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 if claimed on the day of discharge. Limited to: A maximum of 7 days treatment if claimed as part of the hospital account, or R200 if claimed from a retail pharmacy on the day of discharge; No benefit if not claimed on the date of discharge.
Biological medicine during hospitalisation
Limited to R34 828 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs and 21 days’ stay for in-hospital management per beneficiary per annum.
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 800 per family per annum.
Dental and oral surgery (In- or out of hospital)
Limited to R9 768 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R109 167 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 per annum: *Functional R37 342. Vascular R71 390. Pacemaker (single and dual chamber) R67 943. Spinal including artificial disc R39 788. Drug-eluting stents - subject to Vascular prosthesis limit. Mesh R14 939. Gynaecology/urology R10 773. Lens implants R8 188 a lens per eye.
Prosthesis – External
Limited to R27 723 per family. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
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 R40 506. Knee replacement R53 866. Other minor joints R16 735.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 000 per family per annum.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies)
100% Scheme tariff. Limited to a combined in and out of hospital benefit of R40 000 per family per annum. Co-payment of R2 000 per scan, not applicable for PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Oncology
Oncology programme. 100% Scheme tariff. Subject to pre-authorisation, protocols 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. Subject to pre-authorisation and protocols. Limited to R10 859 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 R87 068 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, subject to pre-authorisation, protocols, funding guidelines and DSPs. A co-payment of R2 746 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the procedure shall be paid in full if it is done in an acute hospital, if it is arranged with the Scheme before the time
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Overall day-to-day limit
M = R13 187, M1+ = R26 373.
GP and Specialist consultations
Savings first. Limited to M = R2 715, M1+ = R5 459. (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 998, M1+ = R10 142. (Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
Savings first. Limited to R13 934 per family. Includes repairs to artificial limbs. 100% Scheme tariff. (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 678 per family every 24 months. 100% Scheme tariff. Subject to pre-authorisation
Supplementary services
Savings first. Limited to M = R5 329, M1+ = R11 061. (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 381 per family. (Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary. Frame = R1 210 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR Contact lenses = R2 025 OR Non-network Provider: Consultation - R400 fee at non network provider Frame = R908 AND Single vision lenses = R215 OR Bifocal lenses = R460 OR Multifocal lenses = R1 040 (consisting of R810 per base lens plus R230 per branded lens add-on) In lieu of glasses members can opt for contact lenses, limited to R2 025
Basic radiology and pathology
Savings first. Limited to M = R3 950, M1+ = R7 901. (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 a combined in- and out-of hospital benefit of R40 000 per family per annum. Co-payment of R2 000 per scan, except for an involuntary use of a non-DSP for a PMB condition. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the adovementioned limit and co-payment. Subject to pre-authorisation.
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. 100% of Scheme tariff. Subject to pre-authorisation, protocols 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 = R8 044, M1+ = R16 087. Co-payment of 25% for non-formulary medicine.
Biological medicine
PMBs only as per funding protocol.
Other high-cost medicine
100% Scheme tariff. Subject to pre-authorisation.
Acute medicine
Savings first. Limited to M = R2 846, M1 + = R5 890. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Member choice:
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 706
Adult dependant: R4 008
Child dependant: R1 440
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years 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 if claimed on the day of discharge. Limited to: A maximum of 7 days treatment if claimed as part of the hospital account, or R150 if claimed from a retail pharmacy on the date of discharge. No benefit if not claimed on the date of discharge. Limited to 7 days' medicine
Biological medicine during hospitalisation
Limited to R29 022 per family per annum. Subject to pre-authorisation and funding guidelines.re-authorisation and funding guidelines.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation. Limited to 21 days per beneficiary
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs and 21 days’ stay for in-hospital management per beneficiary per annum. 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 945 per family per annum
Dental and oral surgery (In- or out of hospital)
Limited to R12 210 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R117 652 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 per annum: *Functional R37 342. Pacemaker (single and dual chamber) R68 086. Vascular R71 390. Spinal including artificial disc R40 652. Drug-eluting stents R22 839. Mesh R15 083. Gynaecology/urology R11 061. Lens implants R8 618 a lens per eye.
