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BESTMED PULSE 2 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Bestmed Pulse2
Network

Upfront Payments to hospitals: 

Voluntary use of non-DSP hospital

Co-payments of up to R10 750 apply on admission

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 (PMBs only)
Oncology / Cancer: 
Oncology Programme. 100% Scheme tariff
Neck and Back Operations: 
Spinal R37 195 - Artificial disk R16 340
Joint Replacements: 
Joint Replacements: Hip replacements and other major joints R44 505
Prosthesis: 

Sub Limits per beneficiary:
- Vascular R37 195
- Pacemaker dual chamber
R50 418
- Spinal R37 195
- Artificial disk R16 340
- Drug eluting stents
R16 340
- Mesh R16 340
- Gynaecology / Urology
R12 148
- Lens implants R10 428
per lens per eye
- Joint Replacements: Hip
replacements and other
major joints R44 505
- Knee prosthesis R51 976
- Minor joints R19 350
- Functional R15 964

Medical and Surgical Appliances: 
Limited to R9 353 per family
Maternity Confinements: 
100% Scheme tariff
In Hospital Dentistry: 
100% Scheme tariff
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: 

Unlimited GP visits at
Bestmed GP Network
providers. Specialist
consultations must be
referred and approved by
NP. Limited M=R2 903,
M1+ =R5 590. (Subject to
day-to-day overall limit).
Out of Network GP visits
per family limited to
R1 398 as approved by NP

Specialist consultations: 

Unlimited GP visits at
Bestmed GP Network
providers. Specialist
consultations must be
referred and approved by
NP. Limited M=R2 903,
M1+ =R5 590. (Subject to
day-to-day overall limit).
Out of Network GP visits
per family limited to
R1 398 as approved by NP

Acute medicine: 

Subject to Provider
Network Formulary and
subject to MRP
Limited M=R4139, M1+
=R8 385. 100% Scheme
Tari. (Subject to
day-to-day overall limit)

Over-the-counter (OTC) Medicine: 

Limited to R550 per family

Optometry benefits: 
Every 24 months: Consultation 1 per beneficiary at network provider or R300 at non network provider Frame = R825 at network provider or R550 at non-network povider
Specialised Dentistry: 
Specialised dentistry inclusive of dentures are subject to pre- authorisation. Limited to M=R6 611, M1+ = R8 385. (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: 
Subject to NP protocols and tari list. Pre authorisation required. 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 ,
*Pnuemonia vaccines,
Paediatric immunisations,
*DBC programme,
*Contraceptives R2 096
per family

*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 pbpa,
pre-approval required

Total Contributions
Total Contribution Main Member: 
5298.00
Total Contribution Adult: 
5298.00
Total Contribution Child*: 
1259.00
Pulse2
Risk Contributions
Risk Contribution Main Member: 
5298.00
Risk Contribution Adult: 
5298.00
Risk Contribution Child: 
1259.00
Medical Aid Plan Name Term: 
Any