Comparative Guide 2016: Better Living. Better Life

Comparative
Guide
2016
Better living. Better life.

About
Bestmed
Why choose Bestmed?

Over the years Bestmed has grown sustainably and has been able to build a reputable name
in the industry. Our focus is to provide superior healthcare to our members. We are, after all, a
medical scheme for members, by members. That is why it is gratifying to know that we have been
honoured with the Healthcare Product Supplier of the Year award from the Financial Intermediaries
Association of South Africa.
Bestmed is still raising the bar in the medical aid industry to the point where we have grown our
membership to reach the fifth overall position countrywide. Going forward, Bestmed is also focused
on serving our members with the legendary Bestmed touch.
As a self-administered scheme, Bestmed now has more than 93 000 principal members and provides
healthcare benefits to almost 200 000 lives. With our extensive experience and exceptional
expertise, we can negotiate with our service providers to offer our members benefits and services
that are, Rand-for-Rand, the best value compared to other large open medical schemes.
The right fit

Bestmed recognises that members’ healthcare needs will vary depending on age, marital
status and different responsibilities and priorities. To address our members’ desire for choice
and flexibility, we have designed 13 healthcare options which are structured differently to suit
various healthcare needs. So, whether you essentially want to cover hospital costs or require a
more comprehensive offering, covering all healthcare requirements, we have an option for you.
Our Beat, Pace and Pulse product offerings have been designed based on engagements and
conversations with members over our many years of experience. After listening intently to their
concerns, our healthcare experts have translated these insights into benefit options that are
easy to understand and cater for all needs.
Focused on wellness
Your continued health and wellbeing is our primary concern. That is why we encourage all of
our members to live a more preventive, meaningful and productive life through our wellness
programme known as Health Check. We are here to assist you to become a better version of
yourself through choosing a healthier lifestyle.
Our wellness philosophy is based on five basic wellness pillars. We encourage our members to:
Be Active: Incorporate exercise as part of your daily routine to promote positive changes.
Be Safe: Make responsible lifestyle choices to prevent adverse consequences.
Be Nutri-wise: Balanced nutrition is important to maintain a healthy body and mind.
Be Happy: Create and maintain a balance between work, life and home.
Be Fin-fit: Making informed financial decisions in life will ensure financial independence.
The corporate partnership

Bestmed healthcare is based on sound partnerships. The way we engage with our corporate clients
aims to establish and maintain long-term personal relationships, built on mutual trust and integrity.
We further strive to provide affordable, excellent healthcare solutions, be accessible and provide
personalised advice to all members and be flexible so processes are easy to follow.
2 Bestmed Comparative Guide 2016

In line with this vision, Bestmed has adopted a three-pronged approach in order to deliver on its promise,
which includes Corporate Wellness, a Client Service Programme, as well as Administration. Bestmed
advisors are responsible for implementing these service programmes at employer organisations. Today,
Bestmed services over 140 employer organisations, including large corporate businesses, some of South
Africa’s biggest universities and a variety of parastatals.
Don’t worry, be appy!

Bestmed is proud to inform members that the Bestmed app that was launched at the start of 2015, is now
app-reciably better. Members are now able to get even more access to greater functionalities by simply
downloading the Bestmed app onto their smartphones.
The completely user-friendly app will enable you to perform many new functions to ease your interaction
with Bestmed even further.
The second phase of the development of the Bestmed app has been finalised and the app now boasts with
a host of new functionalities that include great features like a service provider search function, updating of
your personal details and receiving your tax certificate directly to your cell phone.
Bestmed Provider Network

Bestmed has over the past four years, established several preferred and designated service provider
networks with provider groups, an initiative designed to make sustainable, high-quality healthcare services
available to our members at affordable premiums.
Member advantages of using Bestmed Provider Networks

• Provider fees are set and managed as agreed.
• Quality of healthcare services are enhanced.
• Downstream costs are better managed.
• Providers are paid directly and on a weekly basis by the Scheme.
• No or minimum co-payments by the members depending on benefits available.
• A longer lasting medical savings account.
• Network lists, provider names and addresses are available on the website.
• A dedicated provider consultant service is available to the Network Providers.
How do I access the detail and location of a network healthcare

service provider?
You need to register on the Bestmed website at www.bestmed.co.za and create your
personal username and password, if you have not done so already. This will allow you, as
the member, to access the different updated provider network lists and utilise all the added
benefits of the website.
Bestmed Comparative Guide 2016 3

Below is a summary of the current Bestmed Provider networks:
Family practitioners
Specialists
Pathology
Oncology
Healthcare Provider Networks Pharmacies
Dentists
Dental therapists
Dental technicians
Orthodontists
Audiologists and speech therapists

Physiotherapists
Occupational therapists
Hearing aid acousticians
Ancillary Networks Counsellors
Midwives
Psychologists
Biokineticists
Dieticians
Stents and pacemakers

Orthopaedic prosthesis
Product Supply Networks Oxygen supply
Sleep apnoea devices
Hearing aid devices
Drug and alcohol rehabilitation

Emergency services
Service Networks Optometry services
Renal dialysis
Wound therapy
The Healthcare Networks and Ancillary Networks are applicable to Beat1 to Beat4 and Pace1 to Pace4 only. Product Supply
Networks and Service Supply Networks are applicable to Beat1 to Beat4, Pace1 to Pace4 and Pulse1 and Pulse2.
Did you know that

you can make your
benefits last longer?
Simply ask your

doctor to prescribe
generic medicines
where possible.
Bestmed can negotiate

with service providers to
offer members benefits
and services that offer,
on a Rand-for-Rand basis,
the best value compared
to other large open
medical schemes.

Bestmed Managed Care Programmes
The Managed Health Care Programmes have been developed to assist members by providing
additional benefits to treat the following specific disease conditions with appropriate treatment,
in a cost-effective manner. These programmes include : Oncology Care, HIV/AIDS Care, Dialysis
Care, Alcohol and substance abuse Care, Wound Care, Stoma Care, Preventative Care and
Maternity Care.
Oncology Care
Bestmed’s various benefit options have specified benefits that define the cover for cancer.
Collectively these benefits are called oncology benefits.
Bestmed provides oncology benefits applying evidence-based medicine principles and

considering affordability across the different benefit options. It has therefore appointed the
Independent Clinical Oncology Network (ICON) for all the benefit options as Designated Service
Provider (DSP), excluding members on Pulse1, Pace3 and Pace4. Bestmed uses the Standard
option of ICON for all members. Members on Pace3 and Pace4 use the South African Oncology
Consortium (SAOC) cancer treatment guidelines. Pulse1 members are referred to state facilities
for treatment, as these are the designated service providers for this option.
Only members registered on the oncology programme qualify for cancer benefits. Members must
forward a clinical summary of their cancer, as set out by their treating doctor, to register on the
programme. This must contain the history, ICD–10 codes, the clinical findings of the doctor as
well as the test results confirming the cancer and the specific type of cancer.
HIV/AIDS Care
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition

caused by the human immunodeficiency virus (HIV). By damaging your immune system, this
virus interferes with your body’s ability to fight the organisms that cause disease.
HIV/AIDS is a sexually transmitted infection. It can also be spread by contact with infected blood
or from mother to child during pregnancy, childbirth or breast-feeding. Without medicine, it may
take years before HIV weakens your immune system to the point that you have full blown AIDS.
There is currently no cure for HIV/AIDS, but there is medicine available that can dramatically
slow down the progression of the disease.
To qualify for benefits, a member or dependant must register on the HIV/AIDS programme. A
member must forward a clinical summary to OneHealth that has been obtained from the treating
doctor. This summary must contain the relevant history, clinical findings, results of the HIV/
AIDS diagnostic test as well as all the CD4 and viral load test results. Any additional results
that have a bearing on the clinical picture or the impact the disease has on the patient, must be
forwarded. Examples of such tests include full blood count, liver function tests and specimens
sent for microscopy.
The programme also makes provision for blood tests to follow the course of the disease and
to measure the response to treatment, medicine and anti–retrovirals, as well as medicine
specifically used to fight the virus. The treatment programme covered by the Scheme is based
on the HIV/AIDS funding guideline and approved treatment depends on the clinical parameters
of each individual. The stage of the disease and the results of blood tests determine what
treatment will be covered and how the individual must be followed up. Cover is also provided
for mother–to–child transmission in pregnancy and as post–exposure prophylaxis. Details can be
obtained by contacting OneHealth Managed Care at the telephone numbers listed under contact
details. Optipharm is the Designated Service Provider for dispensing anti-retroviral medication
to Bestmed members.
Pulse1 and 2 members are advised to send their pathology claims for HIV/AIDS to
Bestmed in order to get all the tariffs paid. The e-mail address is claims@bestmed.co.za.