Prosthesis – External
Limited to R28 297 per family. DSPs apply. Includes artificial limbs limited to one (1) limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
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 R41 800. Knee replacement R55 532. Other minor joints R17 063
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. Limited to R15 000 per family per annum.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies)
Limited to a combined in and out of hospital benefit of R40 000 per family per annum. Co-payment of R2 000 per scan on MRI and CT scans, not applicable to PMBs. PET scans are limited to one (1) scan per beneficiary per annum, not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
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. Subject to pre-authorisation and protocols. Limited to R11 349 per eye.
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 R104 482 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, subject to pre-authorisation, protocols, funding guidelines and DSPs.. A co-payment of R2 746 shall be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the procedure shall be paid in full if it is done in an acute hospital, if it is arranged with the Scheme before the time.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA
Overall day-to-day limit
M = R15 513, M1+ = R31 025
FP and Specialist consultations
Savings first. Limited to M = R3 951, M1+ = R7 037. (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 835, M1+ = R13 728. (Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
Savings first. Limited to R13 934 per family. Includes repairs to artificial limbs. 100% Scheme tariff. (Subject to overall day-to-day limit).
Hearing aids
Subject to pre-authorisation Limited to R12 770 per family every 24 months. 100% Scheme tariff. (Subject to quotation, motivation and audiogram)
Supplementary services
Savings first. Limited to M = R6 033, M1+ = R12 253. (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 R6 033 per family. (Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN) Consultation - One (1) per beneficiary. Frame = R1 210 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR Contact lenses = R2 025 OR Non-network Provider Consultation - R400 fee at non-network provider Frame = R908 AND • Single vision lenses = R215 OR Bifocal lenses = R460 OR Multifocal lenses = R1 040 (consisting of R810 per base lens plus R230 per branded lens add-on) In lieu of glasses members can opt for contact lenses, limited to R2 025
Basic radiology and pathology
Savings first. Limited to M = R3 950, M1+ = R8 044. (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 a combined in and out of hospital benefit of R40 000 per family per annum. Co-payment of R 2 000 per scan, not applicable to PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. 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. Subject to pre-authorisation, protocols and DSPs.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation, protocols 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 = R9 150, M1+ = R18 301. Co-payment of 20% for non-formulary medicine.
Biologicals medicine
PMBs only as per funding protocol.
Other high-cost medicine
PMBs only as per funding protocol.
Acute medicine
Savings first. Limited to M = R3 491, M1 + = R7 052. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
*Member choice:
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 832
Adult dependant: R5 642
Child dependant: R1 689
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years 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 if claimed on the day of discharge. Limited to: A maximum of 7 days treatment if claimed as part of the hospital account, or R200 if claimed from a retail pharmacy on the day of discharge; No benefit if not claimed on the date of discharge.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs, 21 days’ stay for in-hospital management per beneficiary per annum.
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 R16 232 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R140 193 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 per annum: *Functional R39 539. Vascular R71 390. Pacemaker (single and dual chamber) R75 770.Spinal including artificial disc R70 284. Drug-eluting stents R22 983. Mesh R22 983. Gynaecology/urology R17 164. Lens implants R14 738 a lens per eye. Joint replacements: - Hip replacement and other major joints R63 129. - Knee replacement R73 257. - Other minor joints R27 219.
Prosthesis – External
Limited to R33 037 per family per annum. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 000 per family per annum.
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. Limited to a combined in and out of hospital benefit of R42 000 per family per annum. Co-payment of R1 500 per scan, not applicable for PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Oncology
Oncology programme. 100% of Scheme tariff. Subject to pre-authorisation, protocols and DSP. Subject to pre-authorisation and DSP.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs. 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 R11 347 per eye
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 R139 308 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, subject to pre-authorisation, protocols, funding guidelines and DSPs. A co-payment of R2 746 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the procedure shall be paid in full if it is done in an acute hospital, if it is arranged with the Scheme before the time.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Overall day-to-day limit
M = R16 475, M1+ = R32 949.
