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BESTMED PACE 4 2019

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Medical Aid Year: 
2019
Day to day Benefits: 

Day-to-day benefit
M = R32 465
M1+ = R52 353

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: 
Sub Limits per beneficiary: Spinal including artificial disk R60 850
Joint Replacements: 
Sub Limits per beneficiary: Joint Replacements: Hip prosthesis and other major joints R54 449
Prosthesis: 

Sub Limits per beneficiary:
- Vascular R45 150
- Pacemaker dual chamber
R56 706
- Spinal including artificial
disk R60 850
- Drug eluting stents
R20 264
- Mesh R17 845
- Gynaecology / Urology
R14 728
- Lens implants R16 308
per lens per eye
- Joint Replacements: Hip
prosthesis and other
major joints R54 449
- Knee prosthesis R63 049
- Minor joints R20 264
- Functional R17 845

External Limited to R28 058 per
family

Medical and Surgical Appliances: 
100% Scheme tari Limited to R9 460 per family Subject to overall day-to-day limits
Maternity Confinements: 
100% Scheme tariff
In Hospital Dentistry: 
Limited to R18 275 per family
Take home Medicine: 
100% Scheme tari 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=R5 106, M1+
=R8 278. Subject to
day-to-day overall limit

Specialist consultations: 

Limited M=R5 106, M1+
=R8 278. Subject to
day-to-day overall limit

Acute medicine: 

Limited M=R8063, M1+
=R12 524. Subject to MRP
10% co-payment. Subject
to day-to-day overall limit

Over-the-counter (OTC) Medicine: 

Savings account

Optometry benefits: 
Every 24 months: Consultation 1 per beneficiary at network provider
Basic dentistry: 
Limited M=R11 275, M1+ =R19 030. (Subject to day-to-day overall limit)
Specialised Dentistry: 
Limited M=R11 275, M1+ =R19 030. (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: 
Limited M=R5 106, M1+ = R10 051. 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, *PSA Screening
for age 50 years and older
every 24 months, *DBC
programme, Preventative
Dentistry (incl gloves and
sterile equipment), HIB
titre,*Mammogram,*Pap
smear, Bone Densitometry,
*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: 
7330.00
Total Contribution Adult: 
7330.00
Total Contribution Child*: 
1717.00
Pace4
Monthly Medical Savings
Savings Child*: 
52.00
Savings Adult: 
220.00
Savings Main Member: 
220.00
Risk Contributions
Risk Contribution Main Member: 
7110.00
Risk Contribution Adult: 
7110.00
Risk Contribution Child: 
1665.00
Medical Aid Plan Name Term: 
Any