Dialysis Care
Members who require chronic dialysis for end-stage renal disease can register on the dialysis
programme. Depending on clinical and other parameters, the Scheme will consider funding for
peritoneal or haemodialysis. Certain medicines that are used in end-stage renal disease are only
covered when the Scheme funding guidelines are met. Bestmed has appointed National Renal
Care (NRC) as Designated Service Provider (DSP) for renal dialysis services for its members on all
the benefit options.
Only members registered on the dialysis programme qualify for benefits. In order to be
registered on the programme, patients must obtain a clinical summary of their condition as set
out by their treating doctor. This must contain the history, ICD-10 codes and clinical findings of
the doctor as well as the test results and details on any associated disease, e.g. diabetes.
Alcohol and Substance Abuse Care
Bestmed has contracted with various Designated Service Providers (DSPs) to provide
rehabilitation for alcohol and substance abuse. Please note that this benefit is subject to
pre-authorisation and will be funded up to a maximum limit or 21 days, or whichever is
depleted first.
Wound Care
Specialised wound care therapy, including dressings and negative-pressure wound therapy
(NPWT) treatment and related nursing services are included in Bestmed’s Provider Network.
Stoma Care
Bestmed has partnered with a supplier for the supply and distribution of stoma and
incontinence care products. Bestmed members who are registered on Stoma Care receive the
following value-added benefits:
• Patients are assisted to obtain the relevant Scheme authorisation for their stoma products.
• Patients are provided with direct contact details for the supplier’s business unit to address
all their product-related enquiries.
• Patients are provided with a quoting and product sourcing service of the most affordable and
cost-effective products as not all stoma and incontinence care needs of patients are covered
in full by the medical Scheme.
• Direct submissions of claims to Bestmed to ensure that they do not have to pay cash
up front and claim back from the Scheme.
• Free deliveries will be done free of charge.
Preventative Care
At Bestmed we encourage our members to actively pursue a healthier and more active lifestyle
to encourage better health.
In line with this philosophy we have developed preventative care that entitles you, the member,
to undergo a number of screenings, preventative tests and vaccines to encourage better health.
Preventative care is important in making sure you detect medical conditions early and we can
ensure the best care for you in this regard. Bestmed offers preventative care that covers a
number of benefits from the Scheme’s risk benefit, and not your savings. General and option-
specific exclusions may apply to the various options. Please refer to www.bestmed.co.za for
more details.
Flu vaccines: All members are eligible, and annually receive a letter to remind them of this
preventative care benefit when flu vaccines become available.
Pneumonia vaccines: Bestmed identifies high-risk members, every year, who receive a
pneumonia letter to advise them that they are due for their pneumonia vaccination. Special
requests from doctors on behalf of members, to receive these vaccinations are evaluated and
clinically reviewed for authorisation.

Paediatric immunisations: Bestmed reimburses vaccines for children as listed on the
Department of Health vaccine schedule on all Bestmed options.
Back and neck preoperational assessment: Documented Based Care (DBC) for back and
neck rehabilitation is the Bestmed back and neck programme which is an active spine and
joint rehabilitation and treatment programme that has been developed in Finland over the
past 20 years.
The back and neck programme is completely evidence and outcomes based with a success rate
in excess of 85% after a six-week period of rehabilitation and treatment.
DBC principles applied are those of analysing, correcting and maintaining correct body posture
as well as stabilisation of the spine.
All members, except those on Pulse1, are eligible for this benefit. For a member to register on
the programme he/she needs to visit a DBC clinic and have an assessment done by the doctor
who will then motivate if the patient qualifies for this rehabilitation programme. The member
can thereafter send the application to Bestmed for authorisation. It includes twelve sessions
during a six-week period and an evaluation by a Documented Based Care (DBC) clinic.
Haemophilus influenzae Type B vaccine (HIB titre): This vaccine is administered in the
prevention of illnesses that are caused by this bacterium – most commonly bacteremia,
pneumonia, epiglottitis, bacterial meningitis..
Human papillomavirus vaccine (HPV): The HPV vaccination is administered to assist in the
prevention of cervical cancer and anal cancer. This benefit is available to all females between
nine and twenty-six years of age.
Female contraceptives: All females of child-bearing age qualify for female contraceptives to
the value of R1 550 per family per year.
Preventative dentistry: This benefit includes a general full-mouth examination by a general

dentist, full-mouth inter-oral radiographs, scaling and polishing, fissure sealing and space
maintainers for all members. General and option-specific exclusions may apply.
Mammogram: All females 40 years and older qualify for a mammogram. Please note that
protocols and general and option-specific exclusions may apply. Please refer to
www.bestmed.co.za for more details.
Pap smear: All females 18 years and older qualify for a pap smear. Please note that protocols
and general and option-specific exclusions may apply. Please refer to www.bestmed.co.za for
more details.
PSA screening: Prostate-specific antigen (PSA) blood test is a cancer screening test. Prostate-
specific antigen (PSA) is a substance made by cells in the prostate gland (both normal cells
and cancer cells). PSA is mostly found in semen, but a small amount is also found in the blood.
Most healthy men have levels under four nanograms per millilitre (ng/mL) of blood. All males
older than 50, qualify for a PSA test. Please note that protocols and general and option-specific
exclusions may apply. Please refer to www.bestmed.co.za for more details.
One dietician counselling session: One dietician counselling session per family per year is
covered by Bestmed. Please note that protocols and general and option-specific exclusions may
apply. Please refer to www.bestmed.co.za for more details.
Health Check: This programme is available to all Bestmed members, once a year, for free
biometric screenings.
These screenings consist of a detailed questionnaire that you may obtain from the Bestmed
website. Print the questionnaire and complete it. Upon completion please take it to a Dis-Chem,
Clicks, MediRite, ScriptSavers, or Van Heerden pharmacy to have your Health Check completed.
The following information will be obtained from you: your height and weight, while your blood
pressure and rapid cholesterol as well as glucose levels will be tested. Once finalised, please
send it back to Bestmed. Your results will be loaded onto the system and you will receive a
personal report about your health status.
For more information about the Health Check programme please send an e-mail to:
healthcheck@bestmed.co.za or send a fax to: 012 472 6787.

Maternity Care
With so many things to juggle, the Maternity Care programme is created to help moms and dads
through the entire pregnancy and the first two years with a new little one in the home – without
missing a beat. At Bestmed we want you to enjoy this entire experience.
Registering on this programme will give you the following support and benefits:
• A 24-hour professional medical advice line.
• 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 and discount vouchers for
various baby items. Mom can also expect a pregnancy health pack, via Fastmail, within the
first month of registration.
• In your second month after registration, we will send you a beautiful baby bag, to your door,
packed with products to use after baby’s birth. Moms-to-be can expect their bag to contain
wonderful products.
* Please note that you may only register on the Maternity Care programme after the 12th week of pregnancy.
Midwife-assisted
births are covered
at 100% of
Scheme tariff on
all options.
No folly in folic acid. Folic acid

should be taken regularly
by all pregnant moms and
people with a low immunity
to disease. Folic acid prevents
spina bifida in unborn babies
and can play a role in cancer
prevention. It is found in
green leafy vegetables, liver,
fruit and bran.

Beat
Beat
The Beat range offers
flexible hospital benefits
on all Beat options with
limited savings to pay for
out-of-hospital expenses
on some options such as
Beat2 and Beat3 but
extensive out-of-hospital
cover on Beat4. Beat1, 2 and 3 offer an
efficiency discount option
called Beat1 Network,
Beat2 Network and
Beat3 Network.
Method of Scheme benefit payment
Beat1 Beat2 Beat3 Beat4
In-hospital services are paid from In-hospital services are paid from In-hospital services are paid from In-hospital services are paid from
Scheme risk benefit and out-of- Scheme risk benefit and out-of- Scheme risk benefit. Some day-to-day Scheme risk benefit. Some out-
hospital services will be for the hospital services will be paid from the benefits are paid from the Scheme of-hospital services are paid from
member’s own account. Some savings account. Some preventative risk benefit and other services will the annual savings first and, once
Beat
preventative care services are care services are available from be paid from the savings account. depleted, will be paid from the
available from Scheme risk benefit. Scheme risk benefit. Some preventative care services are day-to-day benefit. Once the day-
available from Scheme risk benefit. to-day benefit is depleted, services
can be paid from the available vested
savings. Some preventative care
services are available from Scheme
risk benefit.
Beat Network Range

■■ For members on the Beat Network option, Bestmed offers members a choice of network hospitals for the in-hospital benefits.
■■ Should a member voluntarily choose not to make use of a hospital forming part of a hospital network for the Beat Network benefit option, a maximum
co-payment of R10 000 shall apply to the voluntary use of a non-designated service provider.
■■ Non-network option refers to the standard Beat benefit option. Network refers to the Beat Networks.
In-hospital benefits
Note: Benefits mentioned below are subject to pre-authorisation and clinical protocols.

