Bestmed's network options offer healthcare services and private hospital cover at designated service providers (DSPs).
Accommodation (hospital stay) and theatre fees
Approved PMBs at DSPs.
Take-home medicine
100% Scheme tariff. Limited to 3 days’ medicine.
Biological medicine during hospitalisation
Approved PMBs at DSPs.
Treatment in mental health clinic
Approved PMBs at DSPs. Subject to pre-authorisation. Limited to 21 days per beneficiary
Treatment of chemical and substance abuse
100% Scheme tariff. (only PMBs). Limited to 21 days per beneficiary. Subject to pre-authorisation and DSP network.
Consultations and procedures
Approved PMBs at DSPs. Subject to pre-authorisation.
Surgical procedures and anaesthetics
Approved PMBs at DSPs. Subject to pre-authorisation.
Organ transplants
100% Scheme tariff. (Only PMBs.)
Stem cell transplants
100% Scheme tariff. (PMBs Only).
Major medical maxillo-facial surgery strictly related to certain conditions
Approved PMBs at DSPs.
Dental and oral surgery (In- or out of hospital)
Approved PMBs at DSPs.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Subject to PMBs at DSP network. Limited to R61 384 per family.
Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Items utilised towards treating or supporting a bodily function
Sub-limits per beneficiary:
*Functional R32 550
Pacemaker (dual chamber) R49 711
Vascular R52 500
Endovascular and catheter-based procedures – no benefit
Spinal incl. artificial disk R30 416
Drug-eluting stents – PMBs and DSP products only
Mesh R11 124
Gynaecology/Urology R9 188
Lens implants R6 387 per lens per eye
Prosthesis – External
Approved PMBs at DSPs.
Exclusions (Prosthesis sub-limit subject to preferred provider, otherwise limits and co-payments apply)
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
Hip replacement and other major joints R31 173.
Knee replacement R39 413.
Minor joints R14 762.
Orthopaedic and medical appliances
Approved PMBs at DSPs.
Pathology
Approved PMBs at DSPs.
Basic radiology
Approved PMBs at DSPs.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. Excluding PET scans)
Approved PMBs at DSPs.
Oncology
Approved PMBs at DSPs.
Peritoneal dialysis and haemodialysis
Approved PMBs at DSPs.
Confinements (Birthing)
Approved PMBs at DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
Approved PMBs at DSPs.
HIV/AIDS
Approved PMBs at DSPs.
Midwife-assisted births (Protocols apply)
PMBs and emergency caesarean sections (C-sections).
Alternatives to hospitalisation
Approved PMBs at DSPs.
Advanced illness benefit
Approved PMBs at DSPs
Day procedures
PMBs in network day-hospitals:
Approved PMBs at DSPs. Subject to pre-authorisation, protocols and funding guidelines.
Non-PMBs in network day-hospitals:
100% Scheme tariff. Subject to approved DSPs and pre-authorisation. Limited to R52 500 per family per annum for non-PMB day procedures. A R2 625 co-payment will be incurred per event if a day procedure is done by a non-DSP provider, or if the procedure is voluntarily done in an acute hospital that is not a day hospital. If the provider is a DSP and does not work in a day hospital, the procedure will be paid in full if it is done in an acute hospital. The non-PMB conditions covered are:
Circumcision
Colonoscopy
Sterilisation (male and female)
Gastroscopy
Grommet insertion and myringotomy
Tonsillectomy
Subject to the Managed Healthcare (MHC) protocols and funding guidelines.
International travel cover
Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants.
Co-payments
Co-payment of up to R13 732 per event for voluntary use of a non-DSP hospital.
Family Practitioner (FP) consultations
Unlimited FP consultations. Subject to Bestmed Rhythm FP network.
Subject to pre-authorisation after 10th visit.
Pharmacy clinic nurse consultation
Benefit shall be at 100% of Scheme tariff/cost for unlimited primary care nurse consultations (nappi code 981078001) at network pharmacies.
Specialist consultations
Specialist consultations must be referred by a Rhythm Network Provider.
100% Scheme tariff. Limited to a maximum of R2 441 per family per year. Subject to Rhythm Specialist Network.
Out-of-network and casualty visits
Approved PMB services only.
Medical aids, apparatus and appliances including wheelchairs and hearing aids and appliances
Approved PMB services only.
Supplementary services
PMB only.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
Approved PMB services only.
