Bestmed Pulse 1C 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:
Pulse 1 C
2018 costs Gap
In brief: On Pulse 1 C in 2018:
  • Scheme rate is 100%, and most day-to-day expenses are paid by scheme, or from out of pocket, unless PMBs
  • This plan has co-payments and exclusions for some procedures
  • You must use a Network DSP hospital
  • Bestmed pays for some out of hospital expenses
  • Cancer cover is for PMBs only, and at State hospitals
  • Cover for 27 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

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Contributions:
Main: Adult: Child:
Cost 2018: R1,976 R1,777 R987
Cost 2017: (R1,630) (R1,466) (R814)
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: No savings option on this plan
Children: Pay for all 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
Income band: This plan is only available to households with income in R8,501+pm band.
View other income bands
Find out more
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IN HOSPITAL PROCEDURES:
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 100% scheme rate
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Network hospitals, or up to R10,000 co-payment if you voluntarily choose another hospital
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology:
  • 100% scheme rate
  • N/A
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Up to 500% of scheme rate for service providers
Transplants:
  • PMBs only
  • Up to 500% of scheme rate for service providers
Co-payments:
    R3,200 co-payment for:
  • Private hospital endoscopic procedures
  • Laparoscopic procedures
  • Prostate Procedures
  • Procedures for prolapse/incontinence
  • Arthroscopy, other than acute trauma
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • 100% scheme rate
  • No benefit
Casualty: TBC
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • GP Network: unlimited GP consults
  • Out-of-network: R1,200 per family
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • Three network specialist visits, limited to M=R1,000 and M1+=R1,500
  • No benefit
Pathology:
  • Cover from network, subject to protocols
  • No benefit
General radiology:
  • Cover from network, subject to protocols
  • No benefit
Specialised radiology:
  • No benefit, unless PMB
  • No benefit
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No benefit
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MATERNITY BENEFITS:
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • Midwife births: covered
  • Up to additional 500% of medical aid rate
  • Premature birth (more than 6 weeks before due date): R12,000 lump sum
  • Premature birth (more than 6 weeks before due date):R300 per day, for days 1-13; R600 per day for days 14-20; R1,200 per day for days 21-30
Consultations:
  • From Network, according to protocols
  • No benefit
Scans:
  • From Network, according to protocols
  • No benefit
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CANCER (ONCOLOGY):
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
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:
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • Standard dentistry: subject to network provider and protocols
  • Specialised dentistry: no benefit
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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MEDICATION:
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
  • No benefit
Acute (presrcibed) medication:
  • Subject to Provider Network formulary
  • No benefit
Over-the-counter:
  • R350 per family
  • No benefit
Birth Control:
  • R1,950 per family per year, paid by scheme
  • No benefit
On Discharge:
  • 3 days
  • Up to 500% of scheme rate for service providers
Biological:
  • No benefit
  • No benefit
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OPTOMETRY:
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • Consultation at PPN providers
  • Frame: R150
  • Lenses: Single R175 or Bifocal R380 or Multifocal R380
  • Contact lenses: R555
  • No benefit
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MENTAL HEALTH:
Pulse 1 C
2017 v 2018 benefits
($$ 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: TBC
  • No benefit
Trauma:
  • No benefit.This was subject to pre-authorisation in 2017.
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OTHER BENEFITS:
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • No benefit
  • No benefit
1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • No benefit
Dialysis:
  • PMBs only
HIV:
  • Managed care programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: TBC
  • No benefit
Other:
  • No benefit
  • No benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Pulse 1 C
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • Covered
  • No benefit
Back Rehabilitation Programme:
  • No benefit
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • No benefit
  • No benefit
Mammogram:
  • No benefit
  • No benefit
PAS Test:
  • No benefit
  • No benefit
HIV Test: TBC
  • No benefit
Other:
  • No benefit
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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