Accommodation (hospital stay) 100% Scheme tariff. 100% Scheme tariff.
and theatre fees DSP specialist network applicable if the discounted network option is chosen.
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 100% Scheme tariff.
substance abuse Limited to 21 days or R24 000 per beneficiary. Subject to network facilities.
Consultations and procedures 100% Scheme tariff. 100% Scheme tariff.
DSP specialist network applicable if the discounted network option is chosen.
Surgical procedures and anaesthetics 100% Scheme tariff.
Organ transplants 100% Scheme tariff. (Only PMBs).
Major medical maxillo-facial surgery 100% Scheme tariff. 100% Scheme tariff. 100% Scheme tariff.
strictly related to certain conditions Limited to R9 600 Limited to R9 700 per family. Limited to R9 800
per family. per family.
Dental and oral surgery Limited to R5 000 per family. Limited to R6 000 Limited to R7 500
Cut out herbs before operations.

Some herbal supplements - from
the popular St John’s wort and
ginkgo biloba to garlic, ginger,
ginseng and feverfew - can cause
increased bleeding during surgery,
warn surgeons. It may be wise to
stop taking herbal supplements,
at least two weeks before surgery,
and inform your surgeon about
your herbal use. The Beat range
offers flexible
hospital benefits
with limited savings
to pay for out-of-
hospital expenses on
some options.

In-hospital benefits (continued)
Prosthesis (Subject to preferred 100% Scheme tariff. 100% Scheme tariff. Limited to R59 250 per family. 100% Scheme tariff.
provider, otherwise limits and co- Limited to R58 600 Limited to R72 300
payments apply) per family. per family.
Prosthesis – Internal Sub-limits per beneficiary: Sub-limits per beneficiary: Sub-limits per beneficiary:
Beat
■■ Functional limited to ■■ Functional limited to Functional limited to ■■ Functional limited to
Note: Sub-limit subject to R10 000 R10 000 R11 000 R12 000
the above prosthesis limit. ■■ Vascular R22 250 ■■ Vascular R22 450 ■■ Vascular R23 800
*Functional: Items utilised

■■ Pacemaker (dual ■■ Pacemaker (dual chamber) R30 500 ■■ Pacemaker (dual
towards treating or supporting chamber) R30 500 ■■ Endovascular - no benefit chamber) R39 900
a bodily function ■■ Endovascular - ■■ Spinal R22 450 ■■ Endovascular –
no benefit ■■ Artificial disk - no benefit no benefit
■■ Spinal R22 250 ■■ Drug-eluting stents - no benefit
■■ Spinal R23 800
■■ Artificial disk - ■■ Mesh R7 850
■■ Artificial disk -
no benefit no benefit
■■ Gynaecology/Urology R6 500
■■ Drug-eluting stents - ■■ Drug-eluting stents
■■ Lens implants R5 050 per lens
no benefit R13 400
■■ Mesh R7 850 ■■ Mesh R8 800
■■ Gynaecology/Urology ■■ Gynaecology/Urology
R6 400 R6 500
■■ Lens implants R4 950 ■■ Lens implants R5 050
per lens per lens
■■ Joint replacements:
−− Hip replacement and
other major joints

R24 500
−− Knee replacement
R32 550
−− Minor joints R10 000
Prosthesis – External Limited to R14 200 Limited to R14 300 per family. Limited to R17 400
Exclusions (Prosthesis Joint replacement surgery. Joint replacement surgery. (Except for PMBs). Not applicable.
sub-limit subject to preferred (Except for PMBs). PMBs PMBs subject to prosthesis limits:
provider, otherwise limits and subject to prosthesis limits: ■■ Hip replacement and other major joints
co-payments apply) ■■ Hip replacement and R23 690 R23 700
other major joints ■■ Knee replacement R29 250
R23 500 ■■ Minor joints R10 000
■■ Knee replacement
R28 950
■■ Minor joints R9 900
Orthopaedic and medical appliances 100% Scheme tariff.
Pathology 100% Scheme tariff.
Diagnostic imaging 100% Scheme tariff.
Specialised diagnostic imaging 100% Scheme tariff. Subject to co-payments 100% Scheme tariff.
Oncology Oncology programme. 100% Scheme tariff.
Peritoneal dialysis and 100% Scheme tariff.
haemodialysis
Confinements 100% Scheme tariff.
Refractive surgery 100% Scheme tariff. 100% Scheme tariff.
Subject to pre-authorisation and protocols. Limited to R6 500 per eye. Subject to pre-authorisation
and protocols. Limited to
R7 000 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 R2 400 on all endoscopic investigations Co-payment of Not applicable.
and specialised diagnostic imaging if done in private R2 400 on all endoscopic
hospital. Any other facility, no co-payment. investigations if done in
private hospital. Any other
facility, no co-payment.

Out-of-hospital benefits
Note: Benefits mentioned below may be subject to pre-authorisation and clinical protocols.
All payments are made at Scheme tariff.

Overall day-to-day limit Not applicable. M = R9 900, M1+ = R19 850.
Beat
GP and specialist consultations No benefit. Savings account. Savings first. Scheme tariffs
apply. Limited to M = R2 450,
M1+ = R4 350. (Subject to overall
day-to-day limit)
Basic and specialised dentistry No benefit. Basic: Preventative benefit or savings account. Savings first. Scheme tariffs
Specialised: Savings account. apply. Limited to M = R4 100,
Orthodontic: Subject to pre-authorisation. M1+ = R8 250. (Subject to overall
day-to-day limit) Orthodontics are
subject to pre-authorisation.
Medical aids, apparatus and No benefit. Savings account. Savings first. 100% Scheme
appliances including wheelchairs tariff. Limited to R8 500 per
and hearing aids family. (Subject to overall
day-to-day limit)
Supplementary services No benefit. Savings account. Savings first. Scheme tariffs
apply. Limited to M = R3 700,
day-to-day limit)
Wound care benefit (incl. Savings first. 100% Scheme tariff. Savings first. 100% Scheme
dressings and negative pressure Limited to R2 600 per family. (Subject to overall day-to-day limit) tariff. Limited to R3 700 per
wound therapy (NPWT) treatment family. (Subject to overall
and related nursing services - day-to-day limit)
out-of-hospital)
Optometry benefit No benefit. Savings account. ■■ Consultation R325 ■■ Consultation R325
(PPN capitation provider) ■■ Frame R550 ■■ Frame R500
−− Single-vision lenses −− Single-vision lenses
R150 OR R150 OR
−− Bifocal lenses −− Bifocal lenses R325 OR
R325 OR −− Multifocal lenses R600
−− Multifocal lenses R600 ■■ Contact lenses R1 210
■■ Contact lenses R1 000
Diagnostic imaging No benefit. Savings account. Savings first. Scheme tariffs
and pathology apply. Limited to M = R2 470,
day-to-day limit)
Specialised diagnostic imaging 100% Scheme tariff. Savings first. 100% Scheme 100% Scheme tariff.
Limited to R4 000 per family. tariff. Limited to R8 350 Limited to R12 550 per family.
per family.
Maternity benefits No benefit. Savings account. 100% Scheme tariff.

2 sonars and up to 12 antenatal consultations.
Rehabilitation services No benefit. Savings account. Vested savings.
after trauma

Medicine
Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, formularies, funding guidelines and the Mediscor Reference Price (MRP).
Approved CDL and non-CDL chronic medicine costs will pay from the non-CDL chronic medicine limit first. Once the limit is depleted, CDL chronic medicine will
continue to pay unlimited from Scheme risk.

CDL chronic medicine 100% Scheme tariff. Co-payment of 35% for non-formulary medicine. 100% Scheme tariff.
Beat
Co-payment of 30% for
non-formulary medicine.
Non-CDL chronic medicine No benefit. 5 conditions. 16 conditions.
85% Scheme tariff. Limited to 85% Scheme tariff. Limited to
M = R2 700, M1+ = R5 450. M = R7 400, M1+ = R14 750.
Co-payment of 35% for Co-payment of 30% for
non-formulary medicine. non-formulary medicine.
Biologicals and other No benefit.
high-cost medicine
Acute medicine No benefit. Savings account. Savings first. Limited to
M = R2 250, M1+ = R4 550.
(Subject to overall
day-to-day limit)
Over-the-counter (OTC) medicine No benefit. Savings account. Paid from savings.