GP and Specialist consultations
Savings first. Limited to M = R5 029, M1+ = R10 192. (Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings first and then from day-to-day limit. Limited to M = R8 377, M1+ = R16 756. (Subject to overall day-to-day limit
Orthodontic dentistry
Savings first. 100% Scheme tariff. Subject to pre-authorisation. Limited to R8 126 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 640 per family. Includes repairs to artificial limbs. 100% Scheme tariff. (Subject to overall day-to-day limit)
Wheelchairs
Limited to R17 094 per family every 48 months.
Hearing aids
Limit of R32 000 per beneficiary every 24 months. Subject to quotation, motivation and audiogram.
Supplementary services
Savings first. Limited to M = R3 844, M1+ = R7 688. (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 882 per family. (Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary. Frame = R1 260 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND Lens enhancement = R750 covered OR Contact lenses = R2 215 OR Non-network Provider: Consultation - R400 fee at non-network provider Frame = R945 AND Single vision lenses = R215 OR Bifocal lenses = R460 OR Multifocal lenses = R1 040 (consisting of R810 per base lens plus R230 per branded lens add-on) AND Lens enhancement = R563 covered In lieu of glasses members can opt for contact lenses, limited to R2 215
Basic radiology and pathology
Savings first. Limited to M = R3 950, M1+ = R7 901. (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 a combined in and out of hospital benefit of R42 000 per family per annum. Co-payment of R1 500 per scan, except for an involuntary use of a non-DSP for a PMB condition. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Managed Healthcare - Back and Neck Preventative Programme
Benefits payable at 100% of contracted fee. Subject to pre-authorisation, protocols and DSP
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 983 M1+ = R21 966. Co-payment of 20% for non-formulary medicine.
Biological medicine
Limited to R200 964 per beneficiary.
Other high-cost medicine
100% Scheme tariff. Subject to pre-authorisation.
Acute medicine
Savings first. Limited to M = R3 295, M1 + = R6 590. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Member choice:
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: R8 132
Adult dependant: R7 974
Child dependant: R1 793
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years 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 if claimed on the day of discharge. Limited to: A maximum of 7 days treatment if claimed as part of the hospital account, or R200 if claimed from a retail pharmacy on the day of discharge. No benefit if not claimed on the date of discharge.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation. Limited to 21 days per beneficiary
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs and 21 days’ stay for in-hospital management per beneficiary per annum. 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 R20 397 per family per annum.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R140 912 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 per annum: Functional R39 539. Vascular R75 783. Pacemaker (single and dual chamber) R75 770. Spinal including artificial disc R70 418. Drug-eluting stents R22 983. Mesh R22 983. Gynaecology/urology R17 237. Lens implants R14 738 a lens per eye. Joint replacements: - Hip replacement and other major joints R63 201. - Knee replacement R73 615. - Other minor joints R27 219.
Prosthesis – External
Limited to R33 182 per family per annum. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 000 per family per annum.
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. Limited to a combined in and out of hospital benefit of R42 000 per family per annum. Co-payment of R1 500 per scan, not applicable for PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation
Oncology programme
100% Scheme tariff. Subject to pre authorisation and DSPs. 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. Subject to pre-authorisation and protocols. Limited to R12 210 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 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 R139 308 per beneficiary per annum. Subject to available benefit, pre-authorisation and treatment plan.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Day procedures
Day procedures performed in a day hospital by a DSP provider will be funded at 100% network or Scheme tariff, subject to pre-authorisation, protocols, funding guidelines and DSPs. A co-payment of R2 746 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the procedure shall be paid in full if it is done in an acute hospital, if it is arranged with the Scheme before the time.
Overall day-to-day limit
M = R22 015, M1+ = R45 497.
