Bestmed Pulse 2 Option

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

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).

• 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.

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

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