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Overall, the Bestmed Rhythm 1 Medical Aid Plan is a trustworthy and comprehensive medical aid plan that offers 24/7 medical emergency assistance and in-hospital procedures to up to 3 Family Members. The Bestmed Rhythm 1 Medical Aid Plan starts from R1,432 ZAR.
π International Cover | R500,000 β R3 million |
π€ Main Member Contribution | R1,432 β R2,983 |
π₯ Adult Dependent Contribution | R1,432 β R2,983 |
π Child Dependent Contribution | R590 β R1,545 |
π Gap Cover | None |
π₯ Hospital Cover | Unlimited at Rhythm DSPs |
πΆ Prescribed Minimum Benefits (PMB) | βοΈ Yes |
π Screening and Prevention | βοΈ Yes |
πΌ Maternity Benefits | βοΈ Yes |
π³ Medical Savings Account | None |
The Bestmed Rhythm 1 medical aid plan is one of 10, starting from R1,432, and includes day-to-day benefits, and a list of procedures that can be performed at day-hospital facilities.
Gap Cover is not available on the Bestmed Rhythm 1 Plan and according to the Trust Index, Bestmed has a trust rating of 3.5.
π Monthly Income Bracket | π€ Main Member | π₯ +1 Adult Dependent | π +1 Child Dependent |
R0 β R9,000 | R1,432 | R1,432 | R590 |
R9,001 β R14,000 | R1,670 | R1,670 | R710 |
R14,001> | R2,983 | R2,983 | R1,545 |
There are day-to-day benefits available.
Method of Payment on Rhythm 1 Plan
While using DSPs, any benefits related to conditions that meet the requirements for PMBs will be covered.
Bestmed Rhythm 1 Scheme Benefits for Different Medical Events In-Hospital
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The DSP hospital network encompasses all Netcare hospitals in South Africa. In regions without Netcare hospitals, other hospitals are contracted as DSPs.
Bestmed Rhythm 1 Hospital Authorization Process
Bestmed will only authorize admissions to DSP hospitals under contract.
When Bestmed Rhythm 1 members are admitted to a non-DSP hospital
Voluntary use of a non-DSP hospital (unless in the case of an emergency) will result in a co-payment of up to R13,732.
π In-Hospital Accommodation and fees for the theatre | Only approved PMBs are covered at a DSP hospital. |
π Take-home medication after discharge | Covered up to 100% of the Bestmed tariff. Limited to a 7-day supply. |
π Biological medicine received during hospitalization | Only approved PMBs covered at a DSP hospital |
π Treatment in Mental Health Clinics | Only approved PMBs are covered at a DSP hospital. Pre-approval is needed, and a limit of 21 days per beneficiary yearly. |
βοΈ Chemical and Substance Abuse Treatment | Covered up to 100% of the Bestmed tariff. Only DSPs can be used for this benefit. Pre-approval is needed, and a limit of 21 days per beneficiary yearly. |
β Consultations and procedures | Only approved PMBs are covered at a DSP hospital. Subject to pre-approval from Bestmed. |
β³οΈ Surgical Procedures (including anesthetic) | Only approved PMBs are covered at a DSP hospital. Subject to pre-approval from Bestmed. |
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) | Only approved PMBs are covered at a DSP hospital. |
π₯ In- and Out-of-Hospital Dental and oral surgery | Only approved PMBs are covered at a DSP hospital. |
β‘οΈ 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 R61,384 per family. Only approved PMBs are covered at a DSP hospital. |
π 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 R35,550 Vascular β R52,500 Pacemakers (dual chamber) β R49,711 Spinal, including artificial discs β R30,416 Drug-eluting stents β Only PMBs using DSPs Mesh β R11,124 Gynecology/Urology β R9,188 Lens Implants (per lens, per eye) β R6,387 |
π Orthopedic and Medical Appliances | Only approved PMBs are covered at a DSP hospital. |
π Pathology | Only approved PMBs are covered at a DSP hospital. |
π Radiology | Only approved PMBs are covered at a DSP hospital. |
π °οΈ MRI, CT scans, and other specialized diagnostics | Only approved PMBs are covered at a DSP hospital. |
π ±οΈ Oncology | Only approved PMBs are covered at a DSP hospital. |
βοΈ Peritoneal Dialysis and hemodialysis | Only approved PMBs are covered at a DSP hospital. |
π Birthing Confinements | Only approved PMBs are covered at a DSP hospital. |
π HIV/AIDS | Only approved PMBs are covered at a DSP hospital. |
βοΈ Refractive Surgery (and all other procedures that aim to improve or stabilize vision, excluding cataracts) | Only approved PMBs are covered at a DSP hospital. |
