Bestmed's network options offer healthcare services and private hospital cover at designated service providers (DSPs).
Accommodation (hospital stay) and theatre fees
Approved PMBs at DSPs.
Take-home medicine
100% Scheme tariff 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
Approved PMBs at DSPs.
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
Approved PMBs at DSPs. Subject to pre-authorisation.
Surgical procedures and anaesthetics
Approved PMBs at DSPs. Subject to pre-authorisation.
Organ transplants
100% Scheme tariff. (PMBs only.)
Stem cell transplants
100% Scheme tariff. (PMBs Only).
Major medical maxillo-facial surgery strictly related to certain conditions
Approved PMBs at DSPs.
Dental and oral surgery (In- or out of hospital)
Approved PMBs at DSPs.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R64 208 per family. Subject to PMBs at DSP network.
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. Vascular R54 915. Pacemaker (single and dual chamber) R51 998. Spinal including artificial disc R31 815. Drug-eluting stents – subject to Vascular prosthesis limit. DSPs apply. Mesh R11 636. Gynaecology/urology R9 611. Lens implants R6 681 a lens per eye.
Prosthesis – External
Approved PMBs at DSPs.
Exclusions (Prosthesis sub-limit subject to preferred provider, otherwise limits and co-payments apply)
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits: Hip replacement and other major joints R32 607. Knee replacement R41 226. Other minor joints R 15 441.
Orthopaedic and medical appliances
Approved PMBs at DSPs.
Pathology
Approved PMBs at DSPs.
Basic radiology
Approved PMBs at DSPs.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. Excluding PET scans)
Approved PMBs at DSPs. PET scans - PMB only. Subject to pre-authorisation.
Oncology
Approved PMBs at DSPs.
Peritoneal dialysis and haemodialysis
Approved PMBs at DSPs.
Confinements (Birthing)
Approved PMBs at DSPs.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
Approved PMBs at DSPs.
HIV/AIDS
Approved PMBs at DSPs.
Midwife-assisted births (Protocols apply)
PMBs and emergency caesarean sections (C-sections).
Alternatives to hospitalisation
Approved PMBs at DSPs.
Advanced illness benefit
Approved PMBs. Subject to pre authorisation and treatment plan.
Day procedures
PMBs in network day-hospitals:
Approved PMBs at DSPs. Subject to pre-authorisation, protocols and funding guidelines.
Non-PMBs in network day-hospitals:
100% Scheme tariff. Subject to approved DSPs and pre-authorisation. Limited to R54 915 per family per annum for non-PMB day procedures. 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. The non-PMB conditions covered are: Circumcision, Colonoscopy - co-payment applicable, Gastroscopy - co-payment applicable, Myringotomy and grommet insertion, Sterilisation (male and female) and Tonsillectomy
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-DSP hospital co-payment: Co-payment of R14 364 per event for voluntary use of a non-DSP hospital. Procedure-specific co-payments: The co-payment shall not apply to PMB conditions: Colonoscopies R2 000 and Gastroscopies R2 000.
General Practitioner (GP) consultations
Unlimited GP consultations. Subject to Rhythm GP network. Subject to pre approval after 10th visit. Applicable per family per annum.
Pharmacy clinic nurse consultation
100% of Scheme tariff. Unlimited primary care nurse consultations (NAPPI code 981078001) at preferred provider network pharmacy clinic.
Specialist consultations
Specialist consultations must be referred by a Rhythm Network Provider. 100% Scheme tariff. Limited to a maximum of R2 553 per family per year. Subject to Rhythm Specialist DSP network.
Out-of-network and casualty visits
PMB only
Medical aids, apparatus and appliances including wheelchairs and hearing aids and appliances
Approved PMBs at DSPs
Supplementary services
PMB only.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
PMB only.
Basic Dentistry
Where clinically appropriate and subject to Rhythm1 protocols, Rhythm Dental Network Providers and Rhythm approved dental codes.
Optometry Services
Benefits available every 24 months from date of service. Network Provider (PPN): One (1) consultation (eye test) at optometrist network per beneficiary per annum. No benefit for spectacle frames, lenses or contact lenses. Non-network Provider: One (1) consultation per beneficiary = R400. No benefit for spectacle frames, lenses or contact lenses.
Basic pathology
100% Scheme tariff. Basic blood tests as requested by a Rhythm Network GP and network pathologists, subject to Rhythm1 protocols and Rhythm approved pathology codes.
