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Type of Medical Aid Plan: 
Medical Aid Year: 
In Hospital Benefits
Hospital Rate of Payment: 
Hospital Network

100% Scheme tari

Upfront Payments to hospitals: 

Co-payment of R3 440 on all
endoscopic investigations
and MRI & CT scans if done
in a private hospital. Any

other facility no co-pay-
ment/ R10 750 co-payment

for the use of non EDO

Radiology and pathology: 
100% Scheme tariff
MRI and CT scans: 
100% Scheme tariff Limited to R10 160 per family
Organ Transplants: 
100% Scheme tari (only PMBs)
Neck and Back Operations: 
R28 490
Joint Replacements: 
Joint Replacement surgery (except for PMBs). PMBs subject to prosthesis limits: Hip replacement and other major joints R30 208 Knee replacement R37 378 Other minor joints R11 503

Sub Limits per beneficiary:
- Vascular R28 595
- Pacemaker dual chamber
R38 915
- Endovascular and
cathether based
procedures - no benefit
- Spinal R28 595,
- Artificial disk - no benefit
- Drug eluting stents - DSP
products only
- Mesh R10 050
- Gynaecology / Urology
R8 300
- Lens implants R6 235 per
lens per eye
- Functional R12 770

Medical and Surgical Appliances: 
Savings account
Maternity Confinements: 
100% of Scheme tari
In Hospital Dentistry: 
Basic dentistry Preventative benefit or savings account
Take home Medicine: 
100% Scheme tari Lmited to 7 day's supply
Rehabilitation, Hospice and Step-down facilities: 
100% Scheme tari Limited to 21 days or R29 240 per beneficiary Subject to network facilities
Treatment for Mental Health: 
100% Scheme tari Limited to 21 days per beneficiary
Ambulance Service: 
100% Scheme tari Pre-authorised and rendered by ER24
International Travel Benefit: 
Day-to-day benefits
GP consultations: 

Savings account
For EDO options GP and
Specialist visits only at
Bestmed DSP network rates

Specialist consultations: 

Savings account
For EDO options GP and
Specialist visits only at
Bestmed DSP network rates

Acute medicine: 

Savings account
subject to MRP

Over-the-counter (OTC) Medicine: 

Savings account

Optometry benefits: 
Every 24 months: Consultation 1 per beneficiary at network provider
Basic dentistry: 
Preventative benefit or savings account.
Specialised Dentistry: 
Savings account

Orthodontics are subject to

MRI and CT Scans (Out of Hospital): 
100% Scheme tari Limited to R10 160 per family
Radiology and Pathology: 
Savings Account
Pregnancy benefits: 
HRA completion required 100% Scheme tari 9 x antenatal consultations at either GP/Gyne/Midwife 1x 2D ultrasound nuchal translucency scan at 10-12 weeks at gyne 1x 2D ultrasound scan at 20-24 weeks at gyne 1x 2D ultrasound scan first trimester at radiologi
Chronic Conditions
Chronic Conditions: 

26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits - no annual limit applies. —— Addison’s disease —— Asthma —— Bipolar mood disorder —— Bronchiectasis —— Cardiac dysrhythmias —— Cardiac failure —— Cardiomyopathy —— Chronic obstructive pulmonary disease —— Chronic renal disease —— Coronary artery disease —— Crohn’s disease (excl. biologicals such as Revellex*) —— Diabetes insipidus —— Diabetes mellitus Type 1 —— Diabetes mellitus Type 2 —— Epilepsy —— Glaucoma —— Haemophilia —— Hyperlipidaemia —— Hypertension —— Hypothyroidism —— Multiple sclerosis (excl. biologicals such as Avonex*, subject to protocols) —— Parkinson’s disease —— Rheumatoid arthritis (excl. biologicals such as Revellex and Enbrel*) —— Schizophrenia —— Systemic lupus erythematosus —— Ulcerative colitis.

Preventative Care Benefits
Preventative Benefits: 

*Biometric Screenings at
contracted pharmacy or
onsite at employer, *Fitness
Assesment at contracted
biokeneticist - 1 pbpa (ages
older than 13), *Family
dietician assesment - 1pfpa
*Occupational Health
assesement - 1 pbpa (ages
3-12), *Baby Growth
assesment at contracted
nurse - 3pbpa (ages 0 mnth -
3 years), 3X dietician
consultations pbpa (ages
18+) pre-approval required
3x biokineticist
consultations pfpa
pre-approval required

Total Contributions
Total Contribution Main Member: 
Total Contribution Adult: 
Total Contribution Child*: 
Beat 3
Monthly Medical Savings
Savings Child*: 
Savings Adult: 
Savings Main Member: 
Risk Contributions
Risk Contribution Main Member: 
Risk Contribution Adult: 
Risk Contribution Child: