No matter your age, if you are looking to be covered for life’s unexpected tumbles, our hospital plans give unlimited cover for planned and unplanned hospital stays.
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
Biological medicine during hospitalisation
Limited to R11 610 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 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
No benefit. (PMBs only).
Dental and oral surgery (In- or out of hospital)
PMBs only at DSP day hospitals.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R91 183 per family per annum.
Prosthesis – Internal Note: Sub-limits subject to availability of overall prosthesis limit. DSPs apply *Functional: Items used to replace or augment an impaired bodily function.
Sub-limits per beneficiary per annum:
*Functional: R34 047. Pacemaker (single and dual chamber): R51 998. Vascular: R54 915. Spinal including artificial disc: R38 068. Drug-eluting stents - subject to Vascular prosthesis limit. Mesh: R13 360. Gynaecology/urology: R10 917. Lens implants: R8 330 a lens per eye.
Prosthesis – External
No benefit. (PMBs only).
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
Exclusions (Limits and co-payments apply. Preferred provider network available.)
Joint replacement surgery (except for PMBs).
PMBs subject to prosthesis limits. Hip replacement and other major joints: R38 313. Knee replacement: R47 240. Minor joints: R14 695
Orthopaedic and medical appliances *Note: Appliances directly relating to the hospital admission and/or procedure
100% Scheme tariff. Limited to R15 000 per family per annum
Pathology
100% Scheme tariff.
Basic radiology
100% Scheme tariff.
Specialised diagnostic imaging - in- and/or out-of-hospital (including MRI scans, CT scans and nuclear/isotope studies). PET scans are excluded, not applicable to PMBs.
Limited to a combined in- and out-of hospital benefit of R20 000 per family per annum. Co-payment of R2 600 per scan, not applicable to PMBs. PET scans - PMB only. Subject to pre-authorisation.
Oncology
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.
HIV and AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
PMBs only
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 R69 654 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.
Co-payments
Non-network hospital co-payment Co-payment for voluntary use of non-network hospital R14 364 applicable to network options. Procedure-specific co-payments: The co-payment shall not apply to PMB conditions: Arthroscopic procedures R3 660. Back and neck surgery R3 660. Functional nasal and sinus procedures R2 000. Laparoscopic procedures R3 660. • Colonoscopies R2 000. Cystoscopies R2 000. Gastroscopies R2 000. Hysteroscopies R2 000. Sigmoidoscopies R2 000. A co-payment of R2 746, as described in the Day procedures benefit, will be incurred per event if a day procedure is done in an acute hospital that is not a day hospital.
Family Practitioner (FP) and specialist consultations
None.
Medical Savings
None.
Medical aids, apparatus and appliances including wheelchairs and hearing aids (Hearing aids are subject to pre-authorisation)
None.
Supplementary services
None.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
100% Scheme tariff. Limited to R4 267 per family.
Basic and Specialised Dentistry
None.
Optometry Services
None.
Basic radiology and pathology
None.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded)
Limited to a combined in- and out-of hospital benefit of R20 000 per family per annum. Co-payment of R2 600 per scan, not applicable to PMBs. PET scans - PMB only. Subject to pre-authorisation.
Oncology
Oncology programme at 100% of Scheme tariff. Subject to pre-authorisation, protocols and DSP.
Peritoneal dialysis and haemodialysis
100% Scheme tariff. Subject to pre-authorisation and DSPs.
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.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff. Co-payment of 30% for non-formulary medicine.
Non-CDL chronic medicine
No benefit.
Biological medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Other high-cost medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Acute medicine
No benefit.
Over-the-counter (OTC) medicine
No benefit.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
No matter your age, if you are looking to be covered for life's unexpected tumbles, our hospital plans give unlimited cover at any of our network hospitals for planned and unplanned hospital stays.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R2 111
Adult dependant: R1641
Child dependant: R889
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children join as beneficiaries on 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
Biological medicine during hospitalisation
Limited to R11 610 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health facilities
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
No benefit. (PMBs only).
Dental and oral surgery (In- or out of hospital)
PMBs only at DSP day hospitals.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R95 377 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 R34 047. Pacemaker (single and dual chamber) R51 998. Vascular R54 915. Spinal including artificial disc R38 068. Drug-eluting stents - subject to Vascular prosthesis limit. Mesh R 13 360. Gynaecology/urology R10 917. Lens implants R8 330 a lens per eye.
Prosthesis – External
No benefit. (PMBs only).
Exclusions (Prosthesis sub-limits form part of overall Internal prosthesis 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 R40 075. Knee replacement R49 413. Other minor joints R15 371.
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. 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 R20 000 per family per annum. Co-payment of R2 600 per scan, not applicable to PMBs. PET scans - PMB only. Subject to pre-authorisation.
Oncology
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.
HIV and AIDS
100% Scheme tariff. Subject to pre-authorisation and DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
PMBs only
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 R69 654 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 medical 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
Co-payments
Non-network hospital co-payment Co-payment for voluntary use of non-network hospital R14 364 applicable to network options. The co-payment shall not apply to PMB conditions: Arthroscopic procedures R3 660. Back and neck surgery R3 660. Functional nasal and sinus procedures R2 000. Laparoscopic procedures R3 660. Colonoscopies R2 000. Cystoscopies R2 000. Gastroscopies R2 000. Hysteroscopies R2 000. Sigmoidoscopies R2 000.
Family Practitioner (FP) and specialist consultations
None.
Medical Savings
None.
Medical aids, apparatus and appliances including wheelchairs and hearing aids (Hearing aids are subject to pre-authorisation)
None.
Supplementary services
None.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
100% Scheme tariff. Limited to R4 267 per family
Basic and Specialised Dentistry
None.
Optometry Services
None.
Basic radiology and pathology
None.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded)
Limited to a combined in- and out-of hospital benefit of R20 000 per family per annum. Co-payment of R2 600 per scan, not applicable to PMBs. PET scans - PMB only. Subject to pre-authorisation.
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.
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.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff. Co-payment of 30% for non-formulary medicine.
Non-CDL chronic medicine
No benefit.
Biological medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Other high-cost medicine
PMBs only as per funding protocol. Subject to pre-authorisation
Acute medicine
No benefit.
Over-the-counter (OTC) medicine
No benefit.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
No matter your age, if you are looking to be covered for life's unexpected tumbles, this hospital plan gives unlimited cover for unplanned hospital stays.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions
Member: R2 347
Adult dependant: R1 822
Child dependant: R987
Maximum child dependants: 3
Bestmed members pay for only three child dependants. Any additional children join as beneficiaries on 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