β Midwife-assisted birth | Covered up to 100% of the Bestmed tariff. |
π© Supplementary Services | Only approved PMBs are covered at a DSP hospital. |
π Hospitalization Alternatives | Only approved PMBs are covered at a DSP hospital. |
π Palliative and Home-Based Care instead of hospitalization | Only approved PMBs are covered at a DSP hospital. |
π Day Procedures performed at a day hospital | PMBs performed in a network day hospital: Only approved PMBs are covered at a DSP hospital. Subject to pre-authorization Non-PMBs in network day hospitals: 100% Scheme tariff. Subject to pre-approval and approved DSPs. An annual limit of R50,000 applies per family for the nine non-PMB day treatments. Using a non-network hospital will incur an R2,500 co-payment. The nine conditions not covered by the PMB are the following (subject to the Managed Healthcare protocols and funding guidelines): Breast biopsy β lumpectomy Circumcision Colonoscopy Dilatation and curettage (D & C) Female sterilization Gastroscopy Grommet insertion and myringotomy Male sterilization Tonsillectomy |
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. |
πΆ Co-Payments | There is a co-payment of up to R13,732 per event for voluntarily using a hospital not part of the DSP. |
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Members must receive pre-approval for any scheduled treatments or procedures.
Benefits covered by the Bestmed Rhythm Family Practitioners
If the Rhythm Family Practitioner performs services not covered by protocols on Rhythm 1, the member is responsible for the account.
π¨ββοΈ Family Practitioner Consultations | Unlimited consultations with FP. Subject to the Bestmed Rhythm FP network. Subject to pre-approval after the tenth visit. |
π©ββοΈ Pharmacy Clinic Nurse Consultations | 100% of the Scheme rate. Unlimited consultations with a primary care registered nurse (NAPPI code 981078001) at network pharmacies. |
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. |
βοΈ Specialist Consultations | A Rhythm Network Provider must make referrals to specialists. The benefit is covered by up to 100% of the Scheme tariff. There is a limit of up to R2,441 per family. The benefit is subject to the Rhythm Specialist Network. |
β‘οΈ Out-of-network and casualty visits | Only approved PMB services are covered. |
𦻠Medical Aids, Apparatus, and Appliances (including Hearing Aids and Wheelchairs) | Only approved PMB services are covered. |
π©Έ Wound Care Benefit (Dressings, negative pressure wound therapy NPWT treatment, and other nursing services Out-of-hospital) | Only approved PMB services are covered. |
π©Ί Oncology | Only approved PMBs are covered by a DSP provider. |
π§ͺ Peritoneal Dialysis and Hemodialysis | Only approved PMBs are covered by a DSP provider |
π· HIV/AIDS | Only approved PMBs are covered by a DSP provider |
π °οΈ MRI scans, CT scans, isotope studies, and PET scans | Only approved PMB services are covered. |
π ±οΈ Rehabilitation after a traumatic event | Only PMBs are covered. Subject to pre-approval and the use of DSPs. |
There is no benefit for spectacle frames, lenses, or contact lenses.
Basic Dentistry is covered when it is clinically appropriate and according to the Bestmed Rhythm 1 guideline, Bestmed Rhythm Dental Network Providers, and Rhythm-approved dental codes.
You are responsible for paying for pathology codes not included in the Bestmed Rhythm formulary.
You are responsible for paying for any radiology codes not included in the Bestmed Rhythm formulary.
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.
Because this is a network option, members must purchase their medication from Scheme-contracted pharmacies.
1οΈβ£ CDL and PMB Chronic Conditions | Covered up to 100% of the Bestmed tariff. There is a co-payment of 30% for non-formulary medicine when using a preferred provider network pharmacy. |
2οΈβ£ Biological medicine | Only PMBs are covered, and the benefit is subject to pre-approval. |
3οΈβ£ Other high-cost medication | Only PMBs are covered, and the benefit is subject to pre-approval. |
4οΈβ£ Acute Medicine | Covered up to 100% of the Bestmed tariff. Subject to the Bestmed formulary. The benefit is per prescriptions by a Network FP, and medication must be obtained from a DSP pharmacy. |
The Bestmed Rhythm 1 Chronic Condition List and Prescribed Minimum Benefits are as follows:
and many more.
