The Bestmed Beat 2 options ideal for a couple that is starting to take on the world! If you plan that prevention is better than cure and know that life is sometimes unpredictable, this option is ideally suited for you. You will get extensive hospital cover (at private hospitals) and a Savings Account access for day-to-day benefits.
Who should not choose this option?
The Bestmed Beat 2 options is not suited for older individuals and families as they require more day-to-day expenses cover and certain diseases. If you need more cover from a medical aid, please refer to Bestmed’s Pace Options.
Bestmed Beat 2 Option Benefits
- Savings Account: Available
- Day-to-day Benefits: Limited day-to-day benefits
- Over the Counter: Savings account
Value Benefits
- Preventative care benefits
- Contraceptive benefits
- Wound care benefits
- Preventative dentistry
- International travel cover
Contributions
- In-hospital services are paid from Scheme Risk
- Out-of- hospital services are paid from the members’ own pocket
- Some preventative care services are paid from Scheme risk
| Non-Network (NN) / Network (N) | Principal Member | Adult Dependant | Child Dependant* | |
|---|---|---|---|---|
| Risk Amount | NN | R1 398 | R1 087 | R589 |
| N | R1 259 | R978 | R530 | |
| Savings Amount | NN | R287 | R223 | R121 |
| N | R258 | R200 | R109 | |
| Total Monthly Contribution | NN | R1 685 | R1 310 | R710 |
| N | R1 517 | R1 178 | R639 |
* You only pay for a maximum of 4 children. All other children can join as beneficiaries of the Scheme free of charge.
Method of Benefit Payment
On the Bestmed Beat 2 option in-hospital services are paid from Scheme risk and out-of-hospital services are paid from the savings account. Some preventative care services are available from the Scheme risk benefit.
Network Option
- Bestmed Beat 1, 2 and 3 also offer you the decision to lower your monthly contribution in the form of a Network option
- The Network option provides you with a list of designated hospitals for you to use and also saves on your monthly contribution
- The Non-network option provides you with access to any hospital of your choice. This is the standard option
- Please refer to the contributions table
In-hospital Benefits
- All in-hospital benefits referred to in the section below require pre-authorisation
- Clinical protocols,preferred providers, designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP) may apply
- Should a member voluntarily choose not to make use of a hospital forming part of a hospital network for the Beat Network benefit option, a maximum co-payment of R10 000 shall apply for the voluntary use of a non-designated service provider
| Medical Event | Scheme Benefit |
|---|---|
| Accommodation (hospital stay) and theatre fees | 100% Scheme tariff. DSP specialist network applicable if the network option is chosen |
| Take-home medicine | 100% Scheme tariff – Limited to 7 days’ medicine |
| Treatment in mental health clinics | 100% Scheme tariff – Limited to 21 days per beneficiary |
| Treatment of chemical and substance abuse | 100% Scheme tariff – Limited to 21 days or R27 200 per beneficiary & subject to network facilities |
| Consultations and procedures | 100% Scheme tariff. DSP specialist network applicable if the discounted network option is chosen. |
| Surgical procedures and anaesthetics | 100% Scheme tariff |
| Organ transplants | 100% Scheme tariff (Only PMBs) |
| Major medical maxillo-facial surgery strictly related to certain conditions | PMBs only at DSP day hospitals |
| Dental and oral surgery | PMBs only at DSP day hospitals |
| Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply) |
100% Scheme tariff. Limited to R66 400 per family |
| Prosthesis – Internal Note: Sub-limit subject to the prosthesis limit |
Sub-limits per beneficiary:
|
| Prosthesis – External | No benefit |
| Exclusions Limits and co-payments applicable Preferred provider network available. |
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
|
| Orthopaedic and medical appliances | 100% Scheme tariff |
| Pathology | 100% Scheme tariff |
| Diagnostic imaging | 100% Scheme tariff |
| Specialised diagnostic imaging | 100% Scheme tariff – subject to co-payments |
| Oncology | PMBs only (DSP: State hospitals where available) |
| Peritoneal dialysis and haemodialysis | PMBs only at DSPs |
| Confinements | 100% Scheme tariff |
| Refractive surgery | No benefit |
| Midwife-assisted births | 100% Scheme tariff |
| Supplementary services | 100% Scheme tariff |
| Alternatives to hospitalisation | 100% Scheme tariff |
| Emergency Evacuation | 100% Scheme tariff. Pre-authorised and rendered by ER24 |
| Co-payments | 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 |
Out-of-hospital Benefits
- Benefits below may be subject to pre-authorisation, clinical protocols, preferred providers, designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP)
- Most out-of-hospital expenses, such as visits to a FP or Specialist, are paid in full by you directly to the service provider
- Should you not use all of the funds available in your medical savings account, these funds will be transferred into your Savings account at the beginning of the following financial year
- Members choosing the efficiency discount option (Network option) are required to make use of Scheme-contracted service providers.