Limited to R500.
Preventative care benefits


Preventative care ■■ Flu vaccines ■■ Flu vaccines ■■ Flu vaccines ■■ Flu vaccines
Health Check and ■■ Pneumonia vaccines ■■ Pneumonia vaccines ■■ Pneumonia vaccines ■■ Pneumonia vaccines
lifestyle screenings ■■ Paediatric immunisations ■■ Paediatric immunisations ■■ Paediatric immunisations ■■ Paediatric immunisations
■■ Female contraceptives - ■■ Female contraceptives - ■■ Female contraceptives - ■■ Female contraceptives -
Note: Refer to Scheme
R1 550 per family R1 550 per family R1 550 per family R1 550 per family
rules for funding
■■ DBC programme ■■ DBC programme ■■ DBC programme ■■ DBC programme
criteria applicable to
each preventative
■■ Health Check ■■ Preventative dentistry ■■ Preventative dentistry ■■ Preventative dentistry
care benefit. (Biometric screenings) (incl. gloves and sterile (incl. gloves and sterile (incl. gloves and sterile
■■ Pap smear – ages 18 and equipment) equipment) equipment)
above, every 24 months. ■■ Health Check ■■ Health Check ■■ Haemophilus influenzae
(Biometric screenings) (Biometric screenings) Type B vaccine (HIB)
■■ Pap smear – ages 18 and ■■ Pap smear – ages 18 and ■■ Mammogram
above, every 24 months. above, every 24 months. ■■ HPV vaccinations
■■ PSA Screening for ages
50 years and above, every
24 months.
■■ Health Check
(Biometric screenings)
■■ Pap smear – ages 18 and
above, every 24 months
■■ One dietician counselling
session per family.
Disclaimer on exclusions: General and option-specific exclusions apply. Please refer to www.bestmed.co.za for more details.

Chronic conditions list (CDL & non-CDL)
The Chronic Disease List (CDL) provides cover for the 27 listed chronic conditions for which medical schemes must cover the diagnosis, medical management and
medicines as published by the Council for Medical Schemes. Non-CDL chronic conditions are those additional conditions that Bestmed provides chronic medicine cover for.
Authorisation for CDL and non-CDL chronic medicines is subject to clinical funding guidelines and protocols, formularies and Designated Service Providers (DSPs) where
applicable. Below is the list of CDL and non-CDL conditions that Bestmed covers on the various benefit options.
Note: Benefits mentioned below are subject to pre-authorisation, clinical protocols, formularies, funding guidelines and the Mediscor Reference Price (MRP).

Beat
Reimbursement for CDL 100% Scheme tariff

Reimbursement for non-CDL No benefit 85% Scheme tariff
Non-formulary co-payment 35% 30%
No. of non-CDL conditions covered 0 5 16
CDL 1 Addison's disease
CDL 2 Asthma
CDL 3 Bipolar mood disorder
CDL 4 Bronchiectasis
CDL 5 Cardiomyopathy
CDL 6 Chronic renal failure
CDL 7 Chronic obstructive pulmonary disease (COPD)
CDL 8 Congestive heart failure
CDL 9 Coronary artery disease
CDL 10 Crohn's disease
CDL 11 Diabetes insipidus
CDL 12 Diabetes mellitus Type 1
CDL 14 Dysrhythmia
CDL 15 Epilepsy
CDL 16 Glaucoma
CDL 17 Haemophilia
CDL 18 HIV/AIDS
CDL 19 Hyperlipidaemia
CDL 20 Hypertension
CDL 21 Hypothyroidism
CDL 22 Multiple sclerosis
CDL 23 Parkinson's disease
CDL 24 Rheumatoid arthritis
CDL 25 Schizophrenia
CDL 26 Systemic lupus erythematosus (SLE)
CDL 27 Ulcerative colitis
non-CDL 1 Acne - severe
Attention deficit disorder/Attention deficit hyperactivity
non-CDL 2
disorder (ADD/ADHD)
non-CDL 3 Allergic rhinitis
non-CDL 4 Eczema
non-CDL 5 Migraine prophylaxis
non-CDL 6 Gout prophylaxis
non-CDL 7 Endometriosis
non-CDL 8 Major depression
non-CDL 9 Chronic anaemia
non-CDL 10 Polycystic ovarian disease
non-CDL 11 Graves’ disease
non-CDL 12 Obsessive compulsive disorder
non-CDL 13 Stroke
Paraplegia/Quadriplegia
non-CDL 14
(medication to treat)
non-CDL 15 Pulmonary embolism
non-CDL 16 Female menopause

Contributions
Non-Network (NN)/
NN N NN N NN N NN
Network (N)
Risk R1 144 R1 029 R1 174 R1 057 R1 782 R1 604 R2 688
PRINCIPAL MEMBER Savings R0 R0 R240 R216 R365 R328 R551
Beat
Total R1 144 R1 029 R1 414 R1 273 R2 147 R1 932 R3 239
Risk R888 R800 R912 R821 R1 266 R1 140 R2 220
ADULT DEPENDANT Savings R0 R0 R187 R168 R259 R233 R455
Total R888 R800 R1 099 R989 R1 525 R1 373 R2 675
Risk R481 R433 R495 R445 R688 R619 R665
CHILD DEPENDANT Savings R0 R0 R101 R91 R141 R127 R136
Total R481 R433 R596 R536 R829 R746 R801
Maximum contribution 4
child dependants*
Recognition of a child Under 21, unless a registered student.
dependant
* You only pay for a maximum of four children. All other children join as beneficiaries of the Scheme free of charge.
Abbreviations
CDL = Chronic Disease List; DBC = Documentation Based Care (back rehabilitation programme); DSP = Designated Service Provider;
GP = General Practitioner or Doctor; Health Check = Biometric Screenings; HIB = Haemophilus influenzae Type B vaccine; HPV = Human
Papilloma Virus; M = Member; M1+ = Member and family; MRP = Mediscor Reference Price; PMB = Prescribed Minimum Benefits;
PPN = Preferred Provider Negotiators; PSA = Prostate Specific Antigen.
For a more detailed overview of your benefit option and to receive a membership guide please contact service@bestmed.co.za
Disclaimer: All the 2016 product information appearing in this brochure is provided without a representation or warranty whatsoever, whether expressed
or implied and no liability pertaining thereto will attach to Bestmed Medical Scheme. All information regarding the 2016 benefit options and accompanying
services including information in respect of the terms and conditions or any other matters is subject to prior approval of the Council for Medical Schemes (CMS)
and may change without notice having due regard to the CMS’s further advices. Bestmed accepts no liability whatsoever for any loss whether direct, indirect or
consequential arising from information provided in this brochure or any actions and/or transactions resulting therefrom.
Please visit www.bestmed.co.za for the complete liability and responsibility disclaimer for Bestmed Medical Scheme as well as our terms and conditions.

At the beginning of 2015,
Bestmed launched its new App.
Today, we’ve just made it
App-iness. New app-reciably better! So, if you
haven’t already downloaded
and improved. the Bestmed App onto your
smartphone, there’s no better
time to do it than right now.
Here are seven reasons why:

• Even more user-friendly home screen, with more
functionalities, including a slide-out menu for ease
of reference.
• Receive your tax certificate straight to
your smartphone.
• Automatic updates on all communication
the Scheme sends to its Members.
• Quick information about your benefits, including
hospital, chronic and savings balance sent straight
to your phone.
• Submit your chronic medication application form
directly via the Bestmed App.
• Update your personal details directly from
your phone.
• Search for a service provider in your chosen area
of preference.
So don’t delay, download your new and improved

Bestmed App today.
For iPhone download the Bestmed App from the App Store
For Android get the App from the Play Store or Windows Store
www.bestmed.co.za
Better living. Better life.

© Bestmed Medical Scheme 2016
Bestmed Medical Scheme is a registered Medical Scheme (reg. no. 1252)
and an Authorised Financial Services Provider (FSP no. 44058).
Pace
Pace
The Pace range offers
more comprehensive
hospital benefits, Scheme
benefits and additional
savings benefits to cover
extensive out-of-hospital
expenses. The options in
this category are Pace1,
Pace2, Pace3 and Pace4.
Pace1 Pace2 Pace3 Pace4
In-hospital services are paid from Scheme risk benefit. Some out-of-hospital services are paid from the In-hospital services, out-of-hospital services and
annual savings first and once depleted will be paid from the day-to-day benefit. Once the day-to-day preventative care services are paid from Scheme
benefit is depleted, services can be paid from the available vested savings. Some preventative care risk benefit. Once out-of-hospital risk benefits are
services are available from Scheme risk benefit. depleted, further claims will be paid from savings.
All benefits below are subject to pre-authorisation and clinical protocols.

