The Bestmed Pace 3 options is ideally suited for the mature family that requires comprehensive chronic benefits and excellent hospital cover. This option enables you to rest easy knowing that your family is well covered.
Who should not choose this option?
Due to the Bestmed Pace 3’s comprehensive cover this option might not be suited for young and healthy individuals or couples without families. Be sure to checkout Bestmed’s Beat 3, Pace 1, Beat 4 and Pace 2 options.
Bestmed Pace 3 Option Benefits
- Savings Account: Available
- Day-to-day Benefits: Available
- Over the Counter: Available
Value Benefits
- No co-payment or automatic self-payment gaps
- FP and Specialist consultations
- Optometry
- Dentistry
- Maternity benefits
| Principal Member | Adult Dependant | Child Dependant* | |
|---|---|---|---|
| Risk Amount | R4 565 | R3 674 | R784 |
| Savings Amount | R805 | R648 | R139 |
| Total Contribution | R5 370 | R4 322 | R923 |
* You only pay for a maximum of four children. All other children can join as beneficiaries of the Scheme free of charge.
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.
| Medical Event | Scheme Benefit |
|---|---|
| Accommodation (hospital stay) and theatre fees | 100% Scheme tariff |
| 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 (only PMBs) Limited to 21 days per beneficiary or R27 200 per beneficiary Subject to network facilities |
| Consultations and procedures | 100% Scheme tariff |
| Surgical procedures and anaesthetics | 100% Scheme tariff |
| Organ transplants | 100% Scheme tariff |
| Major medical maxillo-facial surgery strictly related to certain conditions | 100% Scheme tariff |
| Dental and oral surgery | Limited to R14 200 per family (This limit applies to both in- and out-of-hospital benefits) |
| Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply) |
100% Scheme tariff. Limited to R98 100 per family |
| Prosthesis – Internal Note: Sub-limit subject to the prosthesis limit |
Sub-limits per beneficiary:
|
| Prosthesis – External | Limit of R23 100 per family |
| Orthopaedic and medical appliances | 100% Scheme tariff |
| Pathology | 100% Scheme tariff |
| Diagnostic imaging | 100% Scheme tariff |
| Specialised diagnostic imaging | 100% Scheme tariff |
| Oncology | 100% Scheme tariff Oncology programme |
| Peritoneal dialysis and haemodialysis | 100% Scheme tariff |
| Confinements | 100% Scheme tariff |
| Refractive surgery | 100% Scheme tariff Limited to R8 500 per eye |
| 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 |
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.
| Medical Event | Scheme Benefit |
|---|---|
| Overall Day-to-day Limit | M = R16 200, M1+ = R33 480 |
| FP & Specialist Consultations | Savings first 100% Scheme tariff M = R3 700, M1+ = R7 500 (subject to overall day-to-day limit) |
| Basic & Specialised Dentistry | Savings first Basic: Preventative benefit or savings account. Limit once savings exceeded Specialised: Savings account then limit once savings exceeded. Scheme tariff thereafter. Orthodontic: Subject to pre-authorisation Limited to M = R6 150, M1+ = R11 450 (subject to overall day-to-day limit) |
| Medical aids, apparatus and appliances including wheelchairs and hearing aids | Savings first Limited to R8 800 per family (subject to overall day-to-day limit) Limit on wheelchairs of R11 900 per family per 48 months Limit on hearing aids of R27 300 per beneficiary per 24 months. |
| Supplementary Services | Savings first Limited to M = R2 260, M1+ = R4 750 (subject to overall day-to-day limit) |
| Wound Care Benefit (incl. dressings, negative pressure wound therapy (NPWT) treatment and related nursing services – out-of-hospital) |
100% Scheme tariff Savings first Limited to R9 000 per family (subject to overall day-to-day limit) |
| Optometry Benefit (PPN capitation provider) |
Optometry services are obtained from and paid by PPN at 100% of cost per beneficiary every 24 months.*
For services rendered by a non-network provider, the following maximum amounts per beneficiary apply every 24 months:
|
| Diagnostic Imaging & Patholog | Savings first Limited to M = R3 000, M1+ = R5 950 (subject to overall day-to-day limit) |
| Maternity Benefits | 100% Scheme tariff 2 sonars and up to 12 antenatal consultations |
| Specialised Diagnostic Imaging | MRI/CT scans: Maximum of 3 scans per beneficiary. PET scan: 1 scan per beneficiary. |
| Rehabilitation Services After Trauma | 100% Scheme tariff |
| Oncology | 100% Scheme tariff Oncology programme |
| Peritoneal Dialysis & Haemodialysis | Subject to pre-authorisation and DSPs |
* 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.