The following out-of-hospital benefits are paid for by the Scheme:
| Medical Event | Scheme Benefit |
|---|---|
| FP and Specialist Consultations | Savings account. FP and specialist consultations only at Bestmed DSPs at network tariffs. |
| Basic & Specialised Dentistry | Basic: Preventative benefit or savings account Specialised: Savings account Orthodontic: Subject to pre-authorisation |
| Medical Aids, Apparatus & Appliances | Savings account |
| Supplementary Services | Savings account |
| Wound care benefit (incl. dressings, negative pressure wound therapy treatment and related nursing services – out-of-hospital) |
100% Scheme tariff – limited to R2 970 per family |
| Optometry Benefit (PPN capitation provider) |
Savings account |
| Diagnostic Imaging & Pathology | Savings account |
| Specialised diagnostic imaging | 100% Scheme tariff – limited to R4 500 per family |
| Oncology | PMBs only at DSPs |
| Peritoneal dialysis and haemodialysis | PMBs only at DSPs |
| Maternity Benefits | Savings account |
| Rehabilitation services after trauma | Savings account |
Medicine
- Benefits below may be subject to pre-authorisation, clinical protocols, preferred providers, designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP)
- Members choosing the efficiency discount option (Network option) are required to make use of Scheme-contracted pharmacies to obtain their medicine
| Benefit Description | Scheme Benefit |
|---|---|
| CDL & PMB chronic medicine | 100% Scheme tariff – co-payment of 40% for non-formulary medicine |
| Non-CDL chronic medicine | No benefit |
| Biologicals and other high-cost medicine | No benefit |
| Acute medicine | Savings account |
| Over-the-counter (OTC) medicine | Savings account |
Preventative Care Benefits
Benefits below may be subject to pre-authorisation, clinical protocols, preferred providers, designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP).
| Preventative Care Benefit | Gender & Age Group | Quantity & Frequency | Benefit Criteria |
|---|---|---|---|
| Flu Vaccines | All ages | 1 per beneficiary per year | Applicable to all active members and beneficiaries |
| Pneumonia Vaccines | Children < 2 years High-risk adult group |
Children: As per schedule of Department of Health Adults: Twice in a lifetime with booster above 65 years of age |
Adults: The Scheme will identify certain high-risk individuals who will be advised to be immunised |
| Paediatric Immunisations | Babies and children | Funding for all paediatric vaccines according to the state-recommended programme | |
| Female Contraceptives | All females of child-bearing age | Quantity and frequency depending on product up to the maximum allows amount. Mirena device – 1 device every 60 months |
Limited to R1 950 per family per year. Includes all items classified in the category of female contraceptives |
| Spinal/Back Treatment Programme (DBC) | All ages | 6 weeks, once per year | Applicable to beneficiaries who have serious spinal and/or back problems and may require surgery. The Scheme may identify appropriate participants for evaluation at a DBC clinic. Based on the evaluation done by a DBC clinic, a rehabilitation treatment plan is drawn up and initiated which lasts 6 weeks, consecutively |
| Preventative Dentistry (incl gloves & sterilie equipment) |
Refer to Preventative Dentistry section for details | ||
| Pap Smear | Females 18 years and older | Once every 24 months | Can be done at a gynaecologist or FP. Consultation will be for member’s own account |
| BetterMe Wellness Benefits Note: BIometric screening activates the other assessment benefits |
|
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Preventative Dentistry
Services mentioned below may be subject to pre-authorisation, clinical protocols and funding guidelines.
