Bestmed Pace 1 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:
Pace 1
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R3,312 R2,325 R836
Cost 2017: (R3,055) (R2,145) (R711)
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: R7,944 R5,580 R2,004
Extended Fund: RM= R9,180
M1+= R18,360
R R
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:
Pace 1
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:
  • Unlimited
  • N/A
Specialised Radiology:
  • Co-payment: none
  • Sublimit: none
  • Rate: 100% scheme rate
  • N/A
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:
  • N/A
  • N/A
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:
Pace 1
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Limited to R1,890 per person and R3,800 per family
  • Paid from savings first, then from extra fund
  • Shared with specialist benefit
  • 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:
  • Shared with GP benefits, see above
  • No benefit
Pathology:
  • R2,750 perperson and R5,500 per family
  • Paid from and savings first, then from extra fund
  • Shared with radiology benefit
  • No benefit
General radiology:
  • R2,750 perperson and R5,500 per family
  • Paid from and savings first, then from extra fund
  • Shared with pathology benefit
  • No benefit
Specialised radiology:
  • R12,300 per family, paid by scheme
  • Sublimit increased by R40,000
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • R3,700 per person and R7,700 per family
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  • No benefit
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MATERNITY BENEFITS:
Pace 1
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:
  • 12 consults, paid by scheme
  • No benefit
Scans:
  • 2 scans, paid by scheme
  • No benefit
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CANCER (ONCOLOGY):
Pace 1
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • PMBs only
  • 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:
Pace 1
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, paid from savings first, then extra fund if available, subject to limit below
  • Limited to M= R3,400 and M1+ =R6,900
  • 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 and overall dentistry limits as above
  • No benefit
Maxillo Facial Surgery:
  • R11,000 per family
  • Other dental/oral surgery: R6,800 per family
  • 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:
Pace 1
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 7 conditions covered at 85% scheme rate
  • Co-payment if out of formulary: 35% co-payment
  • Overall limit: R5,600 per person and R11,200 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
  • No benefit

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Acute (presrcibed) medication:
  • Limited to M1= R1,980 and M1+ =R4,100
  • Paid from savings first, then extra fund
  • No benefit
Over-the-counter:
  • TBC
  • 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:
Pace 1
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • Consultation: R365
  • Frame: R550
  • Lenses: Single R175 or Bifocal R380 or Multifocal R695
  • Contact lenses: R1,420
  • Refractive surgery: R7,560 per eye
  • Paid by scheme, subject to day-to-day limit
  • No benefit

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MENTAL HEALTH:
Pace 1
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • 21 days per person
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Out-of-hospital:
  • Limited to M =R1,890 and M1+ =R3,800
  • Paid from savings first, then extra fund
  • Shared with GP and specialist benefit
  • No benefit
Trauma:
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OTHER BENEFITS:
Pace 1
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • R9,700 per family
  • Paid from savings first, then extra fund
  • No benefit

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1.1. Hearing Aids:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • PMBs only
HIV:
  • Managed care programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: TBC
  • No benefit
Other:
  • Wound care: R3,050 per family
  • First from savings, then extra fund if available
  • Rehab after trauma: vested savings
  • No benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Pace 1
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:
  • Covered
  • No benefit
PAS Test: TBC
  • No benefit
HIV Test: TBC
  • No benefit
Other:
  • HPV and HIB Vaccinations
  • 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): R13,650
  • Vascular: R27,700
  • Pacemaker, dual chamber: R47,300
  • Spinal: R27,700
  • Mesh: R10,400
  • Gynaecology/Urology: R7,500
  • Lens implants: R5,700 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: R28,200
  • Knee replacement: R37,500
  • Minor Joints: R11,650

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Sub-limits:
  • Internal: R76,000 per family
  • External: R19,300 per family
  • 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