The Bestmed Pulse 2 option is a comprehensive network option ideal for mature families that has advanced healthcare needs. This option provides unlimited cover for hospitalisation at a network of hospitals (mainly Netcare) and primary care services at a network of providers.
If you need chronic treatment and day-to-day benefits you will first have to consult a network family practitioner (FP) for referral.
Who should not choose this option?
The Bestmed Pulse 2 option is not suited for young couples with families. To get more value, check out the Beat and Pace ranges.
Bestmed Pulse 2 Option Benefits
- Savings Account: Unavailable
- Day-to-day Benefits: Available
- Over the Counter: Available
Value Benefits
- Preventative care
- FP & Specialist consultations
- Optometry
- Dentistry
| Principal Member | Adult Dependant | Child Dependant* | |
|---|---|---|---|
| Risk Amount | R4 732 | R4 732 | R1 124 |
| Savings Amount | R0 | R0 | R0 |
| Total Contribution | R4 732 | R4 732 | R1 124 |
* 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 Pulse 2 option in-hospital services are paid from Scheme risk benefit. The Bestmed Pulse 2 network covers most out-of-hospital services. Some day-to-day services and preventative care services are available from the Scheme risk benefit.
Bestmed Pulse 2 members must make use of the Pulse Specialist DSP network.
Please familiarise yourself with the Designated Service Providers (DSPs) and networks for this option. This includes Pulse DSP specialist network and DSP hospitals. Hospital costs will be covered unlimited at the Scheme negotiated tariff at the Bestmed Pulse hospital network as listed on the Bestmed website.
The DSP hospital network consists of all Netcare hospitals in South Africa. In areas where there are no Netcare hospitals, other hospitals are contracted as DSPs.
Please refer to the Bestmed website on www.bestmed.co.za for a list of the DSP hospitals.
Voluntary use of a non-DSP hospital (except in the case of an emergency) will result in a co-payment of up to R10 000 for the member’s account.
Process for hospital authorisation
- All members on the Bestmed Pulse 2 option must make use of Bestmed family practitioners (FPs)
- The Bestmed network FP will refer the member to a Bestmed DSP specialist should a specialist consultation be required
- Should the Bestmed DSP indicate that hospitalisation is required, the member needs to contact Bestmed on 080 022 0106 for pre-authorisation. Bestmed will only authorise admissions to contracted DSP hospitals
Emergency admittance in a non-DSP hospital
- Should a member be admitted for an emergency condition in a non-DSP hospital, Bestmed will require the patient to be stabilised in that non-DSP hospital
- As soon as the patient is stabilised, he/she will be transferred to the closest DSP hospital by ER24
- All in-hospital benefits referred to in the section below require pre-authorisation from Bestmed
- Bestmed clinical funding protocols and limits may apply
| Medical Event | Scheme Benefit |
|---|---|
| Accommodation (hospital stay) and theatre fees | 100% Scheme tariff at designated service provider (DSP) hospital |
| 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 (Only PMBs) |
| Major medical maxillo-facial surgery strictly related to certain conditions | 100% Scheme tariff |
| Dental and oral surgery | 100% Scheme tariff |
| Prosthesis (Subject to preferred provider, otherwise limits and co-payments apply) |
100% Scheme tariff. Limited to R89 500 per family |
| Prosthesis – Internal Note: Sub-limit subject to the prosthesis limit |
Sub-limits per beneficiary:
|
| Prosthesis – External | Limit of R21 600 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 and Designated Service Provider (DSP) MRP applies to medicine claims where applicable The Designated Service Provider is ICON |
| Peritoneal dialysis and haemodialysis | 100% Scheme tariff Only DSPs Subject to pre-authorisation |
| Confinements | 100% Scheme tariff |
| Refractive surgery | 100% Scheme tariff Limited to R7 950 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 |
| Co-payments | Co payment of up to R10 000 per event for voluntary use of a non-DSP hospital |
Most out-of-hospital benefits are paid through Bestmed at the 100% negotiated contract tariff.
The Bestmed FP and Pulse dental networks are conveniently located across South Africa.
Members on Bestmed Pulse 2 are required to make use of the Bestmed FP provider network for primary healthcare services.
