The Best Medical Aids
The Best Hospital Plans
Overall, the Bestmed Pace 3 Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and international travel cover to up to 3 Family Members. The Bestmed Pace 3 Medical Aid Plan starts from R8,280 ZAR.
π International Cover | R500,000 β R3 million |
π€ Main Member Contribution | R8,280 |
π₯ Adult Dependent Contribution | R6,665 |
π Child Dependent Contribution | R1,424 |
π₯ Hospital Cover | Unlimited |
Extended Cover for Oncology | Access to extended protocols |
π Annual Limit | Several limits and sub-limits |
π Gap Cover | None |
π Diabetes Care Program | βοΈ Yes |
β€οΈ Mental Healthcare Program | βοΈ |
The Bestmed Pace 3 medical aid plan is one of 10, starting from R8,280 and includes unlimited in-hospital cover up to 100% of the scheme tariff, oncology cover, international travel cover, and more.
Gap Cover is not available on the Bestmed Pace 3 Plan and according to the Trust Index, Bestmed has a trust rating of 3.5.
π€ Main Member | π₯ +1 Adult Dependent | π +1 Child Dependent |
R8,280 | R6,665 | R1,424 |
π€ Main Member | π₯ +1 Adult Dependent | π +1 Child Dependent |
R1,159 x 12 Months | R933 x 12 Months | R199 x 12 Months |
Savings Account / Day-to-day Benefits
Method of Payment on Pace 3 Plan
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While employing designated service providers (DSPs), all benefits for conditions that satisfy the requirements for Prescribed Minimum Benefits (PMBs) will be covered. This will not impact your savings (annual or vested).
Bestmed Pace 3 Scheme Benefits for Different Medical Events In-Hospital
All listed benefits are subject to pre-approval, clinical protocols, and funding guidelines.
π In-Hospital Accommodation and fees for the theatre | Covered up to 100% of the Bestmed tariff. |
π Take-home medication after discharge | Covered up to 100% of the Bestmed tariff. Limited to a 7-day supply. |
π Treatment in Mental Health Clinics | Covered up to 100% of the Bestmed tariff. Limited to 21 days per beneficiary yearly. |
βοΈ Chemical and Substance Abuse Treatment | Covered up to 100% of the Bestmed tariff. Limited to 21 days or R37,352 per beneficiary per year. Subject to members using network facilities. |
π Consultations and procedures | Covered up to 100% of the Bestmed tariff. |
π Surgical Procedures (including anesthetic) | Covered up to 100% of the Bestmed tariff. |
β€οΈ Organ Transplants | Covered up to 100% of the Bestmed tariff. Only PMBs are covered. |
π Major medical maxillo-facial surgery (Only specified conditions) | Covered up to 100% of the Bestmed tariff. |
π¦· In- and Out-of-Hospital Dental and oral surgery | There is a limit of R19,500 per family. |
𦡠Prostheses are subject to preferred providers or co-payments, and limits will apply | Covered up to 100% of the Bestmed tariff. There is a limit of p to R134,715 per family. |
π¦Ύ Internal Prostheses (Preferred Providers or limits and co-payments will apply) Functional items used must be towards treating or supporting bodily functions | The following sub-limits apply per beneficiary Functional limited to β R37,800 Pacemakers (dual chamber) β R72,450 Vascular β R72,450 Spinal, including artificial discs β R67,321 Drug-eluting stents β R21,972 Mesh β R21,972 Gynecology/Urology β R16,479 Lens Implants (per lens, per eye) β R14,090 Joint replacements: Hip replacement and other major joints β R60,422 Knee replacement β R70,378 Other minor joints β R26,022 |
βοΈ External prostheses | There is an annual limit of R31,723 per family. Members must use a DSP. This benefit will cover artificial limbs but is limited to one limb every 60 months. |
β³οΈ Orthopedic and Medical Appliances | Covered up to 100% of the Bestmed tariff. |
βοΈ Pathology | Covered up to 100% of the Bestmed tariff. |
β Radiology | Covered up to 100% of the Bestmed tariff. |
π MRI, CT scans, and other specialized diagnostics | Covered up to 100% of the Bestmed tariff. |
π Oncology | Covered up to 100% of the Bestmed tariff. The benefit is subject to pre-authorization and the use of DSP |
