  • No benefit
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OPTOMETRY:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
    Consultation: R365
  • Frame: R550
  • Lenses: Single R175 or Bifocal R380 or Multifocal R695
  • Contact lenses: R1,420
  • Refractive surgery: R7,000 per eye
  • Paid by scheme
  • No benefit
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MENTAL HEALTH:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital:
  • 21 days per person
  • Up to 500% of scheme rate for service providers
Out-of-hospital:
  • Paid from day-to-day benefit
  • No benefit
Trauma:
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OTHER BENEFITS:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • Paid from day-to-day benefit
  • No benefit
1.1. Hearing Aids:
  • Paid from day-to-day benefit
  • No benefit
1.2. Wheelchairs:
  • Paid from day-to-day benefit
  • No benefit
Dialysis:
  • PMBs only
HIV:
  • Managed care programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: TBC
  • No benefit
Other:
  • Wound care: R2,950 per family, paid by scheme
  • No benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Beat 3 Network
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
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:
  • No benefit
  • No benefit
PAS Test:
  • No benefit
  • No benefit
HIV Test: TBC
  • No benefit
Other:
  • No benefit
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2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overal Limit:
Sub-limits:

    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