GP and Specialist consultations
Savings first. 100% Scheme tariff. M = R5 316, M1+ = R10 773. (Subject to overall day-to-day limit)
Basic and specialised dentistry
Savings first and then from day-to-day limit. Limited to M = R9 027, M1+ = R16 829. (Subject to overall day-to-day limit)
Orthodontic dentistry
Savings first. 100% Scheme tariff. Subject to pre-authorisation. Limited to R10 448 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 640 per family. Includes repairs to artificial limbs. 100% Scheme tariff. (Subject to overall day-to-day limit)
Wheelchairs
Limited to R17 094 per family every 48 months.
Hearing aids
Limit of R32 000 per beneficiary every 24 months. Subject to quotation, motivation and audiogram.
Continuous/Flash Glucose Monitoring (CGM/FGM)
100% Scheme tariff. Limited to R23 218 per family per annum. Subject to pre-authorisation.
Supplementary services
Savings first. Limited to M = R3 247, M1+ = R6 823. (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 983 per family. (Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary. Frame = R1 260 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND Lens enhancement = R750 covered OR Contact lenses = R2 215 OR Non-network Provider:Consultation - R400 fee at non-network provider. Frame = R945 AND Single vision lenses = R215 OR Bifocal lenses = R460 OR Multifocal lenses at R1 040 (consisting of R810 per base lens plus R230 per branded lens add-on) AND Lens enhancement = R563 covered In lieu of glasses members can opt for contact lenses, limited to R2 215
Basic radiology and pathology
Savings first. Limited to M = R4 310, M1+ = R8 546. (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 a combined in- and out-of hospital benefit of R42 000 per family per annum. Co-payment of R1 500 per scan, except for an involuntary use of a non-DSP for a PMB condition. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. 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. 100% of Scheme tariff. Subject to pre-authorisation, protocols 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 15% for non-formulary medicine.
Non-CDL chronic medicine
20 conditions. 90% Scheme tariff. Limited to M = R16 878, M1+ = R33 757. Co-payment of 15% for non-formulary medicine.
Biological medicine
Limited to R402 194 per beneficiary.
Other high-cost medicine
100% Scheme tariff. Subject to pre-authorisation.
Acute medicine
Savings first.Limited to M = R2 197, M1+ = R4 942. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine
Member choice:
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: R9 336
Adult dependant: R7 515
Child dependant: R1 606
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years 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 if claimed on the day of discharge. Limited to: A maximum of 7 days treatment if claimed as part of the hospital account, or R200 if claimed from a retail pharmacy on the date of discharge; No benefit if not claimed on the date of discharge.
Treatment in mental health clinic
Approved PMBs at DSPs. Limited to a maximum of 21 days per beneficiary per financial year in hospital including inpatient electroconvulsive therapy and inpatient psychotherapy, OR 15 contact sessions for out-patient psychotherapy per beneficiary per financial year. Subject to pre-authorisation.
Treatment of chemical and substance abuse
Benefits shall be limited to the treatment of PMB conditions and subject to the following: Pre-authorisation, DSPs and 21 days’ stay for in-hospital management per beneficiary per annum. 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 R24 419 per family per annum.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R15 000 per family per annum.
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies).
100% Scheme tariff. Limited to a combined in- and out-ofhospital benefit of R45 000 per family per annum. Co-payment of R1 500 per scan, not applicable for PMBs. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. Subject to pre-authorisation.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R162 601 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 per annum: *Functional R43 932. Vascular R75 783. Pacemaker (single and dual chamber) R75 770. Spinal including artificial disc R81 308. Drug-eluting stents R27 077. Mesh R23 845. Gynaecology/urology R19 679. Lens implants R21 790 a lens per eye. Joint replacements: - Hip replacement and other major joints R72 755. - Knee replacement R84 245. - Other minor joints R27 077.
Prosthesis – External
Limited to R37 491 per family per annum. DSPs apply. Includes artificial limbs limited to 1 limb every 60 months. Repair work to artificial limbs will be funded from the out-of-hospital Medical aids, apparatus and appliances benefit.