Basic Dentistry
Where clinically appropriate and subject to Bestmed Rhythm1 protocols, Bestmed Rhythm Dental Network Providers and Rhythm approved dental codes.
Optometry Services
Benefits available every 24 months from date of service.
Consultation - 1 per beneficiary at optometrist network
No benefit for spectacle frames, lenses or contact lenses.
Basic pathology
100% Scheme tariff.
Basic blood tests as requested by a Bestmed Rhythm Network FP and subject to Bestmed Rhythm1 protocols and Rhythm approved pathology codes.
Basic radiology
100% Scheme tariff.
Basic X-rays as requested by your Bestmed Rhythm Network FP and subject to Bestmed Rhythm1 protocols and Rhythm approved radiology codes.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded).
Approved PMB services only.
Oncology
Approved PMB services only. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
Approved PMB services only.
HIV/AIDS
Approved PMB services only.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff.
30% co-payment on non-formulary medicine at a preferred provider network pharmacy.
Biological medicine
PMBs only. Subject to pre-authorisation
Other high-cost medicine
PMBs only. Subject to pre-authorisation
Acute medicine
100% Scheme tariff. Subject to Bestmed formulary only. As prescribed by network provider and obtained from DSP pharmacy.
Children:
Adults:
Adults:
100% Scheme tariff at DSP network. Subject to the following benefits:
Add Dependants
*Your monthly contribution will be determined by the higher of the gross monthly income of the Main Member and Spouse/Partner on the membership upon submitting your application. Three months’ payslips will be required upon applying with Bestmed and proof of income will be requested annually to determine the correct income category for the membership. If your are unable to provide the requested, the highest income bracket being used.
Our network options offer you unlimited in-hospital cover with either limited essential day-to-today benefits, or comprehensive savings for your consultations with designated healthcare providers.
Contributions (income R0 - R9 000)Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.
Get personalised pricing
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Accommodation (hospital stay) and theatre fees
100% Scheme tariff at a designated service provider (DSP) hospital.
Take-home medicine
100% Scheme tariff. Limited to 3 days’ medicine
Biological medicine during hospitalisation
Limited to R16 648 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health clinics
100% Scheme tariff. Limited to 21 days per beneficiary.
Treatment of chemical and substance abuse
100% Scheme tariff (only PMBs). Limited to 21 days per beneficiary subject to network facilities.
Consultations and procedures
100% Scheme tariff. Subject to pre-authorisation and DSP network.
Surgical procedures and anaesthetics
100% Scheme tariff.
Excluded from benefits: functional nasal surgery, surgery for medical conditions, e.g. Epilepsy, Parkinson’s disease, etc., and procedures where stimulators are used.
Organ transplants
100% Scheme tariff. (PMBs only)
Stem cell transplants
100% Scheme tariff. (PMBs Only).
Major medical maxillo-facial surgery strictly related to certain conditions
Approved PMBs at DSPs.
Dental and oral surgery (In- or out of hospital)
Approved PMBs at DSPs.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R61 384 per family.
Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Item utilised towards treating or supporting a bodily function.
Sub-limits per beneficiary:
*Functional R32 550
Pacemaker (dual chamber) R49 711
Vascular R52 500
Endovascular and catheter-based procedures – no benefit
Spinal incl. artificial disk R30 416
Drug-eluting stents – PMBs and DSP products only
Mesh R11 124
Gynaecology/Urology R9 188
Lens implants R6 387 per lens per eye
Prosthesis – External
Approved PMBs at DSPs.
Exclusions (Prosthesis sub-limit subject to preferred provider, otherwise limits and co-payments apply)
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
Hip replacement and other major joints R31 173.
Knee replacement R39 413.
Minor joints R14 762
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R7 554 per family.
Pathology
100% Scheme tariff.
Basic Radiology
100% Scheme tariff
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies)
100% Scheme tariff Subject to pre-authorisation.
Confinements (Birthing)
100% Scheme tariff.
Oncology
Oncology programme. 100% of Scheme tariff. DSP applies. Subject to pre-authorisation.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
Approved PMBs at DSPs.
HIV/AIDS
100% Scheme tariff Subject to pre-authorisation and DSPs.
Midwife-assisted births (Protocols apply)
PMBs and emergency caesarean sections (C-sections).
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff. Subject to pre-authorisation and DSPs or preferred providers.
