Bestmed BEAT 1 Option

Contributions

	Non-Network/Network	Principal Member	Adult Dependant	Child Dependant*
Risk Amount	NN	R1 363	R1 058	R573
Risk Amount	N	R1 226	R953	R516
Savings Amount	NN	–	–	–
Savings Amount	N	–	–	–
Total Monthly Contribution	NN	R1 363	R1 058	R573
Total Monthly Contribution	N	R1 226	R953	R516

* You only pay for a maximum of 4 children. All other children can join as beneficiaries of the Scheme free of charge.

No savings option is available
Scheme rate is 100%
Most day-to-day expenses are paid from out of pocket, unless PMBs
You must use a network hospital
Treatment and medicine for 27 chronic conditions covered by scheme
Cancer (PMB only) is treated in state hospitals, but you can upgrade to higher plan on cancer diagnosis to receive private hospital treatment
There are co-payments for in-hospital MRIs and CT Scans (gap cover pays this co-payment)
There is a benefit for out-of-hospital specialised radiology (paid in full with gap cover)
Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.

In-Hospital Benefits

Specialists:	Up to 100% scheme rate
Hospital Choice:	Network hospitals, or up to R10 000 co-payment for non-network hospitals
Specialised Radiology:	R3 200 co-payment for private hospitals
Supplementary Services: (Physio, etc)	100% of scheme rate
Transplants:	Bestmed pays for treatment of PMBs only
Co-payments:	Scopes: R3 200 co-payment for private hospitals Specialised radiology: R3 200 co-payment for private hospitals
Alternatives to hospitals:	100% of scheme rate
Casualty:	Only PMBs
Other:	none

Out-of-Hospital Benefits

Savings available:	No savings available
General info:	This plan has no savings fund, so most out-of-hospital costs are paid by you Out-of-hospital costs authorised as part of PMB treatment (eg. cancer, asthma or stroke) are paid by Bestmed
GP consultations:	Out of your own pocket
Childcare:	No extra benefits
Specialists consultations:	Out of your own pocket
Pathology:	Out of your own pocket
General radiology:	Out of your own pocket
Specialised radiology:	R4 500 per family
Supplementary Services: (Physio, etc)	Out of your own pocket

Maternity Benefits

Hospital stay:	Up to scheme rate, includiing for births with midwife
Consultations:	Out of your own pocket
Scans:	Out of your own pocket

Oncology (Cancer) Benefits

Overall coverage (in and out of hospital):	Bestmed will pay for cancer treatment in a state hospital only, and only for PMBs. If you are diagnosed with cancer while on this plan, you can upgrade your plan immediately to receive cover at private hospital

Dentistry Benefits

Dentistry:	Out of your own pocket PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes.
Orthodontics:	Out of your own pocket
Maxillo Facial Surgery:	Out of your own pocket, unless it’s to treat a PMB. PMB conditions (eg. fracture of face bones, orbit or/and jaw) are always paid by schemes.

Medication Benefits

Chronic:	All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. 40% co-payment if not on Bestmed’s formulary list
Acute (presrcibed) medication:	Out of your own pocket
Over-the-counter:	Paid from day-to-day benefit
Birth Control:	R1 950 per family per year, paid by Bestmed
On Discharge:	7 days
Biological:	Out of your own pocket

Optometry Benefits

Optometry:	Out of your own pocket, unless for an approved in-hospital or day clinic procedure PMB conditions are always paid by schemes Refractive surgery: No benefit

Mental Health Benefits

In-hospital:	Bestmed will pay for up to 21 days per person at 100% scheme rate, and may require use of specific providers Cover for PMB mental conditions is always paid for by scheme, in and out of hospital
Out-of-hospital:	Cover for PMB mental conditions is always paid for by scheme, in and out of hospital For non-PMB conditions, you pay this out of pocket
Trauma:	PMB conditions are covered for in and out of hospital treatment Example of PMB condition: Acute stress disorder accompanied by recent significant trauma>, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts

Other Benefits

General Appliances:	Out of your own pocket
1.1. Hearing Aids:	Out of your own pocket
1.2. Wheelchairs:	Out of your own pocket
Dialysis:	Bestmed only pays for PMB cases, with a designated network provider
HIV:	Managed care programme
Emergency Transport:	ER24
International Insurance:	TBC
Other:	Wound care: R2 970 per family, paid by scheme

Preventative Benefits

Flu vaccination:	Covered
Pneumonia vaccines:	Covered
Back Rehabilitation Programme:	Covered
Biometric Screening:	Covered
Child Immunisation:	Covered
Pap Smear:	Covered: 18yrs+ every 2 years
Mammogram:	No benefit
PAS Test:	No benefit
HIV Test:	TBC
Other:	No benefit

Prosthetic Benefits

Overal Limit:	Internal: R66 400 per family External: no benefit
Sub-limits:	Functional (treating or supporting a bodily function): R11 880 Vascular: R26 500 Pacemaker, dual chamber: R36 200 Spinal: R26 500 Mesh: R9 300 Gynaecology/Urology: R7 600 Lens implants: R5 800 per lens Exclusions: Endovascular and catheter-based procedures Artificial disk Drug eluting stents Joint replacements, unless PMBs PMB joint replacements: Hip replacement and other major joints: R27 900 Knee replacement: R34 400 Minor Joints: R10 700

Overal Limit: