Bestmed's comprehensive plans offer excellent hospital and chronic benefits to young, middle-age and established families.
Accommodation (hospital stay) and theatre fees
100% Scheme tariff.
Take-home medicine
100% Scheme tariff. Limited to 7 days' medicine
Biological medicine during hospitalisation
Limited to R33 296 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health clinic
100% Scheme tariff. Limited to 21 days per beneficiary
Treatment of chemical and substance abuse
100% Scheme tariff. Limited to 21 days or R37 352 per beneficiary. Subject to network facilities.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
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
100% Scheme tariff. Limited to R15 105 per family
Dental and oral surgery (In- or out of hospital)
Limited to R9 338 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R104 366 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 R35 700
Pacemaker (dual chamber) R64 955
Vascular R68 250
Endovascular and catheter-based procedures - no benefit
Spinal incl. artificial disk R38 038
Drug-eluting stents - PMBs and DSP products only
Mesh R14 282
Gynaecology/Urology R10 299
Lens implants R7 828 a lens per eye
Prosthesis – External
Limited to R26 504 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.
Exclusions (Limits and co-payments applicable. Preferred provider network available.)
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
• Hip replacement and other major joints R38 725
• Knee replacement R51 497
• Minor joints R15 999
Orthopaedic and medical appliances
100% Scheme tariff.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies)
100% Scheme tariff
Oncology
100% Scheme tariff. Subject to pre-authorisation. DSP applies.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs
Confinements (Birthing)
100% Scheme tariff.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Subject to pre-authorisation and protocols. Limited to R10 381 per eye.
HIV/AIDS
100% Scheme tariff. Subject to preauthorisation and DSPs
Midwife-assisted births
100% Scheme tariff
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff. Limited to R83 239 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures
Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 625.
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.
Overall day-to-day limit
M = R12 607, M1+ = R25 213.
FP and Specialist consultations
Savings first. Limited to M = R2 596, M1+ = R5 219. (Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings and then from day-to-day limits. Orthodontic: Subject to pre-authorisation. Limited to M = R4 778, M1+ = R9 696. (Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
100% Scheme tariff. Savings first. Limited to R13 321 per family. Includes repairs to artificial limbs. (Subject to overall day-to-day limit)
Continuous/Flash Glucose Monitoring (CGM/FGM)
Refer to medical aids, apparatus and appliances limit listed above.
Wheelchairs
Subject to medical apparatus and appliance limits.
Hearing aids
Limited to R9 252 per family every 24 months. 100% Scheme tariff. Subject to pre-authorisation.
Supplementary services
Savings first. Limited to M = R5 095, M1+ = R10 575. (Subject to overall day-to-day limit)
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
100% Scheme tariff. Savings first. Limited to R4 188 per family. (Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service.
Network Provider (PPN)
Consultation - 1 per beneficiary
Frame = R1 000 covered AND
100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR
Contact lenses = R1 840
Non-network Provider
Consultation - R365 fee at non-network provider
Frame = R750 AND
Single vision lenses = R215 OR
Bifocal lenses = R460 OR
Multifocal lenses = R982.50
In lieu of glasses members can opt for contact lenses, limited to R1 840
Basic radiology and pathology
100% Scheme tariff. Savings first. Limited to M = R3 776, M1+ = R7 554. (Subject to overall day-to-day limit)
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)
100% Scheme tariff. Limited to R16 891 per family. Limited to one (1) scan of the lumbar and cervical spine region for conservative back and neck scans per beneficiary per annum.
Rehabilitation services after trauma
100% Scheme tariff.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Managed Healthcare - Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff. Co-payment of 25% for non-formulary medicine.
Non-CDL chronic medicine
7 conditions. 90% Scheme tariff. Limited to M = R7 690, M1+ = R15 380. Co-payment of 25% for non-formulary medicine.
Biological medicine
PMBs only. Subject to pre-authorisation.
Other high-cost medicine
100% Scheme tariff.
Acute medicine
Savings first. Limited to M = R2 721, M1 + = R5 631. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Member choice:
1. R1 110 OTC limit per family OR
2. Access to full savings for OTC purchases (after R1 110 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
Subject to the available savings.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
Excellent hospital benefits with extensive day-to-day cover. Pace1 is perfect for those who want quality benefits at affordable prices.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R5 061
Adult dependant: R3 555
Child dependant: R1 277
Maximum child dependants: 3
Bestmed members pay for only three child dependants. The rest is covered at no extra cost. 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 
Accommodation (hospital stay) and theatre fees
100% Scheme tariff.
Take-home medicine
100% Scheme tariff. Limited to 7 days' medicine
Biological medicine during hospitalisation
Limited to R27 746 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health clinic
100% Scheme tariff. Limited to 21 days per beneficiary
Treatment of chemical and substance abuse
100% Scheme tariff. Limited to 21 days or R37 352 per beneficiary. Subject to network facilities.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
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
100% Scheme tariff. Limited to R15 244 per family per annum.
Dental and oral surgery (In- or out of hospital)
Limited to R11 673 per family.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R112 478 per family per annum.
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 R35 700
Pacemaker (dual chamber) R65 092
Vascular R68 250
Endovascular and catheter-based procedures - no benefit
Spinal incl. artificial disk R38 864
Drug-eluting stents R21 835
Mesh R14 420
Gynaecology/Urology R10 575
Lens implants R8 239 a lens per eye
Prosthesis – External
Limited to R27 053 per family. DSPs apply. Includes artificial limbs limited to one (1) limb every 60 months.
Exclusions (Limits and co-payments applicable. Preferred provider network available.)
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
• Hip replacement and other major joints R39 962
• Knee replacement R53 090
• Minor joints R16 313
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
Orthopaedic and medical appliances
100% Scheme tariff.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies)
100% Scheme tariff
Oncology
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs
Confinements (Birthing)
100% Scheme tariff.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Limited to R10 850 per eye. Subject to pre-authorisation and protocols.
HIV/AIDS
100% Scheme tariff. Subject to preauthorisation and DSPs
Midwife-assisted births
100% Scheme tariff
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff. Limited to R99 887 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures
Day procedures performed in a day hospital by a DSP provider will be funded at 100% network or Scheme tariff. A co-payment of R2 625 will be incurred per event if a day procedure is voluntarily done by a non-DSP provider, or if the procedure is 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.
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.
Overall day-to-day limit
M = R14 831, M1+ = R29 661.
FP and Specialist consultations
Savings first.
Limited to M = R3 777, M1+ = R6 728
(Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings and then from day-to-day limit.
Orthodontics are subject to pre-authorisation.
Limited to M = R6 534, M1+ = R13 124.
(Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
Savings first. 100% Scheme tariff. Limited to R13 321 per family. Includes repairs to artificial limbs. (Subject to overall day-to-day limit).
Hearing aids
Subject to pre-authorisation. Limited to R12 208 per family every 24 months. 100% Scheme tariff.
Supplementary services
Savings first.
Limited to M = R5 768, M1+ = R11 714.
(Subject to overall day-to-day limit)
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
Savings first. 100% Scheme tariff.
Limited to R5 768 per family.
(Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service.
Network Provider (PPN)
Consultation - 1 per beneficiary.
Frame = R1 000 covered AND
100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR
Contact lenses = R1 840
Non-network Provider
Consultation - R383 fee at non-network provider
Frame = R750 AND
Single vision lenses = R215 OR
Bifocal lenses = R460 OR
Multifocal lenses = R982.50
In lieu of glasses members can opt for contact lenses, limited to R1 840
Basic radiology and pathology
Savings first.
Limited to M = R3 776, M1+ = R7 690.
(Subject to overall day-to-day limit)
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)
100% Scheme tariff. Limited to R19 638 per family.
Managed Healthcare - Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Rehabilitation services after trauma
100% Scheme tariff.
CDL and PMB chronic medicine
100% Scheme tariff. Co-payment of 20% for non-formulary medicine.
Non-CDL chronic medicine
9 conditions. 90% Scheme tariff.
