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Beat 3 network 2021

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

All out of hospital claims are paid from the savings account, which is 16% of monthly contribution

In Hospital Benefits
Are you prepared to use designated hospitals?: 
Yes
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: 

Beat Network Hospital and Designated Service Provider(DSP) specialist network

Upfront Payments to hospitals: 

If you use a hospital outside of the Beat Hospital Network, there will be an upfront payment of R11 874

Casualty / Emergency Visits: 
No benefit
Specialists: 
100% of BT. DSP specialist network applicable
Other healthcare professionals eg. Physio, Occupational, Dietician: 
100% of BT. DSP specialist network applicable
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
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 R79 678 per family. Internal: Sub-limits per beneficiary: Functional limited to R14 107; Vascular R31 586; Pacemaker (dual chamber) R42 986 Endovascular and catheter-based procedures - No benefit; Spinal R31 586; Artificial disc - No benefit; Drug-eluting stents- PMBs and DSP products only; Mesh R11 101; Gynaecology/Urology R9 168; Lens implants R6 887 per lens, per eye. PMB prosthesis limits; hip replacement and other major joints R33 368; knee replacement R41 288; minor joints R12 706. External: No benefit except for PMBs

Medical and Surgical Appliances: 
In hospital; 100% of BT. Out of hospital; savings account
Maternity Confinements: 
100% of BT
In Hospital Dentistry: 
Limited to R8 075 per family. Maxillofacial surgery at 100% of BT, limited to R12 944 per family
Take home Medicine: 
100% of BT. Limited to 7 days supply
Rehabilitation, Hospice and Step-down facilities: 
Savings account 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: 
100% of BT. Subject to pre-authorisation and DSPs
Ambulance Service: 
ER 24 for emergencies
International Travel Benefit: 
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: 

Subject to available savings

Specialist consultations: 

Subject to available savings

Acute medicine: 

Subject to available savings

Over-the-counter (OTC) Medicine: 

Subject to available savings

Optometry benefits: 
Subject to services rendered by a PPN provider per 24 month cycle. Consultation, frame and 100% of cost for standard lenses or contact lenses = R1 565
Basic dentistry: 
Subject to Preventative Benefit or available savings
Specialised Dentistry: 
Subject to available savings
Orthodontics: 

Subject to available savings and pre-authorisation

MRI and CT Scans (Out of Hospital): 
100% of BT. Limited to R11 223 per family, excluding PET scans
Radiology and Pathology: 
Subject to available savings
Pregnancy benefits: 
Subject to registration on the Maternity Care programme after 12 weeks; 9 antenatal and 1 post-natal consult at a GP or gynaecologist or midwife and 2x 2D scans. Maternity supplements x 9 to maximum of R100 per month
Physiotherapy and Occupational Therapy day to day: 
Subject to available savings
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: 
5 conditions. 80% of BT and limited to M = R3 444; M1+ = R7 006
Preventative Care Benefits
Preventative Benefits: 

Flu, pneumonia and travel vaccines; paediatric immunisation; female contraceptives R2 315 pbpa; back and neck preventative programme; preventative dentistry; age and frequency specific tests for pap smear; HPV vaccines; mammogram and PSA screening. 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: 
2805.00
Total Contribution Adult: 
1995.00
Total Contribution Child*: 
1085.00
Beat 3 Network
Annual Medical Savings Account
Annual Medical Savings Main Member: 
5388.00
Annual Medical Savings Adult: 
3828.00
Annual Medical Savings Child*: 
2088.00
Monthly Medical Savings
Savings Child*: 
174.00
Savings Adult: 
319.00
Savings Main Member: 
449.00
Risk Contributions
Risk Contribution Main Member: 
2356.00
Risk Contribution Adult: 
1676.00
Risk Contribution Child: 
911.00
Medical Aid Plan Name Term: 
Beat 3 Network