Bestmed Pulse specialist DSP Network
All members must use the Bestmed Pulse specialist DSP Network as the contracted Designated Service Provider (DSP).
| Medical Event | Scheme Benefit |
|---|---|
| Overall Day-to-day Limit | M = R12 250, M1+ = R24 350 |
| FP Consultations | Unlimited, FP visits at a Bestmed FP network provider:
Out-of-Network:
|
| Specialist Consultations | 100% Scheme tariff
Limited to M = R2 700, M1+ = R5 200 Referral by the network FP is required for specialist consultations Subject to Bestmed Pulse Specialist DSP Minor procedures performed in the provider’s rooms must be pre-approved by Bestmed. |
| Basic & Specialised Dentistry | Basic Dentistry: 100% Scheme tariff – subject to the Bestmed Pulse 2 approved tariff listSpecialised Dentistry:100% Scheme tariff – subject to overall day-to-day limit)Limited to M = R6 1250, M1+ = R7 800Exclusions Apply:
|
| Dentures | Limited to a maximum of two removeable acrylic dentures (i.e. two single denture plates) per family every 24 months
At Bestmed Pulse network dental provider and accredited dental laboratories and in accordance with the Bestmed Pulse 2 list of approved codes only |
| Medical aids, apparatus and appliances including wheelchairs and hearing aids | 100% Scheme tariff. Limited to R8 700 per family. Limit on wheelchairs of R11 200 per family per 48 months. Limit on hearing aids of R24 200 per beneficiary per 24 months at DSP. Subject to quotation, motivation and audiogram. |
| Supplementary Services (Services rendered by dieticians, chiropractors, homeopaths, orthoptists, acupuncturists, speech therapists, audiologists, occupational therapists, chiropodists, biokineticists, psychologists and social workers) |
100% Scheme tariff Limited to M = R3 600, M1+ = R7 150 – subject to overall day-to-day limit Must be referred by a network provider only. |
| Maternity Benefits | 2 sonars and up to 12 antenatal consultations |
| Wound Care Benefit (incl. dressings, negative pressure wound therapy (NPWT) treatment and related nursing services – out-of-hospital) |
100% Scheme tariff Limited to R8 400 per family |
| Optometry PPN Benefits (PPN capitation provider) |
100% Scheme tariff
|
| Diagnostic Imaging & Patholog | 100% Scheme tariff. Primary care pathology and radiology must be requested via the network FP according to the network approved Pulse 2 protocols and tariff list. (Subject to overall day-to-day limit) |
| Specialised Diagnostic Imaging | 100% Scheme tariff
Subject to pre-authorisation |
| Oncology | 100% Scheme tariff Oncology Programme and Designated Service Provider (DSP) MRP applies to medicine claims where applicable The DSP is ICON |
| Peritoneal Dialysis & Haemodialysis | 100% Scheme tariff Subject to pre-authorisation and DSPs National Renal Care (NRC) |
| Rehabilitation Services After Trauma | No benefit |
- All benefits below are subject to approval, pre-authorisation, 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 chronic limit. 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 – unlimited Must be prescribed by a network provider and obtained from a network pharmacy Co-payment of 25% for non-formulary medicine |
| Non-CDL chronic medicine | 85% of Scheme tariff 16 conditions Limited to M = R5 800, M1+ = R11 600 Must be prescribed by a network provider and obtained from a network pharmacy Co-payment of 25% for non-formulary medicine |
| Biologicals and other high-cost medicine | 100% Scheme tariff Limited to R132 000 per beneficiary |
| Acute medicine | 100% Scheme tariff Limited M = R3 850, M1+ = R7 800 (Subject to overall day-to-day limit) Must be prescribed by a network provider and obtained from a network pharmacy No benefit for medicine not on the acute medicine formulary |
| Over-the-counter (OTC) medicine | 100% Scheme tariff Limited to R550 per family. (Subject to acute medicine limit and available funds in the overall day-today limit) Subject to provider network formulary |
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 |
| Paediatric Immunisations | Babies & children | Funding for all paediatric vaccines according to the state-recommended programme |
|
| 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 |
| 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 |
| BetterMe Wellness Benefits Note: BIometric screening activates the other assessment benefits |
|
||
| 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 | Osteoarthritis |
| Non-CDL 15 | Alzheimer’s disease |
| Non-CDL 16 | 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
