Bestmed Beat 1 Network medical aid plan: 2019

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Beat 1 Network
2019 Costs:
Total Cost pm:

Main member:

R1,335

Adult:

R1,038

Child: (Pay only for first 4)

R562
Savings (per year):
  • No savings option on this plan
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In brief (2018):
  • Scheme rate is 100%, (gap increases this to 500%)
  • Most day-to-day expenses are paid from out of pocket, unless PMBs
  • You must use a network hospital
  • Treatment and medicine for 27 chronic conditions covered by scheme
  • Cancer (PMB only) is treated in state hospitals, but you can upgrade to higher plan on cancer diagnosis to receive private hospital treatment
  • There are co-payments for in-hospital MRIs and CT Scans (gap cover pays this co-payment)
  • There is a benefit for out-of-hospital specialised radiology (paid in full with gap cover)
  • 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:
Beat 1 Network
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:
  • You or your gap cover pay R3,200 co-payment if done in private hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
Transplants:
  • PMBs only
Co-payments:
  • Scopes: You or your gap cover pay R3,440co-payment if done in private hospital
  • Specialised radiology: You or your gap cover pay R3,440co-payment if done in private hospital
Alternatives to hospitals:
  • Bestmed pays up to 100% scheme rate
  • You pay the balance, if any
Casualty:
  • No benefit, unless PMB
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)
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

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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):
Beat 1 Network
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • This plan has no savings fund, so most out of hospital costs are paid by you
  • Remember, out of hospital costs authorised as part of PMB treatment (eg. cancer, asthma or stroke) are always paid by the scheme, even on this plan.
GP consultations:
  • No benefit, unless PMB
Childcare:
  • No extra benefits
Specialists consultations:
  • No benefit, unless PMB
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • Bestmed pays up to R4,837 per family
  • You or your gap cover pay the balance
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
What next?
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MATERNITY BENEFITS:
Beat 1 Network
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% scheme rate
Consultations:
  • No benefit, unless PMB
Scans:
  • No benefit, unless PMB
What next?
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CANCER (ONCOLOGY):
Beat 1 Network
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, at DSP (designated service provider)
What next?
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DENTISTRY:
Beat 1 Network
Scheme Benefits Notes and Links:
Standard Dentistry:
  • No benefit
Specialised Dentistry:
  • No benefit
In-Hospital Dentistry:
  • No benefit, unless PMB
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • You pay this out of pocket, unless it's to treat a PMB (then, at DSP day hospitals only).
  • PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
What next?
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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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MEDICATION:
Beat 1 Network
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary: 40%
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
  • R2,097 per family per year, paid by Bestmed
On Discharge:
  • 7 days
Biological:
  • No benefit, unless PMB level of care
What next?
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OPTOMETRY:
Beat 1 Network
Scheme Benefits: Notes and Links:
Optometry:
Limit:No benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
What next?
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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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MENTAL HEALTH:
Beat 1 Network
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
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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?
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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OTHER BENEFITS:
Beat 1 Network
Scheme Benefits Notes and Links:
General Appliances:
    Out of hospital, you pay this out of pocket
  • In-hospital, 100% scheme rate
  • No benefit
1.1. Hearing Aids:
  • You pay this out of pocket
1.2. Wheelchairs:
  • You pay this out of pocket
Dialysis:
  • Bestmed only pays for PMB cases, with a designated network provider
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: R3,193 per family, paid by Bestmed
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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WELLNESS/PREVENTATIVE BENEFITS:
Beat 1 Network
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: .
Pap Smear:
  • Covered, 18yrs+ every 2 years
Mammogram:
  • No benefit, unless PMB
PAS Test:
  • No benefit, unless PMB
HIV Test:
Other:
  • HPV Vaccinations
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:
Beat 1 Network
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R71,380 per family
  • External: no benefit
Sub-limits:
    (per person):
  • Functional (treating or supporting a bodily function): R12,770
  • Vascular: R28,490
  • Pacemaker, dual chamber: R38,915
  • Spinal: R28,490
  • Mesh: R9,998
  • Gynaecology/Urology: R8,170
  • Drug eluting stents: DSP products only
  • Lens implants: R6,235 per lens
    Exclusions:
  • Endovascular and catheter-based procedures
  • Artificial disk
  • Joint replacements, unless PMB
    PMB joint replacements - prothesis limits:
  • Hip replacement and other major joints: R29,993
  • Knee replacement: R36,980
  • Minor Joints: R11,503
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