Bestmed Pace 3B medical aid plan: 2018

This plans has been discontinued for 2018. See below for similar.

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 3 A
Quick Overview
Main: Adult: Child:
Total Cost pm: R5,370 R4,322 R923
Savings: R9,660 R7,776 R1,668
Extended Fund: RM= R16,200
M1+= R33,480
R R
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
Income band: This plan is only available to households with income in All income levelspm band.
View other income bands
  • Scheme rate is 100%, and most day-to-day expenses are paid by scheme, or from savings or from out of pocket, unless PMBs
  • Bestmed supplements your savings for some out of hospital claims with an extra fund. It also pays for refractive surgery
  • Cover for 46 chronic conditions
  • 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:
Pace 3 A
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:
  • 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:
  • Covered at 100% scheme rate
  • 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 3 A
Benefits Gap benefits
GP consultations:
  • Limited to R3,700 per person and R7,500 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
Childcare:
  • No benefit
Specialists consultations:
  • Shared with GP benefits, see above
  • No benefit
Pathology:
  • R3,000 per person and R5,950 per family
  • Paid from savings first, then from extra fund
  • Shared with radiology benefit
  • No benefit
General radiology:
  • R3,000 per person and R5,950 per family
  • Paid from savings first, then from extra fund
  • Shared with pathologybenefit
  • No benefit
Specialised radiology:
  • 3 MRI/CT scans and 1 PET scan per family, paid by scheme
  • No benefit
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • R2,260 per person and R4,750 per family
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  • No benefit
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MATERNITY BENEFITS:
Pace 3 A
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:
  • 12 consults, paid by scheme
  • No benefit
Scans:
  • 2 scans, paid by scheme
  • No benefit
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CANCER (ONCOLOGY):
Pace 3 A
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • Oncology program
  • Biological medicine: R280,000 per person
  • Sublimit increased by R40,000
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DENTISTRY:
Pace 3 A
Benefits Gap benefits
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= R6,150 and M1+ =R11,450
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments
Orthodontics:
  • Subject to pre-authorisation and overall dentistry limits as above
  • No benefit
Maxillo Facial Surgery:
  • 100% Scheme Rate
  • Other dental/oral surgery: R14,200 per family
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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MEDICATION:
Pace 3 A
Benefits Gap benefits
Chronic:
  • No. of chronic conditions covered: 26 CDLs and PMBs plus 19 conditions covered at 85% scheme rate
  • Co-payment if out of formulary: 25% co-payment
  • Overall limit: R12,420 per person and R24,840 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
  • No benefit
Acute (presrcibed) medication:
  • Limited to M1= R1,300 and M1+ =R3,200
  • Paid from day-to-day benefit
  • 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:
  • R280,000 per person
  • Sublimits increased by R40,000
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OPTOMETRY:
Pace 3 A
Benefits Gap benefits
Optometry:
  • Consultation: R365
  • Frame: R550
  • Lenses: Single R175 or Bifocal R380 or Multifocal R695
  • Contact lenses: R1,420
  • Refractive surgery: R8,500 per eye
  • Paid by scheme, subject to day-to-day limit
  • No benefit
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MENTAL HEALTH:
Pace 3 A
Benefits Gap benefits
In-hospital:
  • 21 days per person
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Out-of-hospital:
  • Limited to M =R3,700 and M1+ =R7,500
  • Paid from savings first, then extra fund
  • Shared with GP and specialist benefit
  • No benefit
Trauma:
  • 100% scheme rate
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OTHER BENEFITS:
Pace 3 A
Benefits Gap benefits
General Appliances:
  • R8,800 per family
  • Paid from savings first, then extra fund
  • No benefit
1.1. Hearing Aids:
  • R27,300 per family, every 2 years
  • No benefit
1.2. Wheelchairs:
    R11,900 per family every 4 years
  • No benefit
Dialysis:
  • 100% scheme rate
HIV:
  • Managed care programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: TBC
  • No benefit
Other:
  • Wound care: R9,000 per family
  • First from savings, then extra fund if available
  • No benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Pace 3 A
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:
  • Covered
  • No benefit
Pap Smear:
  • Covered, 18yrs+ every 2 years
  • No benefit
Mammogram:
  • Covered
  • No benefit
PAS Test:
  • Covered
  • No benefit
HIV Test: TBC
  • No benefit
Other:
  • HPV and HIB Vaccinations
  • Bone densitometry
  • No benefit
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PROSTHETICS:
Pace 3 A
Benefits Gap benefits
Overal Limit:
  • Functional (treating or supporting a bodily function): R16,000
  • Vascular: R36,700
  • Pacemaker, dual chamber: R52,750
  • Spinal: R36,700
  • Artificial disk: 16,000
  • Drug-eluting stent: R16,000
  • Mesh: R16,000
  • Gynaecology/Urology: R12,000
  • Lens implants: R10,260 per lens
  • Hip replacement and other major joints: R44,000
  • Knee replacement: R51,250
  • Minor joints: R18,950
Sub-limits:
  • Internal: R98,100 per family
  • External: R23,100 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