Advanced illness benefit
100% Scheme tariff, limited to R66 591 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures
Day procedures at a day-hospital facility funded at 100% Scheme tariff. Subject to pre-authorisation. DSPs apply for PMBs. Co-payment of R2 625 if procedure is done in an acute hospital.
International travel cover
Leisure Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 90 days, with R3 million for a family i.e. member and dependants.
Business Travel: Limited to 45 days and R500 000 cover for travel to the USA. All other countries covered up to 45 days, with R3 million for a family i.e. member and dependants.
Co-payments
Co-payment of up to R13 732 per event for voluntary use of a non-DSP hospital.
Family Practitioner (FP) consultations
Unlimited FP consultations. Subject to Bestmed Rhythm FP network. Applicable per family per annum.
Specialist consultations
Specialist consultations (this includes minor procedures done in specialist rooms and all consumables used), must be referred by a Rhythm Network Provider and approved by Bestmed.
Limited to M = R1 665; M1+ = R2 775.
Subject to Rhythm Specialist DSP network.
Out-of-network and casualty visits
Out-of-network visits to an FP and casualty visits are limited to a maximum of R1 647 per family per year.
Basic radiology and pathology that falls within formulary when received as a result of the casualty visit will be paid from the out-of-network and casualty visits limit.
Once limit has been reached the costs will be for the member’s own account.
Emergency visits are unlimited at any State facility.
You will be required to pay for all treatment received at the point of service. The cost of these services may be claimed back by completing an Out-of-network claim form which can be downloaded from the Bestmed website or obtained from Bestmed.
Reimbursements are subject to Bestmed Rhythm2 protocols.
Medical aids, apparatus and appliances including wheelchairs and hearing aids and appliances
Approved PMB services only.
Supplementary services
Approved PMB services only.
Includes services rendered by:
dieticians
chiropractors
homeopaths
orthoptists
acupuncturists
speech therapists
audiologists
occupational therapists
podiatrists
biokineticists
psychologists and
social workers
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
Approved PMB services only.
Basic Dentistry
Where clinically appropriate and subject to Bestmed Rhythm1 protocols, Bestmed Rhythm Dental Network Providers and Rhythm approved dental codes.
Dentures
Limited to a maximum of 2 removable acrylic dentures (i.e. 2 single denture plates) per family every 24 months.
Optometry Services
Benefits available every 24 months from date of service.
Consultation - 1 per beneficiary
Frame = R245 covered (Frame refund value after network discount R184) AND standard lenses
Single vision lenses = R215 OR
Bifocal lenses = R460
Multifocal lenses = R460
In lieu of glasses members can opt for contact lenses, limited to R700
Basic pathology
100% Scheme tariff.
Basic blood tests as requested by a Bestmed Rhythm Network FP and subject to Bestmed Rhythm2 protocols and Rhythm approved pathology codes.
Basic radiology
100% Scheme tariff.
Basic X-rays as requested by your Bestmed Rhythm Network FP and subject to Bestmed Rhythm2 protocols and Rhythm approved radiology codes.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded).
Approved PMB services only.
Oncology
Oncology programme. 100% Scheme tariff. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff.
30% co-payment on non-formulary medicine at a preferred provider network pharmacy.
Biological medicine
PMBs only. Subject to pre-authorisation
Other high-cost medicine
PMBs only. Subject to pre-authorisation
Acute medicine
100% Scheme tariff. Subject to Bestmed formulary only. As prescribed by network provider and obtained from DSP pharmacy.
Over-the-counter (OTC) medicine
Limited to R666 per family.
Subject to preferred provider network pharmacy.
Includes sunscreen, vitamins and minerals with nappi codes on Scheme formulary.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
Our network options offer you unlimited in-hospital cover with either limited essential day-to-today benefits, or comprehensive savings for your consultations with designated healthcare providers. This option is income level dependant.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions (income level R0 - R5 500)
Member: R2 100
Adult dependant: R1 996
Child dependant: R1 264
Maximum child dependants: 3
Contributions (income level R5 501 - R8 500)
Member: R2 523
Adult dependant: R2 397
Child dependant: R1 514
Maximum child dependants: 3
Contributions (income level R8 501 and higher)
Member: R3 027
Adult dependant: R2 725
Child dependant: R1 514
Maximum child dependants: 3
Child dependants under the age of 24 years and registered students up to the age of 26 years, in accordance with the Rules, are regarded as child dependants.
Get personalised pricing
call for more information