Oncology
Oncology programme. 100% of Scheme tariff. Subject to pre-authorisation and DSPs. Access to extended protocols.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre authorization and DSPs.
Confinements (Birthing)
100% Scheme tariff.
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 R12 210 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. R58 046 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 R139 308 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, subject to pre-authorisation, protocols, funding guidelines and DSPs. A co-payment of R2 746 will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital. If a DSP is used and the DSP does not work in a day hospital, the procedure shall be paid in full if it is done in an acute hospital, if it is arranged with the Scheme before the time.
International travel cover
Holiday travel: Limited to 90 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA. Business travel: Limited to 60 days and R5 000 000 per family, i.e. members and dependants. Limited to R1 000 000 per family for travel to the USA.
Overall day-to-day limit
M = R43 380, M1+ = R69 954.
GP and Specialist consultations
Limited to M = R6 823, M1+ = R11 061. (Subject to overall day-to-day limit)
Basic and specialised dentistry
Limited to M = R15 066, M1+ = R25 428. (Subject to overall day-to-day limit)
Orthodontic dentistry
100% Scheme tariff. Subject to pre-authorisation. Limited to R12 770 per event for beneficiaries up to 18 years of age. (Subject to overall day-to-day limit)
Medical aids, apparatus and appliances
Limited to R12 640 per family. Includes repairs to artificial limbs. 100% Scheme tariff. (Subject to overall day-to-day limit)
Wheelchairs
Limited to R17 094 per family every 48 months.
Hearing aids
Limited to R35 000 per beneficiary every 24 months subject to pre-authorisation. Subject to quotation, motivation and audiogram.
Insulin pump (excluding consumables)
100% Scheme tariff. Limited to R50 806 per beneficiary every 24 months. Subject to pre-authorisation.
Continuous/Flash Glucose Monitoring (CGM/FGM)
100% Scheme tariff. Limited to R29 022 per family per annum. Subject to pre-authorisation.
Supplementary services
Limited to M = R6 823, M1+ = R13 430. (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)
Limited to R16 663 per family. (Subject to overall day-to-day limit)
Optometry benefit
Benefits available every 24 months from date of service. Network Provider (PPN): Consultation - One (1) per beneficiary. Frame = R1 260 covered AND 100% of cost of standard lenses (single vision OR bifocal OR multifocal) AND Lens enhancement = R750 covered OR Contact lenses = R2 620 OR Non-network Provider: Consultation - R400 fee at non-network provider. Frame = R945 AND Single vision lenses = R215 OR Bifocal lenses = R460 OR Multifocal lenses = R1 040 (consisting of R810 per base lens plus R230 per branded lens add-on) AND Lens enhancement = R563 covered In lieu of glasses members can opt for contact lenses, limited to R2 620.
Basic radiology and pathology
100% Scheme tariff. Limited to M = R6 823, M1+ = R13 430. (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 a combined in and out of hospital benefit of R45 000 per family per annum. Co-payment of R1 500 per scan, except for an involuntary use of a non-DSP for a PMB condition. PET scans are limited to one (1) scan per beneficiary per annum. Not subject to the abovementioned limit and co-payment. 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. 100% of Scheme tariff. Subject to pre-authorisation, protocols 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 10% for non-formulary medicine.
Non-CDL chronic medicine
29 conditions. 100% Scheme tariff.
Limited to M = R24 058, M1+ = R48 335. Co-payment of 10% for non-formulary medicine.
Biological medicine
Limited to R595 247 per beneficiary
Other high-cost medicine
100% Scheme tariff. Subject to pre-authorisation.
Acute medicine
Limited to M = R10 260, M1+ = R15 938. Co-payment of 10% for non-formulary medicine. (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: R11 662
Adult dependant: R11 662
Child dependant: R2 732
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children can join as beneficiaries of the Scheme at no additional cost. Dependants under the age of 24 years are regarded as child dependant.
Get personalised pricing
call for more information
