Bestmed Pace 4 medical aid plan: 2017

Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB. Pay for maximum 4 children.

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IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

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Hospital Choice:
  • Unlimited
Specialised Radiology:
Supplementary Services: (Physio, etc)
Transplants:
Co-payments: n/a
Alternatives to hospitals:

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Limited to M =R4,400 and M1+ =R7,150
  • Paid from day-to-day benefit
  • Shared with specialist benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:

Specialists consultations:
  • Shared with GP benefits, see above
Pathology:
  • Limited to M =R4,400 and M1+ =R8,650
  • Paid from day-to-day benefit
  • Shared with radiology benefit
General radiology:
  • Limited to M =R4,400 and M1+ =R8,650
  • Paid from day-to-day benefit
  • Shared with pathology benefit
Specialised radiology:
  • 3 MRI/CT scans and 1 PET scan per family, paid by scheme
Supplementary Services: (Physio, etc)
  • Limited to M =R4,400 and M1+ =R8,650
  • Paid from day-to-day benefit
  • Shared with radiology benefit

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MATERNITY BENEFITS:
Hospital stay:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

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Consultations:
  • 12 consults, paid by scheme
Scans:
  • 2 scans, paid by scheme

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • Biological medicine: R383,700 per person

Note: 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.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:

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DENTISTRY:
Dentistry:
  • Limited to R9,500 per person and R16,100 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:

Orthodontics:
  • Subject to pre-authorisation
Maxillo Facial Surgery:
  • 100% Scheme Rate
  • Other dental/oral surgery: R15,750 per family

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MEDICATION:
Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 26 conditions covered at 85% scheme rate
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: R15,550 per person and R31,150 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:
Acute (presrcibed) medication:
  • Limited to M1= R6,950 and M1+ =R10,800 with 10% co-payment
  • Paid from day-to-day benefit
Over-the-counter:
  • Paid from savings
Birth Control:
  • R1,800 per family per year, paid by scheme
On Discharge:
  • 7 days
Notes:

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OPTOMETRY:
Optometry:
  • Consultation: R350
  • Frame: R550
  • Lenses: Single R165 or Bifocal R360 or Multifocal R660
  • Contact lenses: R1,710
  • Refractive surgery: R7,900 per eye
  • Paid by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
  • 21 days per person
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:


Out-of-hospital:
  • Limited to M =R4,400 and M1+ =R7,150
  • Paid from day-to-day benefit
  • Shared with GP and specialist benefit

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OTHER BENEFITS:
General Appliances:
  • R8,150 per family
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:

1.1. Hearing Aids:
  • R28,150 per family, every 2 years
1.2. Wheelchairs:
  • R11,050 per family every 4 years
Dialysis:
HIV:
  • Managed care programme
Emergency Transport: ER24
International Coverage:
Other:
  • Wound care: R10,800 per family, from day-to-day benefit
  • Rehab after trauma: 100% scheme rate

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
  • Covered
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:

Pneumonia vaccines:
  • Covered
Back Rehabilitation Programme:
  • Covered
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered, 18yrs+ every 2 years
Mammogram:
  • Covered
PAS Test:
  • Covered
HIV Test:

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R6,096 R6,096 R1,428
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Optometry, maternity, specialised radiology, trauma rehab, medication, contraceptives and preventative benefits. Limits apply. All else paid from extended fund, from savings or out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R996 R996 R516

Compare with these plans:
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