Limited to M = R8 748, M1+ = R17 496. Co-payment of 20% for non-formulary medicine.
Biologicals medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Other high-cost medicine
100% Scheme Tariff.
Acute medicine
Savings first. Limited to M = R3 337, M1 + = R6 742 (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Member choice:
1. R1 110 OTC limit per family OR
2. Access to full savings for OTC purchases (after R1 110 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
Subject to the available savings.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
A comprehensive plan for those with specific healthcare needs, including chronic benefits and savings.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R6 059
Adult dependant: R5 004
Child dependant: R1 498
Maximum child dependants: 3
Bestmed members pay for only three child dependants. The rest is covered at no extra cost. 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
Accommodation (hospital stay) and theatre fees
100% Scheme tariff.
Take-home medicine
100% Scheme tariff. Limited to 7 days’ medicine.
Treatment in mental health clinic
100% Scheme tariff. Limited to 21 days per beneficiary per beneficiary
Treatment of chemical and substance abuse
100% Scheme tariff. Limited to 21 days or R37 352 per beneficiary. Subject to network facilities.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
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
100% Scheme tariff.
Dental and oral surgery (In- or out of hospital)
Limited to R15 518 per family.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R134 028 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 R37 800
Pacemaker (dual chamber) R72 438
Vascular R68 250
Spinal incl. artificial disk R67 193
Drug-eluting stents R21 972
Mesh R21 972
Gynaecology/Urology R16 40
Lens implants R14 090 per lens per eye
Joint replacements:
Hip replacement and other major joints R60 353
Knee replacement R70 035
Other minor joints R26 022
Prosthesis – External
Limited to R31 584 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.
Orthopaedic and medical appliances
100% Scheme tariff.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans only included as indicated per option)
100% Scheme tariff
Oncology
Oncology programme. 100% of Scheme tariff. Subject to pre-authorisation and DSP.
Peritoneal dialysis and haemodialysis
100% Scheme tariff Subject to pre-authorisation and DSPs
Confinements (Birthing)
100% Scheme tariff.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Limited to R10 848 per eye.
HIV/AIDS
100% Scheme tariff. Subject to preauthorisation and DSPs
Midwife-assisted births
100% Scheme tariff
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff limited to R133 182 per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures
Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 625.
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.
Overall day-to-day limit
M = R15 750, M1+ = R31 500.
FP and Specialist consultations
Savings first.
Limited to M = R4 808, M1+ = R9 744.
(Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings and then from day-to-day limit.
Limited to M = R8 009, M1+ = R16 019.
(Subject to overall day-to-day limit)
Orthodontic dentistry
Savings first. 100% Scheme tariff. Subject to pre-authorisation. Limited to R7 769 per event for beneficiaries up to 18 years of age. Subject to overall day-to-day limit.
Medical aids, apparatus and appliances
Savings first. Limited to R12 084 per family.
Includes repairs to artificial limbs.
(Subject to overall day-to-day limit)
Wheelchairs
Limited to R16 342 per family every 48 months.
Hearing aids
Limited to R33 302 per beneficiary every 24 months subject to pre-authorisation.
Supplementary services
Savings first.
Limited to M = R3 675, M1+ = R7 350.
(Subject to overall day-to-day limit)
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
Savings first. Limited to R7 535 per family.
(Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service.
Network Provider (PPN)
Consultation - 1 per beneficiary.
Frame = R1 040 covered AND
100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
Lens enhancement = R750 covered OR
Contact lenses = R2 010
Non-network Provider
Consultation - R365 fee at non-network provider
Frame = R780 AND
Single vision lenses = R215 OR
Bifocal lenses = R460 OR
Multifocal lenses = R982.50
Lens enhancement = R562.50 covered
In lieu of glasses members can opt for contact lenses, limited to R2 010
Basic radiology and pathology
Savings first.
Limited to M = R3 776, M1+ = R7 554.