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 | β‘οΈ Gender and Age Group | π Quantity and Frequency | βοΈ Criteria |
π Flu Vaccines | All | 1 per beneficiary yearly | Applies to all active participants and recipients. |
βοΈ 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. |
β³οΈ 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. |
β 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. |
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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:
1οΈβ£ 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. |
2οΈβ£ 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. |
3οΈβ£ 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. |
4οΈβ£ Maternity Benefits | Covered up to 100% of the Scheme tariff using network providers for the following benefits: Consultations Six prenatal consultations 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. |
The Maternity care program is available to pregnant members and their dependents, providing comprehensive services and information.
It has been designed with expectant parentsβ specific needs and support networks.
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.
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Bestmed Rhythm 1 Exclusion
Some of the following are excluded from Rhythm 1. The comprehensive list can be found on the official Bestmed website.
Unkept appointments by members, and more.
Bestmed Rhythm 1 Waiting Periods
Depending on pre-existing or existing conditions, the following might apply when you register for medical coverage with the Bestmed Rhythm 1 plan:
A late-joiner contribution penalty will apply.
BestMed Rhythm 1 | KeyHealth Essence | Fedhealth FlexiFed 2 | |
π International Cover | R500,000 β R3 million | TBA | None |
π€ Main Member Contribution | R1,432 β R2,983 | R1,990 | R2,491 |
π₯ Adult Dependent Contribution | R1,432 β R2,983 | R1,595 | R2,227 |
π Child Dependent Contribution | R590 β R1,545 | R717 | R740 |
π Annual Limit | Several limits and sub-limits | Unlimited Hospital Cover | Unlimited at hospitals in the Fedhealth network |
π₯ Hospital Cover | Unlimited at Rhythm DSPs | Unlimited | Unlimited |
πΆ Prescribed Minimum Benefits (PMB) | βοΈ Yes | βοΈ Yes | βοΈ Yes |
π Screening and Prevention | β Yes | β Yes | β Yes |
π Home Care | βοΈ Yes | βοΈ Yes | βοΈ Yes |
π€ Optometry Benefit | β Yes | β Yes | β Yes |
In conclusion, the Bestmed Rhythm 1 Plan is an ideal medical aid option for individuals seeking a comprehensive cover adaptable to their income and who do not mind using Designated Service Providers (DSPs) as allocated by Bestmed.
Furthermore, the plan offers primary healthcare services and preventative care benefits, including private hospital cover, which are paid for from the scheme risk-benefit.
You might also consider the following options BestMed has to offer:
DSPs are healthcare service providers contracted with Bestmed to provide medical services to members of the Rhythm 1 Plan. These may include Rhythm Specialist DSPs and DSP hospitals.
Bestmed Rhythm 1 covers hospitalization, chronic medication, and day-to-day medical expenses. The plan also offers primary healthcare services and preventative care benefits, including private hospital cover, which are paid for from the scheme risk-benefit.
The waiting period for the Bestmed Rhythm 1 Plan is 3 months for general healthcare services and 12 months for certain specified conditions, such as pre-existing conditions and pregnancy.
Yes, you can add dependents to your Bestmed Rhythm 1 Plan. Dependents include your spouse or life partner and your children up to the age of 26 years, or up to the age of 27 years if they are full-time students.
The co-payment on the Bestmed Rhythm 1 Plan is a fee that you are required to pay for certain medical services or procedures. The co-payment amount varies depending on the service or procedure, but it is usually a percentage of the cost, up to a specified limit.
To make a claim on your Bestmed Rhythm 1 Plan, you need to complete a claim form and submit it to Bestmed. You can do this online or by visiting one of Bestmed’s offices. You will also need to provide any relevant documentation, such as receipts or invoices.
No, you cannot change your Bestmed Rhythm 1 Plan during the year, unless you experience a life-changing event, such as getting married, having a baby, or getting divorced. In such cases, you may be able to change your plan, but you will need to provide proof of the event.
Rhythm Specialists DSPs are healthcare providers providing medical services related to the Rhythm 1 Plan. These service providers have contracted with Bestmed to offer their services to plan members.
You can contact Bestmed by calling their Call Center, emailing them, or visiting their website to chat with a consultant or access the online self-service portal. Bestmed consultants are available to assist you with any queries or assistance.
In emergency hospitalization, the member, their representative, or the hospital must notify Bestmed of the memberβs hospitalization as soon as possible or on the first working day after hospital admission.
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