π©ββοΈ Peritoneal Dialysis and hemodialysis | Covered up to 100% of the Bestmed tariff. The benefit is subject to pre-authorization and the use of DSP |
π¨ββοΈ Birthing Confinements | Covered up to 100% of the Bestmed tariff. |
π Mammary surgery on a breast cancer patientβs unaffected (non-cancerous) breast | Covered up to 100% of the Scheme price for reconstructive surgery (which may involve symmetrizing, partial or total mastectomy, etc.) on a breast cancer patientβs healthy breast. The benefit is restricted to R40,476 and requires pre-approval. |
π· HIV/AIDS | Covered up to 100% of the Bestmed tariff. The benefit is subject to pre-authorization and the use of DSP |
π© Refractive Surgery (and all other procedures that aim to improve or stabilize vision, excluding cataracts) | Covered up to 100% of the Bestmed tariff. Subject to pre-approval and other protocols. Covered up to a limit of R11,117 per eye. |
πΆ Midwife-assisted birth | Covered up to 100% of the Bestmed tariff. |
π©Ί Supplementary Services | Covered up to 100% of the Bestmed tariff. |
π©Έ Hospitalization Alternatives | Covered up to 100% of the Bestmed tariff. |
π§ͺ Palliative and Home-Based Care instead of hospitalization | Covered up to 100% of the Bestmed tariff. There is a limit of R133,182 per beneficiary yearly. Subject to benefit availability, pre-authorization, and treatment plan. |
β¬οΈ Day Procedures performed at a day hospital | Funded at 100% of the Network or Scheme Tariffs if DSPs are used. There is a co-payment of R2,625 when voluntarily using a non-DSP specialist or hospital. |
π International Travel Cover | Leisure Travel: Cover is limited to 45 days and R500,000 for trips to the United States. All other nations are insured for up to 90 days, and a family (member and dependents) is protected for R3 million. Business Travel to the United States is limited to 45 days and covers up to R500,000. All other nations are insured for up to 45 days, and a family (member and dependents) is protected for R3 million. |
π Day Procedures performed at a Day Hospital | Day procedures at DSPs or day hospitals will be reimbursable at the full network or Scheme rate. Voluntary utilization of non-DSP specialists and acute hospitals will incur an R2,500 co-payment. |
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If you have a treatment plan for a Chronic Disease List (CDL) or Prescribed Minimum Benefit (PMB) condition/s, the services in the treatment plan will be paid for first from the applicable day-to-day limit.
After the limit has been exhausted, claims will continue to be paid from Scheme risk up to the maximum amount indicated in the treatment plan.
π Overall day-to-day limits | Main Member β R21,047 Main Member + Dependents β R43,496 |
π FP and Specialist Consultations | These consultations are first covered using available funds from the medical savings account. The following limits apply and are subject to the overall day-to-day limit: Main Member β R5,082 Main Member + Dependents β R10,299 |
π¬ Diabetes Primary Care Consultation | Covered up to 100% of the Scheme price subject to HaloCare registration. Two consultations for primary care at Dis-Chem pharmacies. Paid initially from the βFP and specialist consultationsβ daily benefit, then Scheme risk. |
π¦· Basic and Specialized Dentistry | Paid from savings and then from the daily limit. Orthodontics needs pre-approval. The following limits apply to this benefit, subject to the overall day-to-day limit: Main Member β R9,989 Main Member + Dependents β R16,089 |
β³οΈ Medical devices, apparatus, appliances | Covered from available savings first. Covered up to 100% of the Bestmed tariff. There is a limit of up to R12,084 per family. This benefit includes repairs to artificial limbs. The benefit is subject to the overall day-to-day limit. |
β‘οΈ Continuous (CGM) or Flash Glucose Monitoring (FGM) | Covered up to 100% of the Bestmed tariff. There is a limit of R22,197 per family yearly. The benefit is subject to pre-approval. |
π©π»βπ¦Ό Wheelchairs | This benefit is limited to R16,342 per family every four years. |
