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Bestmed Beat 2 2018

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Type of Medical Aid Plan: 
New Generation
Medical Aid Year: 
2018
Day to day Benefits: 

No overall limit

Co-payments: 
R3 200
In Hospital Benefits
Are you prepared to use designated hospitals?: 
No
Hospital Rate of Payment: 
100% of Scheme Rate
Hospitals: 

Network or Non-network hospital.

Upfront Payments to hospitals: 

Co-payment of R3 200 on all endoscopic investigations and specialised diagnostic imaging if done in a private hospital. Any other facility, no co-payment.

Casualty / Emergency Visits: 
Subject to Savings.
Specialists: 
Associated specialists covered in full. Other specialists covered up to 100% of Bestmed Rate.
Other healthcare professionals eg. Physio, Occupational, Dietician: 
Unlimited at Bestmed tariff
Radiology and pathology: 
Unlimited at Bestmed tariff
Scopes (gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy): 
Unlimited at Bestmed tariff
MRI and CT scans: 
Unlimited at Bestmed tariff
ICU and High Care: 
No annual limit applies.
Dialysis: 
No annual limit applies.
Organ Transplants: 
No annual limit applies - PMB only
Oncology / Cancer: 
100% scheme tarifff - oncology programme
Neck and Back Operations: 
Spinal limited to R26 600
Joint Replacements: 
PMB only
Prosthesis: 

Internal (includes knee (R34 400) & hip (R27 900) replacements, pacemakers (R36 200), etc) Lens implants: R5 800 per beneficiary, Functional R11 880, Vascular R26 500, Endovascular and catheter-based procedures - no benefit, spinal R26 500, Artificial disk - no benefit, Mesh R9 300, Gynaecology / Urology R7 600.

External: (such as artificial arms or legs) No benefit

Medical and Surgical Appliances: 
Savings account.
Maternity Confinements: 
No annual limit applies
In Hospital Dentistry: 
No benefit, (PMB's only at DSP day hospital)
Take home Medicine: 
7 days’ supply.
Rehabilitation, Hospice and Step-down facilities: 
100% scheme tariff
Treatment for Mental Health: 
100% scheme tariff, limited to 21 days per beneficiary
HIV / AIDS: 
HIV programme
Ambulance Service: 
ER24
International Travel Benefit: 
ER24
Day-to-day benefits
GP consultations: 

Not applicable.

Specialist consultations: 

Savings first. FP and specialist consultations only at Bestmed DSP's at network tariffs.Not applicable

Acute medicine: 

Subject to savings.

Over-the-counter (OTC) Medicine: 

Subject to savings.

Optometry benefits: 
Subject to savings.
Basic dentistry: 
Preventative or savings account.
Specialised Dentistry: 
Savings account.
Orthodontics: 

Subject to pre-authorisation.

MRI and CT Scans (Out of Hospital): 
100% scheme tariff. Limited to R4 500 per family.
Radiology and Pathology: 
Subject to savings.
Pregnancy benefits: 
Savings account.
Physiotherapy and Occupational Therapy day to day: 
Subject to savings.
Chronic Conditions
Provider: 
Pharmacy Direct
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.

Additional Chronic Conditions: 
No benefit.
Preventative Care Benefits
Preventative Benefits: 

Flu vaccines, Pneumonia vaccines, Paediatric immunisations, Female contraceptives R1 950 per family per year, DBC programme, Preventative dentistry, Pap smeer (ages 18 and above every 24 months)

Total Contributions
Total Contribution Main Member: 
1685.00
Total Contribution Adult: 
1310.00
Total Contribution Child*: 
710.00
Beat 2 (Non-network)
Annual Medical Savings Account
Annual Medical Savings Main Member: 
3444.00
Annual Medical Savings Adult: 
2676.00
Annual Medical Savings Child*: 
1452.00
Monthly Medical Savings
Savings Child*: 
121.00
Savings Adult: 
223.00
Savings Main Member: 
287.00
Risk Contributions
Risk Contribution Main Member: 
1398.00
Risk Contribution Adult: 
1087.00
Risk Contribution Child: 
530.00
Principal Member Savings: 
3444.00
Principal Member Total: 
1685.00
Per Adult Dependent Total: 
1310.00
Child dependant Total: 
710.00
Medical Aid Plan Name Term: 
Any