Bestmed Pulse 2 medical aid plan: 2017 v 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 2
2018 costs Gap
In brief: On Pulse 2 in 2018:
  • Scheme rate is 100%, and most day-to-day expenses are paid by scheme, or from out of pocket, unless PMBs
  • You must use a Network DSP hospital
  • Bestmed pays for some out of hospital expenses
  • Cover for 43 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: R4,732 R4,732 R1,124
Cost 2017: (R3,902) (R3,902) (R927)
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
Extended Fund: RM= R12,250
M1+= R24,350
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
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IN HOSPITAL PROCEDURES:
Pulse 2
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 100% scheme rate
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Network hospitals, or up to R10,000 co-payment if you voluntarily choose another hospital
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology:
  • 100% scheme rate
  • N/A
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Up to 500% of scheme rate for service providers
Transplants:
  • PMBs only
  • Up to 500% of scheme rate for service providers
Co-payments: n/a
  • N/A
Alternatives to hospitals:
  • 100% scheme rate
  • No benefit
Casualty: TBC
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
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OUT OF HOSPITAL BENEFITS:
Pulse 2
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • GP Network: unlimited GP consults
  • Out-of-network: R1,200 per family, limited to two consults
  • No benefit
Childcare:
  • No benefit
Specialists consultations:
  • M= R2,700 and M1+ =R5,200
  • Paid from day-to-day benefit
  • No benefit
Pathology:
  • Cover from network, subject to protocols and day-to-day benefit
  • No benefit
General radiology:
  • Cover from network, subject to protocols and day-to-day benefit
  • No benefit
Specialised radiology:
  • Maximum 3 MRI/CT scans and 1 PET scan per person
  • No benefit
Supplementary Services: (Physio, etc)
  • M= R3,600 and M1+ =R7,150
  • Paid from day-to-day benefit
  • No benefit
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MATERNITY BENEFITS:
Pulse 2
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • Midwife births: covered
  • Up to additional 500% of medical aid rate
  • Premature birth (more than 6 weeks before due date): R12,000 lump sum
  • Premature birth (more than 6 weeks before due date):R300 per day, for days 1-13; R600 per day for days 14-20; R1,200 per day for days 21-30
Consultations:
  • 12 consults, paid by scheme
  • No benefit
Scans:
  • 2 scans, paid by scheme
  • No benefit
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CANCER (ONCOLOGY):
Pulse 2
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • Subject to approved treatment plan
  • Biological medicine: R132,000 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.
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DENTISTRY:
Pulse 2
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • M=R6,150 and M1+=R7,800 per family
  • Paid from day-to-day benefit
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
Orthodontics: See above
  • No benefit
Maxillo Facial Surgery:
  • 100% Scheme Rate
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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MEDICATION:
Pulse 2
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 16 conditions covered at 85% scheme rate
  • Co-payment if out of formulary: 25% co-payment
  • Overall limit: M=R5,800 and M1+=R7,800. Once depleted, only CDL and PMBs will continue to be covered by scheme
  • No benefit
Acute (presrcibed) medication:
  • Subject to Provider Network formulary
  • M =R3,600 and M1+ =R7,200
  • Paid from day-to-day benefit
  • No benefit
Over-the-counter:
  • R550 per family
  • 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:
    R132,000 per person
  • Sublimits increased by R40,000
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OPTOMETRY:
Pulse 2
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • Consultation: R365
  • Frame: R550
  • Lenses: Single R175 or Bifocal R380 or Multifocal R695
  • Contact lenses: R1,420
  • Refractive surgery: R7,950 per eye
  • Paid by scheme
  • No benefit
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MENTAL HEALTH:
Pulse 2
2017 v 2018 benefits
($$ 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
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OTHER BENEFITS:
Pulse 2
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • R8,700 per family
  • No benefit
1.1. Hearing Aids:
  • R24,200 per family, every 2 years
  • No benefit
1.2. Wheelchairs:
  • R11,200 per family, every 4 years
  • No benefit
Dialysis:
  • 100% scheme rate
HIV:
  • Managed care programme
  • No benefit
Emergency Transport:
  • No benefit
International Insurance: TBC
  • No benefit
Other:
  • Wound care: R8,400 per family
  • No benefit
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WELLNESS/PREVENTATIVE BENEFITS:
Pulse 2
2017 v 2018 benefits
($$ 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:
  • 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