Bestmed Beat 1 Network medical aid plan: 2017

Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB. Pay for maximum 4 children.

View all plans in this scheme

IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Hospital Choice:
  • Netcare Hospitals, or up to R10,000 co-payment if you voluntarily choose another hospital
Specialised Radiology:
  • Private hospital: R3,000 co-payment
Supplementary Services: (Physio, etc)
Transplants:
Co-payments:
  • Scopes: R3,000 co-payment if in private hospital
  • Specialised radiology: R3,000 co-payment if in private hospital
Alternatives to hospitals:

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • No benefit
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Specialists consultations:
  • No benefit, unless PMB
Pathology:
  • No benefit, unless PMB
General radiology:
  • No benefit, unless PMB
Specialised radiology:
  • R4,200 per family paid by scheme
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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MATERNITY BENEFITS:
Hospital stay:
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Consultations:
  • No benefit
Scans:
  • No benefit

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • PMBs only, at State hospitals

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, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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DENTISTRY:
Dentistry:
  • No benefit, unless PMB
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Orthodontics:
  • No benefit
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: unlimited
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
Acute (presrcibed) medication:
  • No benefit
Over-the-counter:
  • No benefit
Birth Control:
  • R1,800 per family per year, paid by scheme
On Discharge:
  • 7 days
Notes:

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OPTOMETRY:
Optometry:
  • No benefit
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
  • 21 days per person
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:


Out-of-hospital:
  • No benefit

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OTHER BENEFITS:
General Appliances:
  • No benefit out of hospital
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Dialysis:
HIV:
  • Managed care programme
Emergency Transport: ER24
International Coverage:
Other:
  • Wound care: R2,750 per family, paid by scheme

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
  • Covered
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Pneumonia vaccines:
  • Covered
Back Rehabilitation Programme:
  • Covered
Biometric Screening:
  • Covered
Child Immunisation: .
Pap Smear:
  • Covered, 18yrs+ every 2 years
Mammogram:
  • No benefit
PAS Test:
  • No benefit
HIV Test:
  • No benefit

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, but sub-limits can apply
Contributions:
Main: Adult: Child:
Total Cost: R1,131 R879 R476
Children: Pay for maximum 4 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: Wound care, specialised radiology, contraceptives and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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