Accommodation (hospital stay) and
100% Scheme tariff.
theatre fees
Take-home medicine 100% Scheme tariff. Limited to 7 days’ medicine.
Treatment in mental health
100% Scheme tariff. Limited to 21 days per beneficiary.
clinics
Treatment of chemical and 100% Scheme tariff.
substance abuse Limited to 21 days or R24 000 per beneficiary. Subject to network facilities.
Consultations and procedures 100% Scheme tariff.
Surgical procedures and
100% Scheme tariff.
anaesthetics
Organ transplants 100% Scheme tariff. (Only PMBs)
Major medical maxillo-facial 100% Scheme tariff. 100% Scheme tariff.
surgery strictly related to certain Limited to R9 700
conditions per family.
Pace
Dental and oral surgery Limited to R6 000 Limited to R10 000 Limited to R12 500 Limited to R15 000
per family. per family. per family. per family.
Prosthesis (Subject to preferred 100% Scheme tariff. 100% Scheme tariff. 100% Scheme tariff. 100% Scheme tariff.
provider, otherwise limits and Limited to R70 650 Limited to R86 100 Limited to R86 500 Limited to R99 900
co-payments apply) per family. per family. per family. per family.
Prosthesis – Internal Sub-limits per beneficiary: Sub-limits per beneficiary: Sub-limits per beneficiary: Sub-limits per beneficiary:
■■ Functional limited to ■■ Functional limited to ■■ Functional limited to ■■ Functional limited to
Note: Sub-limit subject to R11 500 R12 500 R13 500 R14 000
the above prosthesis limit. ■■ Vascular R23 300 ■■ Vascular R30 800 ■■ Vascular R30 900 ■■ Vascular R35 350
■■ Pacemaker (dual ■■ Pacemaker (dual ■■ Pacemaker (dual ■■ Pacemaker (dual chamber)
chamber) R39 850 chamber) R44 400 chamber) R44 400 R44 400
towards treating or supporting
a bodily function
■■ Endovascular - no benefit ■■ Spinal R30 800 ■■ Spinal R30 900 ■■ Spinal R35 350
■■ Spinal R23 300 ■■ Artificial disk R13 500 ■■ Artificial disk R13 500 ■■ Artificial disk R15 850
■■ Artificial disk - no benefit ■■ Drug-eluting stents ■■ Drug-eluting stents ■■ Drug-eluting stents
■■ Drug-eluting stents - R13 500 R13 500 R15 850
no benefit ■■ Mesh R13 500 ■■ Mesh R13 500 ■■ Mesh R14 000
■■ Mesh R8 750 ■■ Gynaecology/Urology ■■ Gynaecology/Urology ■■ Gynaecology/Urology
■■ Gynaecology/Urology R10 100 R10 200 R11 550
R6 300 ■■ Lens implants R8 650 ■■ Lens implants R8 650 ■■ Lens implants R12 750
■■ Lens implants R4 850 per lens per lens per lens
per lens ■■ Joint replacements: ■■ Joint replacements: ■■ Joint replacements:
−− Hip replacement and −− Hip replacement and −− Hip replacement and
other major joints other major joints other major joints
R37 000 R37 100 R42 650
−− Knee replacement −− Knee replacement −− Knee replacement
R42 950 R43 150 R49 350

−− Minor joints R15 950 −− Minor joints R15 950 −− Minor joints R15 850

Smile Smile Smile:
There are
approximately 642
skeletal muscles. It
takes something like
43 muscles to frown
but only 17 muscles to
smile. You choose!
Don’t skip breakfast. Studies

show that eating a proper
breakfast is one of the most
positive things you can do if
you are trying to lose weight.
Breakfast skippers tend to gain
weight. A balanced breakfast
includes fresh fruit or fruit juice,
a high-fibre breakfast cereal, low-
fat milk or yoghurt, wholewheat
toast and a boiled egg.
Pace
Prosthesis – External Limited to R17 100 Limited to R20 290 Limited to R20 400 Limited to R23 050
per family. per family. per family. per family.
Exclusions (Prosthesis Joint replacement surgery Not applicable.
sub-limit subject to preferred (except for PMBs). PMBs
provider, otherwise limits and subject to prosthesis limits:
co-payments apply) ■■ Hip replacement and
other major joints R23 800
■■ Knee replacement R31 600
Orthopaedic and medical 100% Scheme tariff.
appliances
Specialised diagnostic imaging 100% Scheme tariff.
Peritoneal dialysis and 100% Scheme tariff.
haemodialysis
Refractive surgery 100% Scheme tariff. Limited to R7 000 per eye. 100% Scheme tariff. Limited to R7 500 per eye.
Co-payments Not applicable.

Benefits mentioned below may be subject to pre-authorisation and clinical protocols.

Overall day-to-day limit M = R8 450, M = R11 740, M = R15 000, M = R28 000,
M1+ = R16 790. M1+ = R24 100. M1+ = R31 000. M1+ = R45 100.
GP and specialist Savings first. Savings first. Savings first. Limited to M = R4 200,
consultations Limited to M = R1 650, Limited to M = R3 300, 100% Scheme tariff. M1+ = R6 800. (Subject to
M1+ = R3 400. (Subject to M1+ = R6 600. (Subject to M = R2 700, M1+ = R7 950. overall day-to-day limit)
overall day-to-day limit) overall day-to-day limit) (Subject to overall day-to-
day limit)
Basic and specialised Savings first. Savings first. Savings first. Limited to M = R9 050,
dentistry Basic: Preventative benefit or Basic: Preventative benefit or Basic: Preventative benefit or M1+ = R15 350. (Subject to
savings account. savings account. savings account. overall day-to-day limit)
Limit once savings exceeded. Limit once savings exceeded. Limit once savings exceeded.
Specialised: Savings account Specialised: Savings account Specialised: Savings account
then limit. then limit. then limit.
Orthodontic: Subject to Orthodontic: Subject to Orthodontic: Subject to
pre-authorisation. pre-authorisation. pre-authorisation.
Limited to M = R3 000, Limited to M = R5 050, 100% Scheme tariff. Limited
M1+ = R6 100. (Subject to M1+ = R10 100. (Subject to to M = R5 450, M1+ = R9 350.
overall day-to-day limit) overall day-to-day limit) (Subject to overall day-to-
day limit)
Medical aids, apparatus Savings first. 100% Scheme Savings first. 100% Scheme Savings first. 100% Scheme 100% Scheme tariff. Limited
and appliances tariff. Limited to R8 550 per tariff. Limited to R7 750 per tariff. Limited to R7 750 per to R7 750 per family. (Subject
including wheelchairs family. (Subject to overall day- family. (Subject to overall day- family. (Subject to overall day- to overall day-to-day limit).
and hearing aids to-day limit) to-day limit). to-day limit).
Limit on wheelchairs of
Limit on wheelchairs of Limit on wheelchairs of R10 500 per family per
R10 500 per family per R10 500 per family per 48 months.
48 months. 48 months.
Limit on hearing aids of
Pace
Limit on hearing aids of R21 Limit on hearing aids of R24 R26 800 per beneficiary per
400 per beneficiary per 24 100 per beneficiary per 24 24 months.
months. months.
Supplementary services Savings first. Savings first. Savings first. Limited to M = R4 200,
Limited to M = R3 300, Limited to M = R4 100, Limited to M = R1 150, M1+ = R8 250. (Subject to
M1+ = R6 800. (Subject to M1+ = R8 250. (Subject to M1+ = R2 250. (Subject to overall day-to-day limit)
overall day-to-day limit) overall day-to-day limit) overall day-to-day limit)
Wound care benefit (incl. Savings first. 100% Scheme Savings first. 100% Scheme Savings first. 100% Scheme Limited to R10 300 per
dressings and negative tariff. Limited to R2 700 per tariff. Limited to R5 150 per tariff. Limited to R7 950 per family. (Subject to overall
pressure wound therapy family. (Subject to overall family. (Subject to overall family. (Subject to overall day-to-day limit)
(NPWT) treatment and day-to-day limit) day-to-day limit) day-to-day limit)
related nursing services
- out-of-hospital)
Optometry benefit ■■ Consultation R325 ■■ Consultation R325 ■■ Consultation R325 ■■ Consultation R325
(PPN capitation provider) ■■ Frame R550 AND ■■ Frame R550 AND ■■ Frame R550 AND ■■ Frame R1 050 AND
−− Single vision lenses −− Single vision lenses −− Single vision lenses −− Single vision lenses
R150 OR R150 OR R150 OR R150 OR

−− Bifocal lenses R325 OR −− Bifocal lenses R325 OR −− Bifocal lenses R325 OR −− Bifocal lenses R325 OR
−− Multifocal lenses R600 −− Multifocal lenses R600 −− Multifocal lenses R600 −− Multifocal lenses R600
■■ Contact lenses R1 000 ■■ Contact lenses R1 210 ■■ Contact lenses R1 400 ■■ Contact lenses R1 710
Diagnostic imaging Savings first. 100% Scheme Savings first. 100% Scheme Savings first. 100% Scheme 100% Scheme tariff. Limited
and pathology tariff. Limited to M = R2 450, tariff. Limited to M = R2 450, tariff. Limited to M = R2 700, to M = R4 200, M1+ = R8 250.
M1+ = R4 850. (Subject to M1+ = R4 950. (Subject to M1+ = R5 250. (Subject to (Subject to overall day-to-
overall day-to-day limit) overall day-to-day limit) overall day-to-day limit) day limit)
Maternity benefits 100% Scheme tariff. 2 sonars and up to 12 antenatal consultations.
Specialised diagnostic 100% Scheme tariff. MRI/CT scans: Maximum of three scans per beneficiary.
imaging Limited to R10 900 per family. PET scan: One scan per beneficiary. 100% Scheme tariff.
Rehabilitation services Vested savings. 100% Scheme tariff.
after trauma

Medicine
Approved CDL and non-CDL chronic medicine costs will pay from the non-CDL chronic medicine limit first. Once the limit is depleted, CDL chronic medicine will
continue to pay unlimited from Scheme risk.

