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Beat 1 Non-Network 2021

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Type of Medical Aid Plan: 
Hospital
Medical Aid Year: 
2021
Day to day Benefits: 

No benefit

In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
Unlimited at 100% of Bestmed Tariff (BT). Day procedures are funded at 100% of BT in a day-hospital facility
Hospitals: 

Any

Casualty / Emergency Visits: 
No benefit
Specialists: 
100% of BT
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of BT
Radiology and pathology: 
100% of BT
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
You pay the first R3 800 of the hospital account if done in a private hospital. Any other facility, no co-payment
MRI and CT scans: 
100% of BT. You pay the first R3 800 of the hospital account if done in a private hospital. Any other facility, no co-payment
ICU and High Care: 
100% of BT
Dialysis: 
PMBs only at DSPs
Organ Transplants: 
100% of BT. PMBs only
Oncology / Cancer: 
100% of BT. Subject to pre-authorisation, the ICON network and ICON standard protocols
Neck and Back Operations: 
Subject to the outcome of referral, assessment and rehabilitation treatment at a Bestmed Document Based Care (DBC) back and neck treatment programme
Joint Replacements: 
PMBs only at DSPs and subject to prosthesis limits
Prosthesis: 

100% of BT. Subject to preferred providers and prosthesis limit of R78 846 per family.
Internal: Sub-limits per beneficiary: Functional limited to R14 106; Vascular R31 470; Pacemaker (dual chamber) R42 986; Endovascular and catheter-based procedures - No benefit; Spinal R31 470; Artificial disc - No benefit; Drug-eluting stents - PMB and DSP products only; Mesh R11 044; Gynaecology/Urology R9 025; Lens implants R6 887 per lens, per eye. PMB prosthesis limits; hip replacement and other major joints R33 130; knee replacement R40 848; minor joints R12 706.
External: No benefit except for PMBs

Medical and Surgical Appliances: 
In hospital; 100% of BT. Out of hospital; no benefit
Maternity Confinements: 
100% of BT
In Hospital Dentistry: 
PMBs only at DSP day hospitals
Take home Medicine: 
100% of BT. Limited to 7 days supply
Rehabilitation, Hospice and Step-down facilities: 
No benefit for rehabilitation after trauma. Chemical and substance abuse are subject to network facilities and limited to 21 days or R32 299 per beneficiary. Palliative and home-based care; R8 000 per month for 3 months. Subject to pre-auth and DSP's
Treatment for Mental Health: 
100% of BT. Limited to 21 days per beneficiary
HIV / AIDS: 
PMBs only at DSPs
Ambulance Service: 
ER 24 for emergencies
International Travel Benefit: 
Cover up to R10 million and a maximum of 90 days. Services rendered by Bryte Insurance and managed by ER24.
Day-to-day benefits
GP consultations: 

No benefit

Specialist consultations: 

No benefit

Acute medicine: 

No benefit

Over-the-counter (OTC) Medicine: 

No benefit

Optometry benefits: 
No benefit
Basic dentistry: 
No benefit
Specialised Dentistry: 
No benefit
Orthodontics: 

No benefit

MRI and CT Scans (Out of Hospital): 
100% of BT. Limited to R5 343 per family, excluding PET scans
Radiology and Pathology: 
No benefit
Pregnancy benefits: 
Subject to registration on the Maternity Care programme after 12 weeks; 6 antenatal consults at a GP or gynaecologist or midwife and 2x 2D scans
Physiotherapy and Occupational Therapy day to day: 
No benefit
Chronic Conditions
Provider: 
Bestmed pharmacy network
Chronic Conditions: 

Diagnosis, treatment and care costs of 26 chronic conditions that fall under the PMB Chronic Disease List (CDL), issued by the Council for Medical Schemes. Subject to approval

Additional Chronic Conditions: 
No benefit
Preventative Care Benefits
Preventative Benefits: 

Flu and pneumonia vaccines; female contraceptives R2 315 pbpa; pap smear; HPV vaccines and back and neck preventative programme. Tempo programme has Individual Health Risk Assessments for adults aged 18 and older and age specific assessments for child dependants aged 0 - 17 years; family nutrition assessment and fitness and nutritional interventions for beneficiaries aged 18 and older

Total Contributions
Total Contribution Main Member: 
1680.00
Total Contribution Adult: 
1303.00
Total Contribution Child*: 
706.00
Beat 1
Risk Contributions
Risk Contribution Main Member: 
1680.00
Risk Contribution Adult: 
1303.00
Risk Contribution Child: 
706.00
Medical Aid Plan Name Term: 
Beat 1