| Description of Service | Age | Frequency |
|---|---|---|
| General full-mouth examination by a general dentist (incl. gloves and use of sterile equipment for the visit) |
Above 12 years Under 12 years |
Once a year Twice a year |
| Full-mouth intra-oral radiographs | All ages | Once every 36 months |
| Intra-oral radiographs | All ages | 2x photos per year |
| Scaling and/or polishing | All ages | Twice a year |
| Fluoride treatment | All ages | Twice a year |
| Fissure sealing | Up to and including 21 years | In accordance with accepted protocol |
| Space maintainers | During primary and mixed denture stage | Once per space |
Chronic / Non-Chronic Conditions List (CDL / Non-CDL)
| Chronic Disease List (CDL) | |
|---|---|
| CDL 1 | Addison’s disease |
| CDL 2 | Asthma |
| CDL 3 | Bipolar mood disorder |
| CDL 4 | Bronchiectasis |
| CDL 5 | Cardiomyopathy |
| CDL 6 | Chronic renal disease |
| CDL 7 | Chronic obstructive pulmonary disease (COPD) |
| CDL 8 | Cardiac failure |
| CDL 9 | Coronary artery disease |
| CDL 10 | Crohn’s disease |
| CDL 11 | Diabetes insipidus |
| CDL 12 | Diabetes mellitus type 1 |
| CDL 13 | Diabetes mellitus type 2 |
| CDL 14 | Dysrhythmias |
| CDL 15 | Epilepsy |
| CDL 16 | Glaucoma |
| CDL 17 | Haemophilia |
| CDL 18 | Hyperlipidaemia |
| CDL 19 | Hypertension |
| CDL 20 | Hypothyroidism |
| CDL 21 | Multiple sclerosis |
| CDL 22 | Parkinson’s disease |
| CDL 23 | Rheumatoid arthritis |
| CDL 24 | Schizophrenia |
| CDL 25 | Systemic lupus erythematosus (SLE) |
| CDL 26 | Ulcerative colitis |
Prescribed Minimum Benefits (PMB)
| Prescribed Minimum Benefits (PMB) | |
|---|---|
| PMB 1 | Aplastic anaemia |
| PMB 2 | Chronic anaemia |
| PMB 3 | Benign prostatic hypertrophy |
| PMB 4 | Cushing’s disease |
| PMB 5 | Cystic fibrosis |
| PMB 6 | Endometriosis |
| PMB 7 | Female menopause |
| PMB 8 | Fibrosing alveolitis |
| PMB 9 | Graves’ disease |
| PMB 10 | Hyperthyroidism |
| PMB 11 | Hypophyseal adenoma |
| PMB 12 | Idiopathic thrombocytopenic purpura |
| PMB 13 | Paraplegia/Quadriplegia |
| PMB 14 | Polycystic ovarian syndrome |
| PMB 15 | Pulmonary embolism |
| PMB 16 | Stroke |
Maternity Care Programme
With so many things to juggle, the Maternity Care programme is here to help moms and dads through their entire pregnancy and the first two years with a new little one in the home. At Bestmed, we want you to enjoy this entire experience and feel comfortable knowing that we are here for you.
Registering on this programme will give you the following support and benefits:
- A 24-hour professional medical advice line you can call with any queries, no matter how small.
- Weekly e-mails packed with convenient information about your pregnancy, your baby’s development, how to deal with unpleasant pregnancy symptoms and useful hints.
- Dads won’t be left out as they will also receive e-mails every second week to inform them about the baby’s development and Mom’s progress.
- To make sure your pregnancy starts right, you will receive a welcome pack containing an informative pregnancy book to guide you through the stages as well as discount vouchers for various baby items.
- In your second month after registration, we will send you a useful baby bag packed with products to use after your baby’s birth.
You are able to register on the Maternity Care programme simply by sending an e-mail to info@babyhealth.co.za or you can call us on 086 111 1936.
Please note that you may only register after the 12th week of pregnancy