CDL chronic medicine 100% Scheme tariff. 100% Scheme tariff. 100% Scheme tariff. 100% Scheme tariff.
Co-payment of 35% for Co-payment of 30% for Co-payment of 25% for Co-payment of 20% for
non-formulary medicine. non-formulary medicine. non-formulary medicine. non-formulary medicine.
Non-CDL chronic 10 conditions. 31 conditions. 31 conditions. 45 conditions.
medicine 85% Scheme tariff. 85% Scheme tariff. 85% Scheme tariff. 85% Scheme tariff.
Limited to M = R6 500, Limited to M = R8 950, Limited to M = R14 400, Limited to M = R19 450,
M1+ = R13 080. M1+ = R17 900. M1+ = R28 750. M1+ = R38 950.
Co-payment of 35% for Co-payment of 30% for Co-payment of 25% for Co-payment of 20% for
non-formulary medicine. non-formulary medicine. non-formulary medicine. non-formulary medicine.
Biologicals and other No benefit. Limited to R123 500 Limited to R247 000 Limited to R365 450
high-cost medicine per beneficiary. per beneficiary. per beneficiary.
Acute medicine Savings first. Savings first. Savings first. Limited to M = R6 600,
Limited to M = R1 850, Limited to M = R3 800, Limited to M = R990, M1+ = R10 300. Subject
M1+ = R3 800. (Subject to M1+ = R7 600. (Subject to M1+ = R2 600. (Subject to to MRP (10% co-payment)
overall day-to-day limit) overall day-to-day limit) overall day-to-day limit) (Subject to day- to-day
overall limit)
Over-the-counter Paid from savings. Limited to R500. Savings account.
(OTC) medicine

Pace
Preventative care ■■ Flu vaccines ■■ Flu vaccines ■■ Flu vaccines
Health Check and ■■ Pneumonia vaccines ■■ Pneumonia vaccines ■■ Pneumonia vaccines
lifestyle screenings ■■ Paediatric immunisations ■■ Paediatric immunisations ■■ Paediatric immunisations
■■ Female contraceptives – ■■ Female contraceptives – ■■ Female contraceptives – R1 550 per family
Note: Refer to Scheme R1 550 per family R1 550 per family ■■ DBC programme
rules for funding ■■ DBC programme ■■ DBC programme ■■ Preventative dentistry (incl. gloves and sterile equipment)
criteria applicable to ■■ Preventative dentistry ■■ Preventative dentistry ■■ Haemophilus influenzae Type B vaccine (HIB)
each preventative (incl. gloves and sterile (incl. gloves and sterile ■■ Mammogram
care benefit. equipment) equipment) ■■ PSA screening - ages 50 and above, every 24 months
■■ Haemophilus influenzae ■■ Haemophilus influenzae ■■ HPV vaccines
Type B vaccine (HIB) Type B vaccine (HIB) ■■ Bone densitometry
■■ Mammogram ■■ Mammogram ■■ Health Check (Biometric screenings)
■■ HPV vaccines ■■ PSA screening – ages ■■ Pap smear – ages 18 and above, every 24 months
■■ Health Check 50 and above, every 24 ■■ One dietician counselling session per family.
(Biometric screenings) months
■■ Pap smear – age 18 and ■■ HPV vaccines
above, every 24 months. ■■ Health Check
(Biometric screenings)
■■ Pap smear – age 18 and
above, every 24 months
■■ One dietician counselling
session per family.
Disclaimer on exclusions: General and option specific exclusions apply. Please refer to www.bestmed.co.za for more details.

Chronic conditions list (CDL)
medicines as published by the Council for Medical Schemes. Non-CDL chronic conditions are those additional conditions that Bestmed provides chronic medicine
cover for. Authorisation for CDL and non-CDL chronic medicines is subject to clinical funding guidelines and protocols, formularies and Designated Service Providers
(DSPs) where applicable.
Below is the list of CDL and non-CDL conditions that Bestmed covers on the various benefit options.

Reimbursement for CDL 100% Scheme tariff
Reimbursement for non-CDL 85% Scheme tariff
Non-formulary co-payment 35% 30% 25% 20%
No. of non-CDL conditions covered 10 31 45
CDL 2 Asthma
CDL 3 Bipolar mood disorder
CDL 4 Bronchiectasis
CDL 5 Cardiomyopathy
CDL 6 Chronic renal failure
CDL 11 Diabetes insipidus
CDL 14 Dysrhythmia
CDL 15 Epilepsy
Pace
CDL 16 Glaucoma
CDL 17 Haemophilia
CDL 18 HIV/AIDS
CDL 20 Hypertension
You can save

money by obtaining
pre-authorisation
for planned, in-
hospital medical
procedures in
advance.
Cool off without a beer.

Don’t eat carbohydrates
for at least an hour
after exercise. This will
force your body to break
down body fat, rather
than using the food you
ingest. Stick to fruit and
fluids during that hour,
but avoid beer.

Chronic conditions 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
non-CDL 5 Migraine prophylaxis
non-CDL 8 Major depression
non-CDL 9 Chronic anaemia
non-CDL 10 Polycystic ovarian disease
non-CDL 11 Graves’ disease
non-CDL 12 Obsessive compulsive disorder
non-CDL 13 Stroke
non-CDL 14 Paraplegia/Quadriplegia (medication to treat)
non-CDL 17 Benign prostatic hypertrophy
non-CDL 18 Osteoporosis
non-CDL 19 Psoriasis
non-CDL 20 Urinary incontinence
non-CDL 21 Paget’s disease
non-CDL 22 Gastro oesophageal reflux disease (GORD)
Pace
non-CDL 23 Ankylosing spondylitis
non-CDL 24 Hypophyseal adenoma
non-CDL 25 Osteoarthritis
non-CDL 26 Alzheimer’s disease
non-CDL 27 Aplastic anaemia
non-CDL 28 Collagen diseases
non-CDL 29 Cushing’s syndrome
non-CDL 30 Cystic fibrosis
non-CDL 31 Dermatomyositis
non-CDL 32 Fibrosing alveolitis
non-CDL 33 Hyperthyroidism
non-CDL 34 Hypopituitarism
non-CDL 35 Idiopathic thrombocytopenic pupura
non-CDL 36 Motor neuron disease
Muscular dystrophy and

non-CDL 37
inherited myopathies
non-CDL 38 Neuropathy
non-CDL 39 Myasthenia gravis
non-CDL 40 Polyarteritis nodosa
non-CDL 41 Pulmonary interstitial fibrosis
non-CDL 42 Scleroderma
non-CDL 43 Sjögren’s disease
non-CDL 44 Trigeminal neuralgia
non-CDL 45 Psoriatic arthritis

Contributions
Income level N/A < R98 500 p.a. > R98 501 p.a. N/A
Risk R2 209 R3 281 R3 239 R3 890 R5 263
PRINCIPAL MEMBER Savings R552 R579 R571 R687 R163
Total R2 761 R3 860 R3 810 R4 577 R5 426
Risk R1 550 R3 216 R2 591 R3 103 R5 263
ADULT DEPENDANT Savings R388 R568 R457 R548 R163
Total R1 938 R3 784 R3 048 R3 651 R5 426
Risk R558 R723 R601 R651 R1 233
CHILD DEPENDANT Savings R139 R128 R106 R115 R38
Total R697 R851 R707 R766 R1 271
Maximum contribution 4
child dependant*
Recognition of a child Under 21, unless a registered student.
dependant
*You only pay for a maximum of four children. All other children join as beneficiaries of the Scheme free of charge.
Abbreviations
DBC = Documentation Based Care (Back Rehabilitation Programme); DSP = Designated Service Provider; GP = General Practitioner or
Doctor; Health Check = Biometric Screenings; HIB = Haemophilus influenzae Type B vaccine; HPV = Human Papilloma Virus; M = Member;
M1+ = Member and family; MRI/CT scans = Magnetic Resonance Imaging/Computed Tomography scans; MRP = Mediscor Reference Price;
NP = Network Provider; PET scan = Positron Emission Tomography scan; PMB = Prescribed Minimum Benefits; PPN = Preferred Provider
Negotiators; PSA = Prostate Specific Antigen.
Pace
Curry favour. Hot, spicy foods

containing chillies or cayenne
pepper trigger endorphins,
the feel-good hormones.
Endorphins have a powerful,
almost narcotic, effect and
make you feel good after
exercising. But go easy on the
lamb, pork and mutton and the
high-fat, creamy dishes served
in many Indian restaurants.
Brush up on hygiene. Many people don’t

know how to brush their teeth properly.
Improper brushing can cause as much
damage to the teeth and gums as not
brushing at all. Lots of people don’t
brush for long enough, don’t floss and
don’t see a dentist regularly. Hold your
toothbrush in the same way that you
would hold a pencil, and brush for at
least two minutes. This includes brushing
the teeth, the junction of the teeth
and gums, the tongue and the roof of
the mouth. And you don’t need a fancy,
angled toothbrush – just a sturdy, soft-
bristled one that you replace each month.

