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 In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R4,732 R4,732 R1,124
Cost 2017: (R3,902) (R3,902) (R927)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited overall, with sub-limits
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
  • 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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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
Pulse 2
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: Fusion Gap:
  • Up to 600% 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
  • R350pm per family. More Info or download application below.

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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:
  • Co-payment: none
  • Sublimit: none
  • Rate: 100% scheme rate
  • N/A
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Up to 600% of scheme rate for service providers
Transplants:
  • PMBs only
  • Up to 600% 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.
Other:
  • N/A
  • N/A
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OUT OF HOSPITAL BENEFITS:
Pulse 2
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • GP Network: unlimited GP consults
  • Out-of-network: R1,200 per family, limited to two consults
  • No benefit


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Childcare:
  • No benefit
Specialists consultations:
  • R2,700 per person and R5,200 per family
  • 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)
  • Paid from day-to-day benefit
  • R3,600 per person and R7,150 per family
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  • No benefit
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MATERNITY BENEFITS:
Pulse 2
2017 v 2018 benefits 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

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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 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 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
  • Full cover for in-hospital co-payments

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Orthodontics: See above
  • No benefit
Maxillo Facial Surgery:
  • 100% scheme rate
  • Dental reconstruction as result of trauma or oncology: R40,000 per event

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
Pulse 2
2017 v 2018 benefits 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

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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
  • No benefit
Biological:
  • R132,000 per person
  • Sublimits increased by R40,000
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OPTOMETRY:
Pulse 2
2017 v 2018 benefits 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 Gap benefits Notes
In-hospital:
  • 21 days per person
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Out-of-hospital: TBC
  • No benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
Pulse 2
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • R8,700 per family
  • No benefit

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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 Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit

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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

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
  • 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

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Sub-limits:
  • Internal: R89,500 per family
  • External: R21,600 per family
  • An additional R40,000 per sublimit, per event

    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