Basic radiology
100% Scheme tariff. Basic X-rays as requested by your Rhythm Network GP and subject to Rhythm1 protocols and Rhythm approved radiology codes.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded).
Approved PMBs at DSPs. PET scans - PMB only. Subject to pre-authorisation.
Oncology
Approved PMBs at DSPs. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
Approved PMBs at DSPs.
HIV/AIDS
Approved PMBs at DSPs
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs
CDL and PMB chronic medicine
100% Scheme tariff. 30% co-payment on non-formulary medicine at a preferred provider network pharmacy.
Biological medicine
PMBs only. Subject to pre-authorisation
Other high-cost medicine
PMBs only. Subject to pre-authorisation
Acute medicine
100% Scheme tariff. Subject to Bestmed formulary only. As prescribed by Rhythm Network Provider and obtained from preferred provider pharmacy network.
Children:
Adults:
Adults:
100% Scheme tariff at DSP network. Subject to the following benefits:
Add Dependants
*Your monthly contribution will be determined by the higher of the gross monthly income of the Main Member and Spouse/Partner on the membership upon submitting your application. Three months’ payslips will be required upon applying with Bestmed and proof of income will be requested annually to determine the correct income category for the membership. If your are unable to provide the requested, the highest income bracket being used.
Our network options offer you unlimited in-hospital cover with either limited essential day-to-today benefits, or comprehensive savings for your consultations with designated healthcare providers.
Contributions (income R0 - R9 000)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 at a designated service provider (DSP) hospital.
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 R17 414 per family per annum. Subject to pre-authorisation and funding guidelines.
Treatment in mental health clinics
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. .
Excluded from benefits: functional nasal surgery, surgery for medical conditions, e.g. Epilepsy, Parkinson’s disease, etc., and procedures where stimulators are used.
Organ transplants
100% Scheme tariff. (PMBs only)
Stem cell transplants
100% Scheme tariff. (PMBs Only).
Major medical maxillo-facial surgery strictly related to certain conditions
Approved PMBs at DSPs.
Dental and oral surgery (In- or out of hospital)
Approved PMBs at DSPs.
Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply)
100% Scheme tariff. Limited to R64 208 per family per annum. Limited to R61 384 per family.
Prosthesis – Internal Note: Sub-limit subject to the overall annual prosthesis limit. *Functional: Item utilised towards treating or supporting a bodily function.
Sub-limits per beneficiary per annum: *Functional R34 047. Vascular R54 915. Pacemaker (singular and dual chamber) R51 998. Spinal including artificial disc R31 815. Drug-eluting stents – subject to Vascular prosthesis limit. DSPs apply. Mesh R11 636. Gynaecology/urology R9 611. Lens implants R6 681 a lens per eye.
Prosthesis – External
Approved PMBs at DSPs.
Exclusions (Prosthesis sub-limit subject to preferred provider, otherwise limits and co-payments apply)
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits: Hip replacement and other major joints R32 607. Knee replacement R41 226. Other minor joints R15 441. Functional nasal surgery and surgical procedures where CNS stimulators are used (e.g. epilepsy, Parkinson disease, etc.) will be excluded from benefits, except for PMB conditions.
Orthopaedic and medical appliances
100% Scheme tariff. Limited to R7 901 per family per annum. Limited to R7 554 per family.
Pathology
100% Scheme tariff.
Basic Radiology
100% Scheme tariff
Specialised diagnostic imaging (Including MRI scans, CT scans, isotope studies)
100% Scheme tariff. Limited to a combined in- and out-of-hospital benefit of R18 000 per family per annum. Co-payment of R2 600 per scan, not applicable to PMBs. PET scans - PMB only. Subject to pre-authorisation.
Confinements (Birthing)
100% Scheme tariff.
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, protocols and DSP.
Refractive surgery and all types of procedures to improve or stabilise vision (except cataracts)
Approved PMBs at DSPs.
HIV/AIDS
Subject to pre-authorisation, protocols and DSP.
Midwife-assisted births (Protocols apply)
100% Scheme tariff. Subject to pre-authoristation, DSPs, protocols and funding guidelines.
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-DSP hospital co-payment: Co-payment of R14 364 per event for voluntary use of a non-DSP hospital. Procedure-specific co-payments: The co-payment shall not apply to PMB conditions: Arthroscopic procedures R3 660. Back and neck surgery R3 660. Laparoscopic procedures R3 660. Colonoscopies R2 000. Cystoscopies R2 000. Gastroscopies R2 000. Hysteroscopies R2 000. Sigmoidoscopies R2 000. A R2 746 co-payment, 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.