𦻠Hearing Aids | Subject to pre-approval. There is a limit of up to R35,490 per beneficiary every two years. Paid up to 100% of the Bestmed tariff. |
β Supplementary Services | Covered from available savings first. Limited to the following (subject to overall day-to-day limit): Main Member β R3,104 Main Member + Dependents β R6,523 |
βοΈ Wound Care Benefit (Dressings, negative pressure wound therapy NPWT treatment, and other nursing services Out-of-hospital) | Covered from available savings first. Covered up to 100% of the Bestmed tariff. Limited to R10,500 per family, subject to the overall day-to-day limit. |
π€ Optometry | Benefits are available every 24 months from the last date of service. Network Providers (PPN) Consultations β 1 per beneficiary. Frames are covered up to R1,040 and up to 100% of the cost of standard lenses (single, bifocal, or multifocal), and lens enhancement up to R750. Alternatively, beneficiaries are covered up to R2,010 for contact lenses. Non-Network Providers Consultation β R365 fee when using a Non-Network Provider. Frames are covered up to R780 and: R215 for single-vision lenses. R460 for bifocal lenses. R982.50 for multifocal lenses. R562.50 for lens enhancement. Alternatively, beneficiaries can opt for contact lenses of up to R2,010. |
π Basic Radiology and Pathology | Covered from available savings first. Subject to the overall day-to-day limit. The following limits apply: Main Member β R4,120 Main Member + Dependents β R8,170 |
π Oncology | Oncology program at the full Scheme rate. Subject to pre-approval and DSP. Members have access to extended protocols. |
π Peritoneal Dialysis and Hemodialysis | Covered up to 100% of the Bestmed tariff. Subject to pre-approval and DSP. |
π HIV/AIDS | Covered up to 100% of the Bestmed tariff. Subject to pre-approval and DSP. |
π MRI scans, CT scans, isotope studies, and PET scans | Maximum of 3 scans allowed per beneficiary per year. 1 PET scan is allowed per beneficiary per year. Scans are subject to pre-approval. |
β€οΈ Rehabilitation after a traumatic event | Covered up to 100% of the Bestmed tariff. |
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The following benefits may be subject to pre-authorization, clinical protocols, preferred providers (PPs), designated service providers (DSPs), formularies, funding criteria, the Mediscor Reference Price (MRP), and the exclusions listed in Annexure C of the published Regulations.
After the limit has been depleted, only PMB biological medicine costs will continue to be paid without limit.
1οΈβ£ CDL and PMB Chronic Conditions | Covered up to 100% of the Bestmed tariff. There is a co-payment of 15% for non-formulary medicine. |
2οΈβ£ Non-CDL Chronic medicine (First paid from the non-CDL limit. After that, approved CDL and PMB medicine is paid from the Scheme Risk) | Twenty conditions are covered. Covered up to 90% of the Bestmed tariff. There is a co-payment of 15% for non-formulary medicine. The following limits will apply: Main Member β R15,368 Main Member + Dependents β R30,735 |
3οΈβ£ Biological medicine | Limited to R384,507 per beneficiary per year. |
4οΈβ£ Other high-cost medication | Covered up to 100% of the Bestmed tariff. |
5οΈβ£ Acute Medicine | Savings funds are used first, then covered up to (subject to the overall day-to-day-limit): Main Member β R2,100 Main Member + Dependents β R4,725 |
6οΈβ£ OTC Medication | Members can choose an R1,110 limit per family. Alternatively, access is given to a full savings account for OTC medicine after the R1,110 limit. This will lead to a self-payment gap accumulation. This benefit includes vitamins, minerals, and sunscreen with Nappi codes on the Bestmed formulary. This benefit is subject to available savings funds. |
The Bestmed Pace 3 Chronic Condition List and Prescribed Minimum Benefits are as follows:
CDL
and many more.
NON-CDL
and many more.
PMB
and many more.
The following benefits could be subject to pre-approval, clinical procedures, preferred providers (PPs), designated service providers (DSPs), formularies, funding guidelines, and the Mediscor Reference Pricing (MRP).
π Benefit | π Gender and Age Group | π Quantity and Frequency | π Criteria |
π Flu Vaccines | All | 1 per beneficiary yearly | Applies to all active participants and recipients. |
β‘οΈ Pneumonia Vaccines | Children <2 Years High-risk adult group | Children β according to the Department of Health Adults β Twice in a lifetime with a booster for beneficiaries 65> | Adults: The Scheme will identify high-risk adults who will be encouraged to receive vaccinations. |
π Travel Vaccines | All | Amount and frequency vary by product up to the maximum quantity authorized. | Program risk benefits for mandatory typhoid, yellow fever, tetanus, meningitis, hepatitis, and cholera travel vaccinations. |
πΌ Baby Growth and Development Assessments | 0 β 2 Years | 3 Assessments per year | Pharmaceutical clinics under the Bestmed Network perform assessments. |
βοΈ Female Contraceptives | All female beneficiaries of child-bearing age | Depends on the product according to the maximum allowed amount | Annually limited to R2,678 per beneficiary. Covers all items categorized under the female contraception category. |
β³οΈ Intrauterine device (IUD) insertion | All female beneficiaries of child-bearing age | 1 device every 5 years | Consultation and treatment by a gynecologist or family physician. |
π HPV Vaccinations | Female Beneficiaries 9 β 26 | 3 vaccines per beneficiary | Vaccinations are funded according to the MRP |
π Mammogram | All females 40 years> | Once every 2 years | Covered up to 100% of the Bankmed tariff |
π °οΈ PSA Screening | Male Beneficiaries | Once every 2 years | It may be performed at a urologist, family practitioner, or network pharmacy clinic. The available savings account covers the consultation fee. |
π ±οΈ Back and Neck Preventative Care Program | All | Subject to pre-authorization | Providers of choice (DBC/Workability Clinics). This is a prophylactic approach designed to avoid the need for back and neck surgery. The System could discover suitable volunteers. Based on the initial evaluation, a rehabilitation treatment plan is developed and implemented over a period indicated by the provider. This program is an alternative to surgery. |
π©ββοΈ Pap Smear | Female beneficiaries 18 and older | Once every 24 months | Possible at a gynecologist, family physician, or pharmacy clinic. The consultation will be at the memberβs expense. |
The following services may be subject to pre-approval, clinical protocols, and financial guidelines.
π Service | π Age | π Frequency |
βοΈ General full-mouth examination by a general dentist (including the use of gloves and sterile equipment) | 12 Years> | Once yearly |
β General full-mouth examination by a general dentist (including the use of gloves and sterile equipment) | 12 Years< | Twice yearly |
βοΈ Full-mouth Intra-Oral Photos | All | Once every 3 years |
β Intra-Oral Radiograph | All | 2 photos yearly |
βοΈ Scaling or polishing | All | Twice yearly |
β Fluoride treatment | All | Twice yearly |
βοΈ Fissure Sealing | Up to and including beneficiaries 21 years old | According to the applicable and accepted protocol |
β Space Maintainers | During the primary and mixed denture stage | Once per space |
The Bestmed Tempo wellness program is designed to assist you in enhancing your health and reaping the benefits that come with it. Therefore, members can access the following advantages:
π Temporary Health Assessment (HA) for adults (16 years and older) that includes one of the following per adult beneficiary per year | The Tempo lifestyle questionnaire Blood pressure check Cholesterol check Glucose check Height, weight, and waist circumference These assessments must be conducted at a contracted pharmacy or on-site at employer groups participating in the program. |
π Bestmed Tempo Fitness and Nutrition Programs (for those older than 16) | Fitness 1 x (face-to-face) fitness assessment with a Tempo partner biokinetics. 1 x (virtual or face-to-face) follow-up discussion to receive a customized fitness/exercise plan from a Tempo partner biokinetics. These fitness benefits are designed to support your Tempo Get Active journey. Nutrition 1 x (in-person) nutrition evaluation with a Tempo partner dietician 1 x follow-up (virtual or in-person) consultation with a Tempo partner dietician to receive your personalized healthy-eating plan. These nutritional benefits are designed to support your Tempo Nutritional Health Journey. |
π Emotional wellness journey | Licensed psychologists and healthcare professionals designed this to help you understand and manage your emotions and their impact on your mental health. In addition, this Adventure grants you access to the following: Lifestyle-related knowledge that will assist you in adapting to lifeβs alterations and surprises. Practical obstacles that will allow you to practice the new abilities you must acquire to evolve from your current emotional and mental state to the state you seek. |
π Maternity Benefits | Covered up to 100% of the Scheme tariff. Depending on the following benefits: Consultations Nine prenatal consultations with a general practitioner, gynecologist, or midwife. One postnatal consultation with a general practitioner, gynecologist, or midwife. Ultrasounds 1 x 2D ultrasound scan in the first trimester (between 10 and 12 weeks) performed by an FP OR gynecologist OR radiologist. 1 x 2D ultrasound scan in the second trimester (between 20 and 24 weeks) performed by an FP OR gynecologist OR radiologist. Supplements Any item classified as a pregnancy supplement may be claimed up to a monthly limit of R127 for a maximum of nine months. |
The Maternity care program is available to pregnant members and their dependents, providing comprehensive services and information.
