Bestmed Pulse 2 medical aid plan: 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
Quick Overview
Main: Adult: Child:
Total Cost pm: R4,732 R4,732 R1,124

(Pay only for first 4)

Savings (per year):
  • No savings option on this plan
Extended Fund: RM= R12,250
M1+= R24,350
R R
Gap (optional):
  • Varies. See below for specific recommendation for this plan.
In brief:
  • Scheme rate is 100%, (gap increases this to 500%)
  • You must use a Network DSP hospital
  • Bestmed pays for some out of hospital expenses, including unlimited GPs, optometry and dentistry
  • Bestmed pays for some maternity consults and scans
  • Bestmed pays for refractive surgery
  • Treatment and medicine for 42 chronic conditions covered by scheme
  • There is a benefit for out-of-hospital specialised radiology
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

IN HOSPITAL PROCEDURES:
Pulse 2
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice:
  • Network hospitals
  • No extra benefit
Specialised Radiology:
  • 100% scheme rate
  • No extra benefit necessary
Supplementary Services: (Physio, etc)
  • Bestmed pays up to 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Transplants:
  • No extra benefit available (PMB benefits are paid in full by medical aid)
Co-payments:
  • None
  • No extra benefit necessary
Alternatives to hospitals:
  • Bestmed pays up to 100% scheme rate
  • You pay the balance, if any
  • No extra benefit available
Casualty:
  • Two casualty visits per family, limited to R1,300
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
Other:
  • N/A
  • N/A
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)

No phone calls!
Our quote will include the right gap cover for this plan

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Pulse 2
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: RM= R12,250
M1+= R24,350
R R
General info:
  • This plan has an "extra" fund, so most out of hospital costs are paid by this, subject to sub-limits per benefit (see below)
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • If you use a network GP, your consults are unlimited
  • Out of network GP consults are subject to the day-to-day benefit
  • No extra benefit available
Childcare:
  • No extra benefits
  • No extra benefit available
Specialists consultations:
  • R2,700 per person and R5,200 per family
  • Paid from day-to-day benefit
  • No extra benefit available
Pathology:
  • Paid by Bestmed if network is used, subject to protocols and day-to-day benefit
  • No extra benefit available
General radiology:
  • Paid by Bestmed if network is used, subject to protocols and day-to-day benefit
  • No extra benefit available
Specialised radiology:
  • Bestmed pays for 3 MRI/CT scans and 1 PET scan per family
  • All else is paid by you out-of-pocket
  • No extra benefit available
Supplementary Services: (Physio, etc)
  • R3,600 per person and R7,150 per family
  • Paid from day-to-day benefit
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
Pulse 2
Scheme Benefits Gap benefits
Hospital stay:
  • Bestmed pays up to its scheme rate, includiing for births with midwife
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Consultations:
  • 12 consults, paid by Bestmed
  • No extra benefit available
Scans:
  • 2 scans, paid by Bestmed
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
Pulse 2
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • Subject to approved treatment plan
  • Biological medicine: R132,000 per person
  • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, the gap cancer benefit will cover costs authorised but not paid by your medical scheme (up to the R150,000 per person per year gap cover limit). This includes extra cover for biological medicine short-payments or co-payments. More info

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
Pulse 2
Scheme Benefits Gap benefits
Dentistry:
  • M=R6,150 and M1+=R7,800 per family, paid from day-to-day benefit
  • PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes. More info on PMBs
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)
Orthodontics: See above
  • No extra benefit available
Maxillo Facial Surgery:
  • 100% scheme rate
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
Pulse 2
Scheme Benefits Gap benefits
Chronic:
  • All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. Find out more
  • An additional 16 non-CDL conditions are covered at 85% scheme rate, with an overall limit of R5,800 per person and R11,600 per family
  • If you voluntarily use medicine that is not on Bestmed's list ("formulary"), you pay a 25% co-payment
  • No extra benefit available
Acute (presrcibed) medication:
  • R3,850 per person and R7,800 per family
  • Paid from day-to-day benefit
  • No extra benefit available
Over-the-counter:
  • R550 per family
  • No extra benefit available
Birth Control:
  • R1,950 per family per year, paid by Bestmed
  • No extra benefit available
On Discharge:
  • 7 days
  • No extra benefit available
Biological:
  • R132,000 per person
  • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, the gap cancer benefit will cover costs authorised but not paid by your medical scheme (up to the R150,000 per person per year gap cover limit). This includes extra cover for biological medicine short-payments or co-payments. More info

No phone calls!
Our quote will include the right gap cover for this plan

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OPTOMETRY:
Pulse 2
Scheme Benefits Gap benefits
Optometry: Paid by scheme:
  • Consultation: R365
  • Frame: R550
  • Lenses: Single R175 or Bifocal R380 or Multifocal R695
  • Contact lenses: R1,420
  • Refractive surgery: R7,950 per eye
  • Pays shortfalls and co-payments for any non-PMB in-hospital treatment approved by scheme. (PMBs are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
Pulse 2
Scheme Benefits Gap benefits
In-hospital:
  • Bestmed will pay for up to 21 days per person at 100% scheme rate, and may require use of specific providers
  • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
  • No extra benefit available
  • (PMBs are paid in full by scheme if you use DSP)
Out-of-hospital:
  • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
  • Otherwise, limited to R2,700 per person and R5,200 per family, in network
  • Shared with GP and specialist benefit and paid from day-to-day benefit
  • No extra benefit available
  • (PMBs are paid in full by scheme if you use DSP)
Trauma:
  • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
  • No extra benefit available
  • (PMBs are paid in full by scheme if you use DSP)

No phone calls!
Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
Pulse 2
Scheme Benefits Gap benefits
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
  • Gap cover will pay shortfall for authorised in and out-of-hospital treatment
  • Note that gap does not pay penalties, for example if you have a co-payment because you voluntarily opted to use a non-DSP
HIV:
  • Managed care programme
  • No benefit
Emergency Transport:
  • ER24
  • No benefit
International Insurance: TBC
  • No benefit
Other:
  • Wound care: R8,400 per family
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
Pulse 2
Scheme 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:
  • No benefit
  • No benefit
Mammogram:
  • No benefit
  • No benefit
PAS Test:
  • No benefit
  • No benefit
HIV Test: TBC
  • No benefit
Other:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
Pulse 2
Scheme Benefits Gap benefits
Overal Limit:
  • Internal: R89,500 per family
  • External: R21,600 per family
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
Sub-limits:
  • Functional (treating or supporting a bodily function): R14,850
  • Vascular: R34,600
  • Pacemaker, dual chamber: R46,900
  • Spinal: R34,600
  • Artificial disk: R15,200
  • Drug-eluting stents: R15,200
  • Mesh: R15,200
  • Gynaecology/Urology: R11,300
  • Lens implants: R9,700 per lens
  • Hip replacement and other major joints: R41,400
  • Knee replacement: R48,350
  • Minor joints: R18,000
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid

No phone calls!
Our quote will include the right gap cover for this plan


    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