General Practitioner (GP) consultations
Unlimited GP consultations. Subject to Bestmed Rhythm GP network. Applicable per family per annum.
Specialist consultations
Specialist consultations (this includes minor procedures done in specialist rooms and all consumables used), must be referred by a Rhythm Network Provider. Limited to M = R1 742, M1+ = R2 903. Subject to Rhythm Specialist DSP network.
Out-of-network and casualty visits
Out-of-network visits to a GP and casualty visits are limited to a maximum of R1 723 per family per year. Basic radiology and pathology that falls within formulary when received as a result of the casualty visit will be paid from the out-of-network and casualty visits limit. Once limit has been reached the costs will be for the member’s own account. You will be required to pay for all treatment received at the point of service. The cost of these services may be claimed back by completing an out-of-network claim form which can be downloaded from the Bestmed website or obtained from Bestmed. Reimbursements are subject to Bestmed Rhythm2 protocols.
Medical aids, apparatus and appliances including wheelchairs and hearing aids and appliances
Approved PMB services only.
Supplementary services
Approved PMB services only.
Wound care benefit (incl. dressings, negative pressure wound therapy -NPWT- treatment and related nursing services -out-of-hospital)
Approved PMB services only.
Basic Dentistry
Where clinically appropriate and subject to Bestmed Rhythm1 protocols, Bestmed Rhythm Dental Network Providers and Rhythm approved dental codes.
Dentures
Limited to a maximum of 2 removable acrylic dentures (i.e. 2 single denture plates) per family every 24 months.
Optometry Services
Benefits available every 24 months from date of service. Network Provider (PPN): One (1) consultation per beneficiary. Spectacle frames or lens enhancements limited to R295 AND Standard lenses (i.e. one pair of single vision OR one pair of flat top bifocal lenses inclusive of the charges for extra-large lenses and prismatic correction) at 100% of cost. In lieu of glasses members can opt for contact lenses, limited to R770
Basic pathology
100% Scheme tariff.
Basic blood tests as requested by a Bestmed Rhythm Network GP and subject to Bestmed Rhythm2 protocols and Rhythm approved pathology codes.
Basic radiology
100% Scheme tariff.
Basic X-rays as requested by your Bestmed Rhythm Network GP and subject to Bestmed Rhythm2 protocols and Rhythm approved radiology codes.
Specialised diagnostic imaging (Including MRI scans, CT scans and isotope studies. PET scans excluded).
100% Scheme tariff. Limited to a combined in- and out-of-hospital benefit of R18 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
Subject to pre-authorisation, protocols and DSP. Subject to pre-authorisation and DSPs.
Peritoneal dialysis and haemodialysis
Subject to pre-authorisation, protocols and DSP.
HIV/AIDS
Subject to pre-authorisation, protocols and DSP.
Rehabilitation services after trauma
PMBs only. Subject to pre-authorisation and DSPs.
CDL and PMB chronic medicine
100% Scheme tariff. 30% co-payment for non-formulary medicine at a preferred provider network pharmacy.
Biological medicine
PMBs only. Subject to pre-authorisation
Other high-cost medicine
PMBs only. Subject to pre-authorisation
Acute medicine
100% Scheme tariff. Subject to Bestmed formulary only. As prescribed by Rhythm Network Provider and obtained from preferred provider pharmacy network.
Over-the-counter (OTC) medicine
100% Scheme tariff. Limited to R350 per family per annum and to R120 per event.
Children:
Adults:
Adults:
100% Scheme tariff. Subject to the following benefits
Add Dependants
Our network options offer you unlimited in-hospital cover with either limited essential day-to-today benefits, or comprehensive savings for your consultations with designated healthcare providers. This option is income level dependant.
You pay for a maximum of three children. Any additional children can join as beneficiaries of the Scheme at no additional cost.
Contributions (income level R0 - R5 500)
Member: R2 368
Adult dependant: R2 250
Child dependant: R1 425
Maximum child dependants: 3
Contributions (income level R5 501 - R8 500)
Member: R2 845
Adult dependant: R2 703
Child dependant: R1 707
Maximum child dependants: 3
Contributions (income level R8 501 and higher)
Member: R3 413
Adult dependant: R3 072
Child dependant: R1 707
Maximum child dependants: 3
Bestmed members pay for a maximum of three children. 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