To access these services, members must register for the Bestmed Maternity care program when they receive confirmation of their pregnancy through a pathology test or scan from their family practitioner or gynecologist.
Once registration is complete, a consultant will reach out to them.
Get a better understanding about Maternity Benefits
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Some of the following are excluded from Pace 3. The comprehensive list can be found on the official Bestmed website.
Unkept appointments by members, and more.
Depending on pre-existing or existing conditions, the following might apply when you register for medical cover with the Bestmed Pace 3 plan:
A late-joiner contribution penalty fee will apply.
π Medical Aid Plan | π₯ Bestmed Pace 3 | π₯ Sizwe Hosmed Titanium Executive | π₯ GEMS Onyx |
π Child Dependent Contribution | R1,424 | R,1719 | 1,853 β 2,246 ZAR |
π₯ Adult Dependent Contribution | R6,665 | R7,446 | 4,718 β 5,322 ZAR |
π€ Main Member Contribution | R8,280 | R8,415 | 6,162 β 6,924 ZAR |
π International Cover | R500,000 β R3 million | 100% Scheme Rate | None |
π₯ Hospital Cover | Unlimited | Unlimited | Unlimited |
πΆ Prescribed Minimum Benefits (PMB) | β Yes | β Yes | β Yes |
π Screening and Prevention | βοΈ Yes | βοΈ Yes | βοΈ Yes |
π³ Medical Savings Account | β Yes | β Yes | β Yes |
πΌ Maternity Benefits | βοΈ Yes | βοΈ Yes | βοΈ Yes |
Overall, Bestmed Pace 3 is a comprehensive medical aid plan provided by Bestmed Medical Scheme, intended for individuals and families with high medical care needs.
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Pace 3 provides the highest benefits and coverage among the Bestmed Pace plans, including unlimited in-hospital benefits and a broad range of comprehensive coverage for out-of-hospital medical services.
You might also consider the following options BestMed has to offer:
Bestmed Pace 3 offers comprehensive coverage for various medical services, including specialist consultations, chronic medication, and other healthcare needs. It has higher overall day-to-day limits for general practitioner visits, pathology tests, and other medical services.
Bestmed Pace 3 offers a more extensive range of benefits with higher limits than Bestmed Pace 1 and 2. It also provides more flexibility when it comes to hospital and specialist choices.
Yes, Bestmed Pace 3 is designed for individuals and families who require high levels of medical care and want peace of mind knowing they are covered for a broad range of healthcare needs.
Yes, Bestmed Pace 3 has a higher monthly premium than Bestmed Pace 1 and 2 due to its more comprehensive coverage.
Yes, Bestmed Pace 3 has higher overall day-to-day limits for general practitioner visits, pathology tests, and other medical services compared to other Bestmed Pace plans.
The benefit of choosing Bestmed Pace 3 is that it offers the highest benefits and coverage among the Bestmed Pace plans, including unlimited in-hospital benefits and comprehensive coverage for out-of-hospital medical services.Β Therefore, Bestmed Pace 3 is suitable for individuals and families who require broad medical coverage and peace of mind knowing they are covered for a wide range of healthcare needs.
Yes, Bestmed Pace 3 provides comprehensive coverage for chronic medication.
Yes, Bestmed Pace 3 offers more flexibility regarding hospital and specialist choices.
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