Bestmed Pace 3 Option

On the Bestmed Pace 3 option, in-hospital services are paid from the Scheme risk. Some out-of-hospital services are paid from the annual savings first and once depleted will be paid from the day-to-day benefit. Once the day-to-day benefit is depleted, services can be paid from the available vested savings. Some preventative care services are available from the Scheme risk benefit.

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.

Some indicated benefits are paid from the annual savings at 100% Scheme tariff.

Once the annual savings account is depleted, benefits will be paid from Scheme risk at 100% Scheme tariff (limits apply).

Should you not use all of the funds available in your medical savings account, these funds will be transferred into a vested medical savings account at the beginning of the following financial year.

Any vested credit in your vested medical savings account may be used for out-of-hospital expenses that are not covered by the Scheme, or should you, for instance, have reached your out-of-hospital/day-to-day overall annual limit or the sub-limits as indicated in your benefit guide.

Unused funds in your vested medical savings account at the end of the financial year will be carried over to the credit of your vested medical savings account for the next year.

Clinical funding protocols, preferred providers, designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP) may apply.

* This means that the benefit is limited to only those products and services negotiated by PPN and only those frames specified by PPN.

** Preferred Provider Negotiators (PPN) will pay a maximum amount of R1 420 towards the cost for contact lenses per beneficiary every 24 months, irrespective of whether the beneficiary utilised the services of PPN or a non–network provider.

• All benefits below may be subject to pre-authorisation, clinical protocols, formularies, funding guidelines and the Mediscor Reference Price (MRP)
• Please note that approved CDL, PMB and non-CDL chronic medicine costs will be paid from the non-CDL limit first. Thereafter, approved CDL and PMB chronic medicine costs will continue to be paid (unlimited) from Scheme risk.

* The default OTC choice is 1. R550 OTC limit. Members wishing to choose the other option are welcome to contact Bestmed

100% Scheme tariff. Subject to Scheme protocols. Benefits below may be subject to the Mediscor Reference Price (MRP).

Services mentioned below may be subject to pre-authorisation, clinical protocols and funding guidelines.

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 [email protected] or you can call us on 086 111 1936.

Please note that you may only register after the 12th week of pregnancy