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BESTMED PACE 2 2019

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Medical Aid Year: 
2019
Day to day Benefits: 

Day-to-day benefit
M = R13 932
M1+ = R27 864

In Hospital Benefits
Hospital Rate of Payment: 
100% Scheme tariff
Hospitals: 

No Hospital Network

Specialists: 
100% Scheme tariff
Radiology and pathology: 
100% Scheme tariff
MRI and CT scans: 
Subject to pre- authorisation. MRI/CT scans: Maximum of three scans per beneficiary PET scan: One scan per beneficiary
Organ Transplants: 
100% Scheme tariff
Oncology / Cancer: 
Oncology Programme. 100% Scheme tariff
Neck and Back Operations: 
Limits per beneficiary: Spinal including artificial disk R52 600
Joint Replacements: 
Joint Replacements: Hip prosthesis and other major joints R47 246
Prosthesis: 

Limits per beneficiary:
- Vascular R39 345
- Pacemaker dual chamber
R56 706
- Spinal including artificial
disk R52 600
- Drug eluting stents
R17 200
- Mesh R17 200
- Gynaecology / Urology
R12 846
- Lens implants R11 030
per lens per eye
- Joint Replacements: Hip
prosthesis and other
major joints R47 246
- Knee prosthesis R54 825
- Minor joints R20 371
- Functional R15 964

Medical and Surgical Appliances: 
Savings first. 100% Scheme tari Limited to R9 460 per family. Subject to overall day-to-day limits
Maternity Confinements: 
100% Scheme tariff
Take home Medicine: 
100% Scheme tariff Limited 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: 
Yes
Day-to-day benefits
GP consultations: 

Limited M=R3 978, M1+
=R8 063. Subject to
day-to-day overall limit

Specialist consultations: 

Limited M=R3 978, M1+
=R8 063. Subject to
day-to-day overall limit

Acute medicine: 

Savings first.
Limited M= R4 408, M1+
= R8 815. Subject to overall
day-to-day limits. Subject
to MRP

Over-the-counter (OTC) Medicine: 

Savings account. Limited to
R550 or self-payment gap
member must choose option

Optometry benefits: 
Every 24 months: Consultation 1 per beneficiary at network provider
Basic dentistry: 
Savings first. Limited M=R6270, M1+ =R12 540. Subject to day-to-day overall limit
Specialised Dentistry: 
Savings first. Limited M=R6270, M1+ =R12 540. Subject to day-to-day overall limit
Orthodontics: 

Orthodontics are subject to
pre-authorisation.

MRI and CT Scans (Out of Hospital): 
Subject to pre- authorisation. MRI/CT scans: Maximum of three scans per beneficiary PET scan: One scan per beneficiary
Radiology and Pathology: 
Savings first. Limited M = R2 956 M1+ = R5 913. Subject to day-to-day overall limit
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 radio
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: 

Flu vaccines ,
*Pneumonia vaccines
Paediatric
immunisations, Female
contraceptives - R2 096 per
family, *DBC programme,
Preventative Dentistry (incl
gloves and sterile
equipment), HIB titre,
*Mammogram, *Pap smear,
*HPV vaccinations, *Pap
smear - ages 18 and above,
every 24 months

*Biometric Screenings at
contracted pharmacy or
onsite at employer,
*Fitness Assesment at
contracted BASA
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: 
5111.00
Total Contribution Adult: 
5012.00
Total Contribution Child*: 
1127.00
Pace 2
Monthly Medical Savings
Savings Child*: 
158.00
Savings Adult: 
702.00
Savings Main Member: 
716.00
Risk Contributions
Risk Contribution Main Member: 
4395.00
Risk Contribution Adult: 
4310.00
Risk Contribution Child: 
969.00
Medical Aid Plan Name Term: 
Any