Bestmed Beat 2 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 2 Network
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R1,517 R1,178 R639
Cost 2017: (R1,399) (R1,087) (R589)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited overall, with sub-limits
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: R3,096 R2,400 R1,308
Children: Pay for maximum 4 children
  • 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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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Beat 2 Network
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: 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.

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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:
  • 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: 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.
Other:
  • N/A
  • N/A
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OUT OF HOSPITAL BENEFITS:
Beat 2 Network
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Paid from day-to-day 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


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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:
  • R4,500 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 2 Network
2017 v 2018 benefits 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

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Consultations:
  • Paid from day-to-day benefit
  • No benefit
Scans:
  • Paid from day-to-day benefit
  • No benefit
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CANCER (ONCOLOGY):
Beat 2 Network
2017 v 2018 benefits 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 2 Network
2017 v 2018 benefits 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 reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments

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Orthodontics:
  • Subject to pre-authorisation
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB
  • Dental reconstruction as result of trauma or oncology: R40,000 per event

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
Beat 2 Network
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27
  • Co-payment if out of formulary: 40% co-payment
  • No benefit

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Acute (presrcibed) medication:
  • Paid from day-to-day 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 2 Network
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • Paid from day-to-day benefit
  • No benefit

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MENTAL HEALTH:
Beat 2 Network
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • 21 days per person
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Out-of-hospital:
  • Paid from day-to-day benefit
  • No benefit
Trauma:
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OTHER BENEFITS:
Beat 2 Network
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • Paid from day-to-day benefit
  • No benefit

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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 2 Network
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit

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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

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
  • Functional (treating or supporting a bodily function): R11,800
  • 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

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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