(Subject to overall day-to-day limit)
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)
MRI/CT scans: Maximum of 2 scans per beneficiary - Limited to one (1) scan of the lumbar and cervical spine region for conservative back and neck scans per beneficiary per annum. PET scan: 1 scan per beneficiary - Subject to pre-authorisation.
Managed Healthcare - Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Rehabilitation services after trauma
100% Scheme tariff.
CDL and PMB chronic medicine
100% Scheme tariff.
Co-payment of 20% for non-formulary medicine.
Non-CDL chronic medicine
20 conditions. 90% Scheme tariff.
Limited to M = R10 500 M1+ = R21 000. Co-payment of 20% for non-formulary medicine.
Biological medicine
Limited to R192 126 per beneficiary.
Other high-cost medicine
100% Scheme tariff.
Acute medicine
Savings first. Limited to M = R3 150, M1 + = R6 300.
(Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Member choice:
1. R1 110 OTC limit per family OR
2. Access to full savings for OTC purchases (after R1 110 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
Subject to the available savings.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
Comprehensive cover with in- and out-of-hospital benefits.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R7 212
Adult dependant: R7 072
Child dependant: R1 590
Maximum child dependants: 3
Bestmed members pay for only three child dependants. The rest is covered at no extra cost. 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
Accommodation (hospital stay) and theatre fees
100% Scheme tariff.
Take-home medicine
100% Scheme tariff. Limited to 7 days’ medicine.
Treatment in mental health clinic
100% Scheme tariff. Limited to 21 days per beneficiary
Treatment of chemical and substance abuse
100% Scheme tariff. Limited to 21 days or R37 352 per beneficiary. Subject to network facilities.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
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
100% Scheme tariff.
Dental and oral surgery (In- or out of hospital)
Limited to R19 500 per family.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R134 715 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 R37 800
Pacemaker (dual chamber) R72 438
Vascular R72 450
Spinal incl. artificial disk R67 321
Drug-eluting stents R21 972
Mesh R21 972
Gynaecology/Urology R16 479
Lens implants R14 090 a lens per eye
Joint replacements:
Hip replacement and other major joints R60 422
Knee replacement R70 378
Other minor joints R26 022
Prosthesis – External
Limited to R31 723 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.
Orthopaedic and medical appliances
100% Scheme tariff.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)
100% Scheme tariff
Oncology programme
100% Scheme tariff. DSP applies. Access to extended protocols.
Peritoneal dialysis and haemodialysis
100% Scheme tariff Subject to pre-authorisation and DSPs
Confinements (Birthing)
100% Scheme tariff.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Limited to R11 673 per eye.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
HIV/AIDS
100% Scheme tariff. Subject to preauthorisation and DSPs
Midwife-assisted births
100% Scheme tariff
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff limited to R133 182 per annum. Subject to available benefit, pre-authorisation and treatment plan.
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.
Day procedures
Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 625.
Overall day-to-day limit
M = R21 047, M1+ = R43 496.
FP and Specialist consultations
Savings first. 100% Scheme tariff.
M = R5 082, M1+ = R10 299.
(Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings first and then from day-to-day limit.
Limited to M = R8 630, M1+ = R16 089.
(Subject to overall day-to-day limit)
Orthodontic dentistry
100% Scheme tariff. Subject to pre-authorisation.
Limited to R9 989 per event for beneficiaries up to 18 years of age. Subject to overall day-to-day limit.
Medical aids, apparatus and appliances
Savings first. Limited to R12 084 per family.
Includes repairs to artificial limbs.
(Subject to overall day-to-day limit)
Wheelchairs
Limited to R16 342 per family every 48 months.
Hearing aids
Limited to R37 490 per beneficiary every 24 months subject to pre-authorisation.
Continuous/Flash Glucose Monitoring (CGM/FGM)
100% Scheme tariff. Limited to R22 197 per family per annum. Subject to pre-authorisation.
Supplementary services
Savings first.
Limited to M = R3 104, M1+ = R6 523.
(Subject to overall day-to-day limit)
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
100% Scheme tariff. Savings first.
Limited to R10 500 per family.
(Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service.