| Benefit Description | Scheme Benefit |
|---|---|
| CDL & PMB chronic medicine | 100% Scheme tariff Co-payment of 25% for non-formulary medicine |
| Non-CDL chronic medicine | 19 conditions 85% Scheme tariff Limited to M = R12 420, M1+ = R24 840 Co-payment of 25% for non-formulary medicine |
| Biologicals and other high-cost medicine | Limited to R280 000 per beneficiary |
| Acute medicine | Savings first Limited to M = R1 300, M1 + = R3 200 (subject to overall day-to-day limit) |
| Over-the-counter (OTC) medicine | Member choice*:
|
* 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).
| Preventative Care Benefit | Gender & Age Group | Quantity & Frequency | Benefit Criteria |
|---|---|---|---|
| Flu Vaccines | All ages | 1 per beneficiary per year | At a Bestmed Pulse 1 Network FP or network pharmacy only Subject to Pulse 1 protocols and where clinically necessary |
| 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 & 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 and sterile equipment) |
Refer to Preventative Dentistry section for details | ||
| Haemophilus Influenzae Type B Vaccine (HIB) | Children 5 years and younger | 1 vaccine at 6, 10 and 14 weeks after birth
1 booster vaccine between 15-18 months |
If the booster vaccine was not administered timeously, the maximum age to which it will be allowed is 5 years |
| Mammogram | Females 40 years and older | Once every 24 months | Scheme tariff is applicable |
| PSA Screening | Males 50 years and older | Once every 24 months | |
| HPV Vaccinations | Females of 9 – 26 years old | 3 vaccinations per beneficiary | Vaccinations will be funded at MRP |
| Bone Densitometry | All beneficiaries 45 years and older | Once every 24 months | |
| Pap Smear | Females 18 years and older | Once every 24 months | Can be done at a gynaecologist or FP. Consultation paid from the available savings/consultation benefit |
| BetterMe Wellness Benefits Note: Biometric screening activates the other assessment benefits |
|
||
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 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 |
| Non-Chronic Disease List (Non-CDL) | |
|---|---|
| Non-CDL 1 | Acne – severe |
| Non-CDL 2 | Attention deficit disorder/ Attention deficit hyperactivity disorder (ADD/ADHD) |
| Non-CDL 3 | Allergic rhinitis |
| Non-CDL 4 | Eczema – severe |
| Non-CDL 5 | Migraine prophylaxis |
| Non-CDL 6 | Gout prophylaxis |
| Non-CDL 7 | Major depression |
| Non-CDL 8 | Obsessive compulsive disorder |
| Non-CDL 9 | Osteoporosis |
| Non-CDL 10 | Psoriasis |
| Non-CDL 11 | Urinary incontinence |
| Non-CDL 12 | Paget’s disease |
| Non-CDL 13 | Gastro oesophageal reflux disease (GORD) |
| Non-CDL 14 | Ankylosing spondylitis |
| Non-CDL 15 | Osteoarthritis |
| Non-CDL 16 | Alzheimer’s disease |
| Non-CDL 17 | Collagen diseases |
| Non-CDL 18 | Dermatomyositis |
| Non-CDL 19 | Neuropathy |
| 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 |
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
