Bestmed Beat 1 Network medical aid plan: 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 1 Network
Quick Overview
Main: Adult: Child:
Total Cost pm: R1,226 R953 R516
Savings (per year): No savings option on this plan
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
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
Children: Pay for maximum 4 children
  • Scheme rate is 100%, and most day-to-day expenses are paid from out of pocket, unless PMBs
  • You must use a network hospital
  • Cover for 27 chronic conditions
  • Cancer is treated in State hospitals, and PMB only
  • There are co-payments for in-hospital MRIs and CT Scans
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

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IN HOSPITAL PROCEDURES:
Beat 1 Network
Benefits Gap benefits
Payout Rate for Specialists:
  • 100% scheme rate
Fusion Gap:
  • Up to 600% 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
  • R350pm per family. More Info or download application below.
Hospital Choice:
  • Network hospitals, or up to R10,000 co-payment if you voluntarily choose another hospital
  • R12,800 per family per year for use of a non-network hospital
Specialised Radiology:
  • Co-payment: R3,200 if at private hospital, unless PMB
  • Sublimit: none
  • Rate: 100% scheme rate
  • Co-payment paid by gap cover in full
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Up to 600% of scheme rate for service providers
Transplants:
  • PMBs only
  • Up to 600% of scheme rate for service providers
Co-payments:
  • Scopes: R3,200 co-payment if in private hospital
  • Specialised radiology: R3,200 co-payment if in private hospital
Fusion Gap:
  • 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:
  • No benefit, unless PMB
  • 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.
Other:
  • N/A
  • N/A
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OUT OF HOSPITAL BENEFITS:
Beat 1 Network
Benefits Gap benefits
GP consultations:
  • No benefit, unless PMB
  • Out of hospital treatment for conditions that are PMBs is always paid for by the scheme (not out of savings), but according to protocols
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • No benefit, unless PMB
  • No benefit
Pathology:
  • No benefit, unless PMB
  • No benefit
General radiology:
  • No benefit, unless PMB
  • No benefit
Specialised radiology:
  • R4,500 per family paid by scheme
  • Sublimit increased by R40,000
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No benefit
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MATERNITY BENEFITS:
Beat 1 Network
Benefits Gap benefits
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:
  • No benefit
  • No benefit
Scans:
  • No benefit
  • No benefit
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CANCER (ONCOLOGY):
Beat 1 Network
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only, at State hospitals
  • No benefit
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DENTISTRY:
Beat 1 Network
Benefits Gap benefits
Dentistry:
  • No benefit, unless PMB
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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MEDICATION:
Beat 1 Network
Benefits Gap benefits
Chronic:
  • No. of chronic conditions covered: 26
  • Co-payment if out of formulary: 40% co-payment
  • No benefit
Acute (presrcibed) medication:
  • No benefit
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefit
  • No benefit
Birth Control:
  • R1,950 per family per year, paid by scheme
  • No benefit
On Discharge:
  • 7 days
  • No benefit
Biological:
  • No benefit
  • No benefit
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OPTOMETRY:
Beat 1 Network
Benefits Gap benefits
Optometry:
  • No benefit
  • No benefit
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MENTAL HEALTH:
Beat 1 Network
Benefits Gap benefits
In-hospital:
  • 21 days per person
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Out-of-hospital:
  • No benefit
  • No benefit
Trauma:
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OTHER BENEFITS:
Beat 1 Network
Benefits Gap benefits
General Appliances:
  • No benefit out of hospital
  • No benefit
1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • No benefit
Dialysis:
  • PMBs only
HIV:
  • Managed care programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: TBC
  • No benefit
Other:
  • Wound care: R2,970 per family, paid by scheme
  • No benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Beat 1 Network
Benefits Gap benefits
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • Covered
  • No benefit
Back Rehabilitation Programme:
  • Covered
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation: .
  • 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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PROSTHETICS:
Beat 1 Network
Benefits Gap benefits
Overal Limit:
  • Functional (treating or supporting a bodily function): R11,880
  • Vascular: R26,500
  • Pacemaker, dual chamber: R36,200
  • Spinal: R26,500
  • Mesh: R9,300
  • Gynaecology/Urology: R7,600
  • Lens implants: R5,800 per lens
    Exclusions:
  • Endovascular and catheter-based procedures
  • Artificial disk
  • Drug eluting stents
  • Joint replacements, unless PMB
    PMB joint replacements:
  • Hip replacement and other major joints: R27,900
  • Knee replacement: R34,400
  • Minor Joints: R10,700
Sub-limits:
  • Internal: R66,400 per family
  • External: no benefit
  • An additional R40,000 per sublimit, per event

    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