Network Provider (PPN)
Consultation - 1 per beneficiary.
Frame = R1 040 covered AND
100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
Lens enhancement = R750 covered OR
Contact lenses = R2 010
Non-network Provider
Consultation - R365 fee at non-network provider
Frame = R780 AND
Single vision lenses = R215 OR
Bifocal lenses = R460 OR
Multifocal lenses = R982.50
Lens enhancement = R562.50 covered
In lieu of glasses members can opt for contact lenses, limited to R2 010
Basic radiology and pathology
Savings first.
Limited to M = R4 120, M1+ = R8 170.
(Subject to overall day-to-day limit)
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)
MRI/CT scans: Maximum of 2 scans per beneficiary - Limited to one (1) scan of the lumbar and cervical spine region for conservative back and neck scans per beneficiary per annum. PET scan: 1 scan per beneficiary - Subject to pre-authorisation.
Managed Healthcare - Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.
Access to extended protocols.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Rehabilitation services after trauma
100% Scheme tariff.
CDL and PMB chronic medicine
100% Scheme tariff.
Co-payment of 15% for non-formulary medicine.
Non-CDL chronic medicine
20 conditions. 90% Scheme tariff.
Limited to M = R16 136, M1+ = R32 272. Co-payment of 15% for non-formulary medicine.
Biological medicine
Limited to R384 507 per beneficiary.
Other high-cost medicine
100% Scheme tariff.
Acute medicine
Savings first. Limited to M = R2 100, M1 + = R4 725.
(Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Member choice:
1. R1 110 OTC limit per family OR
2. Access to full savings for OTC purchases (after R1 110 limit) = self-payment gap accumulation. Includes suncreen, vitamins and minerals with nappi codes on Scheme formulary.
Subject to the available savings.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits:
Add Dependants
Pace3 offers comprehensive cover for members that have diverse medical needs. It includes comprehensive chronic benefits and excellent hospital cover.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R8 280
Adult dependant: R6 665
Child dependant: R1 424
Maximum child dependants: 3
Bestmed members pay for only three child dependants. The rest is covered at no extra cost. 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.
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call for more information
Accommodation (hospital stay) and theatre fees
100% Scheme tariff.
Take-home medicine
100% Scheme tariff. Limited to 7 days’ medicine.
Treatment in mental health clinic
100% Scheme tariff. Limited to 21 days per beneficiary
Treatment of chemical and substance abuse
100% Scheme tariff. Limited to 21 days or R37 352 per beneficiary. Subject to network facilities.
Consultations and procedures
100% Scheme tariff.
Surgical procedures and anaesthetics
100% Scheme tariff.
Organ transplants
100% Scheme tariff.
Stem cell transplants
100% Scheme tariff. (PMBs Only).
Major medical maxillo-facial surgery strictly related to certain conditions
100% Scheme tariff.
Dental and oral surgery (In- or out of hospital)
Limited to R23 345 per family.
Orthopaedic and medical appliances
100% Scheme tariff.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies).
100% Scheme tariff
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R155 450 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 R42 000
Pacemaker (dual chamber) R72 438
Vascular R72 450
Spinal incl. artificial disk R77 732
Drug-eluting stents R25 886
Mesh R22 796
Gynaecology/Urology R18 814
Lens implants R20 832 per lens per eye
Joint replacements:
Hip replacement and other major joints R69 555
Knee replacement R80 540
Other minor joints R25 886
Prosthesis – External
Limited to R35 842 per family per annum. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months.
Oncology
Oncology programme. 100% of Scheme tariff. Subject to pre-authorisation and DSP. Access to extended protocols.
Peritoneal dialysis and haemodialysis
100% Scheme tariff Subject to pre-authorisation and DSPs
Confinements (Birthing)
100% Scheme tariff.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
100% Scheme tariff. Limited to R11 673 per eye.
Breast surgery for cancer
Treatment of the unaffected (non-cancerous) breast will be limited to PMB provisions and is subject to pre-authorisation and funding guidelines.
