Bestmed Pace 4 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 4
2018 costs Gap
In brief: On Pace 4 in 2018:
  • 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 first pays your out of hospital expenses form the extra fund, then from your savings. It also pays for refractive surgery
  • Cover for 53 chronic conditions
See full benefits below
For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims to 500% scheme rate
  • pays for ER treatment,
  • covers the 20% co-payment for cancer claims and
  • covers other in-hospital co-payments
See more benefits below, or full benefits here.
What’s new in 2018?
  • There are no major changes to this plan in 2018, other than the usual monetary increases in premiums, benefits and co-payments

.
Contributions:
Main: Adult: Child:
Cost 2018: R6,608 R6,608 R1,548
Cost 2017: (R6,096) (R6,096) (R1,428)
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
Savings: R2376 R2376 R552
Extended Fund: RM= R30,200
M1+= R48,700
R R
Children: Pay for maximum 4 children
2018 Gap prices are to be confirmed, will be about R300 per family of under 65yrs, and R400 per family with a member who is 65yrs+.
Find out more
.
.
.
.
IN HOSPITAL PROCEDURES:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 100% scheme rate
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Unlimited
  • N/A
Specialised Radiology:
  • 100% scheme rate
  • N/A
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Up to 500% of scheme rate for service providers
Transplants:
  • 100% scheme rate
  • Up to 500% of scheme rate for service providers
Co-payments: n/a
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • 100% scheme rate
  • No benefit
Casualty: TBC
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
.
.
.
.
OUT OF HOSPITAL BENEFITS:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • Limited to M =R4,750 and M1+ =R7,700
  • Paid from day-to-day benefit
  • Shared with specialist benefit
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • Shared with GP benefits, see above
  • No benefit
Pathology:
  • Limited to M =R4,750 and M1+ =R9,350
  • Paid from day-to-day benefit
  • Shared with radiology benefit
  • No benefit
General radiology:
  • Limited to M =R4,750 and M1+ =R9,350
  • Paid from day-to-day benefit
  • Shared with radiology benefit
  • No benefit
Specialised radiology:
  • 3 MRI/CT scans and 1 PET scan per family, paid by scheme
  • No benefit
Supplementary Services: (Physio, etc)
  • Limited to M =R4,750 and M1+ =R9,350
  • Paid from day-to-day benefit
  • No benefit
.
.
MATERNITY BENEFITS:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • Midwife births: covered
  • Up to additional 500% of medical aid rate
  • Premature birth (more than 6 weeks before due date): R12,000 lump sum
  • Premature birth (more than 6 weeks before due date):R300 per day, for days 1-13; R600 per day for days 14-20; R1,200 per day for days 21-30
Consultations:
  • 12 consults, paid by scheme
  • No benefit
Scans:
  • 2 scans, paid by scheme
  • No benefit
.
.
.
.
CANCER (ONCOLOGY):
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • Oncology program
  • $Biological medicine: R414,000 per person
  • Sublimit increased by R40,000
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.
.
.
DENTISTRY:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • Limited to R10,250 per person and R17,300 per family, subject to overall limit
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Other sublimits increased by R40,000
Orthodontics:
  • Subject to pre-authorisation and overall dentistry limits as above
  • No benefit
Maxillo Facial Surgery:
  • 100% Scheme Rate
  • Other dental/oral surgery: R17,000 per family
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
.
.
.
.
MEDICATION:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 26 conditions covered at 85% scheme rate
  • Co-payment if out of formulary: 20% co-payment
  • Overall limit: R16,750 per person and R33,650 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
  • No benefit
Acute (presrcibed) medication:
  • Limited to M1= R7,500 and M1+ =R11,650
  • $$ 10% co-payment
  • Paid from day-to-day benefits
  • No benefit
Over-the-counter:
  • Paid from savings
  • No benefit
Birth Control:
  • R1,950 per family per year, paid by scheme
  • No benefit
On Discharge:
  • 7 days
  • Up to 500% of scheme rate for service providers
Biological:
  • R414,400 per person
  • Sublimits increased by R40,000
.
.
.
.
OPTOMETRY:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • Consultation: R365
  • Frame: R550
  • Lenses: Single R175 or Bifocal R380 or Multifocal R695
  • Contact lenses: R1,710
  • Refractive surgery: R8,500 per eye
  • Paid by scheme, subject to day-to-day limit
  • No benefit
.
.
MENTAL HEALTH:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital:
  • 21 days per person
  • Up to 500% of scheme rate for service providers
Out-of-hospital:
  • Limited to M =R4,750 and M1+ =R7,700
  • Paid from day-to-day benefit
  • Shared with GP and specialist benefit
  • No benefit
Trauma:
  • 100% scheme rate
.
.
.
.
OTHER BENEFITS:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • R8,800 per family
  • Paid from day-to-day benefits
  • No benefit
1.1. Hearing Aids:
  • R30,400 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: R11,600 per family
  • From day-to-day benefit
  • No benefit
.
.
WELLNESS/PREVENTATIVE BENEFITS:
Pace 4
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • Covered
  • No benefit
Back Rehabilitation Programme:
  • Covered
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered, 18yrs+ every 2 years
  • No benefit
Mammogram:
  • Covered
  • No benefit
PAS Test:
  • Covered
  • No benefit
HIV Test: TBC
  • No benefit
Other:
  • HPV and HIB Vaccinations
  • Bone densitometry
  • No benefit
.
.
.
.
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overal Limit:
Sub-limits:

    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