Medically necessary breast reduction surgery (Including fees for the surgeon and anaesthetist)
100% Scheme tariff. R55 493 per family per annum (for surgeon and anaesthetist). Theatre and hospital cost will be funded from Scheme risk. Subject to funding protocols, pre-authorisation.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs
Midwife-assisted births
100% Scheme tariff
Supplementary services
100% Scheme tariff.
Alternatives to hospitalisation
100% Scheme tariff
Advanced illness benefit
100% Scheme tariff Limited to R133 182 per annum. Subject to available benefit, pre-authorisation and treatment plan.
Day procedures
Day procedures at DSPs and/or day-hospitals will be funded at 100% network or Scheme tariffs. Voluntary use of non-DSP specialists and acute hospitals will result in a co-payment of R2 625.
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.
Overall day-to-day limit
M = R41 472, M1+ = R66 878.
FP and Specialist consultations
Limited to M = R6 523, M1+ = R10 575.
(Subject to overall day-to-day limit)
Basic and specialised dentistry
Limited to M = R14 403, M1+ = R24 310.
(Subject to overall day-to-day limit)
Orthodontic dentistry
100% Scheme tariff. Subject to preauthorisation.
Limited to R12 208 per event for beneficiaries up to 18 years of age.
Medical aids, apparatus and appliances
Limited to R12 084 per family.
Includes repairs to artificial limbs.
(Subject to overall day-to-day limit)
Wheelchairs
Limited to R16 342 per family every 48 months.
Hearing aids
Limited to R41 746 per beneficiary every 24 months subject to pre-authorisation.
Insulin pump (excluding consumables)
100% Scheme tariff.
Limited to R48 572 per beneficiary every 24 months.
Subject to pre-authorisation.
Continuous/Flash Glucose Monitoring (CGM/FGM)
100% Scheme tariff. Limited to R27 746 per family per annum. Subject to pre-authorisation.
Supplementary services
Limited to M = R6 523, M1+ = R12 839.
(Subject to day-to-day overall limit)
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
Limited to R15 930 per family.
(Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service.
Network Provider (PPN)
Consultation - 1 per beneficiary.
Frame = R1 040 covered AND
100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND
Lens enhancement = R750 covered OR
Contact lenses = R2 375
Non-network Provider
Consultation - R365 fee at non-network provider
Frame = R780 AND
Single vision lenses = R215 OR
Bifocal lenses = R460 OR
Multifocal lenses = R982.50
Lens enhancement = R562.50 covered
In lieu of glasses members can opt for contact lenses, limited to R2 375
Basic radiology and pathology
Limited to M = R6 523, M1+ = R12 839.
(Subject to overall day-to-day limit)
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies and PET scans)
MRI/CT scans: Maximum of 2 scans per beneficiary - Limited to one (1) scan of the lumbar and cervical spine region for conservative back and neck scans per beneficiary per annum. PET scan: 1 scan per beneficiary - Subject to pre-authorisation.
Managed Healthcare - Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSPs.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation and DSP.
Access to extended protocols.
HIV/AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Rehabilitation services after trauma
100% Scheme tariff.
CDL and PMB chronic medicine
100% Scheme tariff.
Co-payment of 10% for non-formulary medicine.
Non-CDL chronic medicine
29 conditions. 100% Scheme tariff.
Limited to M = R23 000, M1+ = R46 209. Co-payment of 10% for non-formulary medicine.
Biological medicine
Limited to R569 070 per beneficiary.
Other high-cost medicine
100% Scheme tariff.
Acute medicine
Limited to M = R9 809, M1+ = R15 237.
10% co-payment.
(Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Subject to available savings.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
You may have above-average medical costs, or would like the maximum cover available. You need the comfort of extensive benefits and cover for hospital expenses.
In addition, there is an individual medical savings account which offer further payment flexibility. With the exclusivity that Pace4 offers, you have the greatest cover with complete peace of mind.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R10 343
Adult dependant: R10 343
Child dependant: R2 423
Maximum child dependants: 3
Bestmed members pay for only three child dependants. The rest is covered at no extra cost. 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