Pulse
The Pulse range offers

full hospital benefits and
out-of-hospital benefits
which are both provided
by designated network
providers only. The
options in this category
are Pulse1 and Pulse2.
Pulse
Pulse1 Pulse2
In-hospital services are paid from Scheme risk benefit. The designated In-hospital services are paid from Scheme risk benefit. The designated
network provider, CareCross, covers most out-of-hospital services. network provider, OneCare, covers most out-of-hospital services.
Some preventative care services are available from Scheme risk benefit. Some day-to-day services and preventative care services are available from
Scheme risk benefit.
All benefits below are subject to pre-authorisation and clinical protocols and designated hospital networks.
Co-payments up to a maximum of R10 000 per event for voluntary use of a non-DSP hospital will be charged.
Pulse1 Pulse2
Accommodation (hospital stay) and theatre fees 100% Scheme tariff at a Netcare DSP hospital.
Take-home medicine 100% Scheme tariff. Limited to 3 days’ 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). 100% Scheme tariff.
Limited to 21 days or R24 000 per beneficiary.
Subject to network facilities.
Consultations and procedures 100% Scheme tariff.
Surgical procedures and anaesthetics 100% Scheme tariff. 100% Scheme tariff.
Excluded from benefits: functional nasal surgery,
surgery for medical conditions e.g. Epilepsy,
Parkinson’s disease etc., and procedures where
stimulators are used.
Organ transplants 100% Scheme tariff. (Only PMBs)
Major medical maxillo-facial surgery strictly No benefit. 100% Scheme tariff.
related to certain conditions
Dental and oral surgery No benefit. 100% Scheme tariff.
Prosthesis (Subject to preferred provider, 100% Scheme tariff. 100% Scheme tariff.
otherwise limits and co-payments apply) Limited to R39 450 per family. Limited to R79 000 per family.
Prosthesis – Internal Sub-limits per beneficiary: Sub-limits per beneficiary:
■■ Functional R8 000 ■■ Functional R12 500
Note: Sub-limit subject to the ■■ Vascular R18 650 ■■ Vascular R29 150
above prosthesis limit ■■ Pacemaker (dual chamber) R30 500 ■■ Pacemaker (dual chamber) R39 450
■■ Endovascular - no benefit ■■ Spinal R29 150
towards treating or supporting
■■ Spinal R18 650 ■■ Artificial disk R12 800
a bodily function ■■ Artificial disk - no benefit ■■ Drug-eluting stents R12 800
■■ Drug-eluting stents - no benefit ■■ Mesh R12 800
■■ Mesh R6 800 ■■ Gynaecology/Urology R9 500
■■ Gynaecology/Urology R5 650 ■■ Lens implants R8 150 per lens
■■ Lens implants R3 900 per lens ■■ Joint replacements:
−− Hip replacement and other major joints R34 800
−− Knee replacement R40 700
−− Minor joints R15 150
Prosthesis – External No benefit. Limited to R19 150 per family.

Exclusions (Prosthesis sub-limit subject to Joint replacement surgery (except for PMBs). Not applicable.
preferred provider, otherwise limits and PMBs subject to prosthesis limits:
co-payments apply) ■■ Hip replacement and other major joints R19 150
■■ Knee replacement R24 200
Pulse
Orthopaedic and medical appliances 100% Scheme tariff. Limited to R4 850 per family. 100% Scheme tariff.
Specialised diagnostic imaging 100% Scheme tariff.
Oncology DSP: State Facilities. Oncology programme. 100% Scheme tariff.
Oncology programme. 100% Scheme tariff.
Peritoneal dialysis and haemodialysis 100% Scheme tariff. National Renal Care. (NRC)
Refractive surgery No benefit. 100% Scheme tariff. Limited to R7 000 per eye.

Pulse1 Pulse2
Co-payments Co-payment where procedure has been clinically Co-payment of up to R10 000 per event for voluntary
approved: use of a non-DSP hospital.
■■ R2 800 on all laparoscopic procedures,
■■ R2 800 on prostate procedures,
■■ R2 800 on procedures for prolapse/incontinence,
■■ R2 800 on arthroscopy other than acute trauma,
■■ R2 800 on endoscopy investigations done
primarily in hospital,
■■ Co-payment of up to R10 000 per event for
voluntary use of a non-DSP hospital.
Note: Granting of benefits under the primary care services and the Scheme benefits shall be subject to treatment protocols, preferred providers, DSPs, dental
procedure codes, pathology and radiology lists of codes and medicine formularies as accepted by the Scheme.
Pulse1 Pulse2
Overall day-to-day limit N/A M = R11 350, M1+ = R22 550.
GP consultations Subject to CareCross Provider Network. Unlimited GP Subject to OneCare Provider Network. Unlimited GP
visits. Member must pay for services up-front and visits. Two out-of-network GP visits per family limited to
claim back from available out-of-network benefit. R1 150 as approved by NP.
Specialist consultations Out-of-network visits with a GP limited to Specialist consultations must be referred and approved
R1 050 per family per year. by NP. Specialist limited to M = R2 250, M1+ = R4 550.
Three specialist visits per family limited to (Subject to overall day-to-day limit)
R1 050 per visit. (Bestmed approval and tariff),
pre-authorisation and referral by NP required.
Basic and specialised dentistry Basic dentistry: Subject to Provider Network. Basic: According to NP tariff list. 100% Scheme tariff.
Specialised dentistry: No benefit. (Subject to overall day-to-day limit).
Specialised: 100% Scheme tariff, subject to
pre-authorisation and day-to-day limit.
Limited to M = R5 450, M1+ = R6 900.
Medical aids, apparatus and appliances No benefit. Limited to R7 700 per family. Limit on wheelchairs of
including wheelchairs and hearing aids R9 900 per family, per 48 months. Limit on hearing aids
of R21 400 per beneficiary per 24 months.
Supplementary services No benefit. Limited to M = R3 200, M1+ = R6 300.
(Subject to overall day-to-day limit)
Wound care benefit (incl. dressings No benefit. Limited to R7 400 per family.
and negative pressure wound therapy
(NPWT) treatment and related nursing
services - out-of-hospital)
Optometry benefits Subject to Provider Network. Protocols apply. Subject to Optical Management programme.
(frames and lenses) Limited to M = R3 200, M1+ = R4 950.
(Subject to overall day-to-day limit)
Maternity benefits Subject to Provider Network. Protocols apply. 2 sonars and up to 12 antenatal consultations.
Diagnostic imaging and Subject to Provider Network. Subject to NP protocols and tariff list.
pathology Protocols and tariff list apply. (Subject to overall day-to-day limit).
Referal by NP required. Referal by NP required.
Pulse
Specialised diagnostic imaging No benefit. Subject to pre-authorisation.

MRI/ CT scans: A maximum of 3 scans per beneficiary.
PET scans: 1 scan per beneficiary.
Oncology DSP: State Facilities. Oncology programme. 100% Scheme tariff.
Oncology programme. 100% Scheme tariff.
Rehabilitation services after trauma No benefit.

Medicine
Note: Benefits mentioned below may be subject to pre-authorisation, formularies, funding guidelines and MRP/MMAP. DSPs may apply.
Approved CDL and non-CDL chronic medicine costs will pay from the non-CDL chronic medicine limit first. Once the limit is depleted,
CDL chronic medicine will continue to pay unlimited.
Pulse1 Pulse2
CDL chronic medicine Unlimited. Subject to Provider Network Formulary and Unlimited. Subject to Provider Network Formulary and
reference price. 100% Scheme tariff. 35% co-payment on reference price. 100% Scheme tariff.
non-formulary medicine prescribed by a specialist. 25% co-payment on non-formulary medicine.
Non-CDL chronic medicine No benefit. 25 conditions. 100% Scheme tariff if prescribed by a NP.
Limited to M = R6 800, M1+ = R13 500.
Co-payment of 25% for non-formulary medicine.
Biologicals and other No benefit. Limited to R116 200 per beneficiary.
high-cost medicine
Acute medicine Subject to Provider Network Formulary and reference price. Subject to Provider Network Formulary and reference price.
100% Scheme tariff. Limited to M = R3 600, M1+ = R7 200. 100% Scheme
tariff. (Subject to overall day-to-day limit)
Over-the-counter (OTC) medicine Can be obtained from preferred provider pharmacy Limited to R1 150 per family subject to acute
subject to CareCross OTC formulary. medicine formulary and reference price.
This benefit is limited to 3 events per beneficiary or a (Subject to overall day-to-day and acute medicine limit)
maximum of 5 events per family per year.
We perceive trust
as a fundamental
requirement of life
which originates
from a commitment
to approach all
relationships with
honesty and integrity.
Additional Scheme
benefits on the
Pulse options
include international
travel cover and
preventative care.

Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, formularies, funding guidelines and MRP/MMAP. DSPs may apply.
Pulse
Pulse1 Pulse2
Preventative care ■■ Flu vaccines ■■ Flu vaccines
Health Check and ■■ Pneumonia vaccines ■■ Pneumonia vaccines
lifestyle screenings ■■ Paediatric immunisations ■■ Paediatric immunisations
■■ Health Check (Biometric screenings) ■■ DBC programme
Note: Refer to Scheme rules for ■■ Health Check (Biometric screenings)
funding criteria applicable to each ■■ Female contraceptives R1 550 per family
preventative care benefit.
Disclaimer on exclusions: General and option specific exclusions apply. Please refer to www.bestmed.co.za for more details.

Chronic conditions list (CDL & non-CDL)
medicines as published by the Council for Medical Schemes. Non-CDL chronic conditions are those additional conditions that Bestmed provides chronic medicine
cover for. Authorisation for CDL and non-CDL chronic medicines is subject to clinical funding guidelines and protocols, formularies and Designated Service Providers
(DSPs) where applicable.
Below is the list of CDL and non-CDL conditions that Bestmed covers on the various benefit options.
Note: Benefits mentioned below are subject to pre-authorisation, formularies, funding guidelines and MRP/MMAP. DSPs may apply.
Pulse1 Pulse2 Pulse1 Pulse2

Reimbursement non-CDL 1 Acne - severe
100% Scheme tariff
for CDL Attention deficit disorder/
Reimbursement Attention deficit
No benefit 100% Scheme tariff non-CDL 2
for non-CDL hyperactivity disorder
(ADD/ADHD)
35% for non-formulary
Non-formulary non-CDL 3 Allergic rhinitis
medicines prescribed by 25%
co-payment
a specialist non-CDL 4 Eczema
No. of non-CDL non-CDL 5 Migraine prophylaxis
No benefit 25
conditions covered
CDL 2 Asthma non-CDL 8 Major depression
CDL 3 Bipolar mood disorder non-CDL 9 Chronic anaemia
CDL 4 Bronchiectasis Polycystic ovarian
non-CDL 10
CDL 5 Cardiomyopathy disease
CDL 6 Chronic renal failure Obsessive compulsive

non-CDL 11
disorder
non-CDL 12 Stroke
Benign prostatic
non-CDL 15
CDL 11 Diabetes insipidus hypertrophy
CDL 12 Diabetes mellitus Type 1 non-CDL 16 Osteoporosis
CDL 13 Diabetes mellitus Type 2 non-CDL 17 Psoriasis
CDL 14 Dysrhythmia non-CDL 18 Urinary incontinence
CDL 15 Epilepsy non-CDL 19 Paget’s disease
CDL 16 Glaucoma Gastro oesophageal

non-CDL 20
reflux disease (GORD)
CDL 17 Haemophilia
non-CDL 21 Hypophyseal adenoma
CDL 18 HIV/AIDS
non-CDL 22 Osteoarthritis
non-CDL 23 Alzheimer's disease
CDL 20 Hypertension
non-CDL 24 Aplastic anaemia
non-CDL 25 Neuropathy

Pulse
With us you get

the best when
it comes to
accessing quality
healthcare.

Contributions
Pulse1 Pulse2
Income level R0 – R6 000 p.m. R6 001 – R10 000 p.m. > R10 001 p.m. N/A
Risk R1 131 R1 357 R1 630 R3 902
PRINCIPAL MEMBER Savings R0 R0 R0 R0
Total R1 131 R1 357 R1 630 R3 902
Risk R1 075 R1 290 R1466 R3 902
ADULT DEPENDANT Savings R0 R0 R0 R0
Total R1 075 R1 290 R1 466 R3 902
Risk R679 R814 R814 R927
CHILD DEPENDANT Savings R0 R0 R0 R0
Total R679 R814 R814 R927
Maximum contribution Not applicable. 4
child dependant*
Recognition of a child Not applicable. Under 21, unless a registered student.
dependant
*You only pay for a maximum of four children. All other children join as beneficiaries on the Scheme free of charge. This is not
applicable to Pulse1.
Abbreviations
DBC = Documentation Based Care (Back Rehabilitation Programme); DSP = Designated Service Provider; GP = General Practitioner or
Doctor; Health Check = Biometric Screenings; M = Member; M1+ = Member and family; MMAP = Maximum Medical Aid Price;
MRI/CT scans = Magnetic Resonance Imaging/Computed Tomography scans; MRP = Mediscor Reference Price; NP = Network Provider;
PET scan = Positron Emission Tomography scan; PMB = Prescribed Minimum Benefits; PSA = Prostate Specific Antigen.
Pulse

Notes

General contact details
086 000 2378
service@bestmed.co.za
012 472 6500
www.bestmed.co.za
@BestmedSocial
www.facebook.com/
BestmedMedicalScheme
WALK-IN FACILITY BESTMED HOTLINE, OPERATED BY KPMG

Should you be aware of any fraudulent, corrupt or unethical
Block A, Glenfield Office Park
practices involving Bestmed, members, service providers or
361 Oberon Avenue
employees, please report this anonymously to KPMG.
Faerie Glen, Pretoria, 0081, South Africa
POSTAL ADDRESS Hotline: 080 111 0210 toll-free from any Telkom line
Hotfax: 080 020 0796
P. O. Box 2297, Arcadia, Pretoria, 0001, South Africa Hotmail: fraud@kpmg.co.za
ER24 AND INTERNATIONAL TRAVEL COVER Postal: KPMG Hotpost at BNT 371
P. O. Box 14671, Sinoville, 0129, South Africa
Tel: 084 124
CARECROSS HEALTH (PULSE OPTIONS ONLY)
HOSPITAL AUTHORISATION
Tel: 021 673 1848
Tel: 080 022 0106 Website: www.carecross.co.za
E-mail: authorisations@bestmed.co.za Fax: 021 413 1805
CHRONIC MEDICINE (BEAT AND PACE OPTIONS) CARECROSS CHRONIC MEDICINE (PULSE OPTIONS ONLY)
Tel: 086 000 2378 Tel: 086 010 2182
E-mail: medicine@bestmed.co.za E-mail: chronic@carecross.co.za
Fax: 012 472 6760 Fax: 021 673 1815
CLAIMS CARECROSS BENEFIT CLAIMS (PULSE OPTIONS ONLY)

Tel: 086 000 2378 Tel: 086 010 3491
E-mail: service@bestmed.co.za (queries) E-mail: bestmed@carecross.co.za
claims@bestmed.co.za (claim submissions)
MATERNITY CARE
SOCIAL MEDIA
Tel: 086 111 1936
Website: www.bestmed.co.za E-mail: info@babyhealth.co.za
Facebook: www.facebook.com/BestmedMedicalScheme
Twitter: @BestmedSocial
This guide was printed in September 2015. For the most recent version of this guide,
please visit our website at www.bestmed.co.za
© Bestmed Medical Scheme 2016
Bestmed Medical Scheme is a registered Medical Scheme (reg. no. 1252) and an Authorised Financial Services Provider (FSP no. 44058).
705485 Bestmed Comparative Guide 21/09/2015

Comparative Guide 2016: Better Living. Better Life

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Comparative

Better living. Better life.

Why choose Bestmed?

The right fit

Be Safe: Make responsible lifestyle choices to prevent adverse consequences.

Be Nutri-wise: Balanced nutrition is important to maintain a healthy body and mind.

The corporate partnership

2 Bestmed Comparative Guide 2016

Don’t worry, be appy!

Bestmed Provider Network

Member advantages of using Bestmed Provider Networks

• Quality of healthcare services are enhanced.

• Downstream costs are better managed.

• Providers are paid directly and on a weekly basis by the Scheme.

• No or minimum co-payments by the members depending on benefits available.

• A longer lasting medical savings account.

• A dedicated provider consultant service is available to the Network Providers.

How do I access the detail and location of a network healthcare

Bestmed Comparative Guide 2016 3

Audiologists and speech therapists

Stents and pacemakers

Drug and alcohol rehabilitation

Did you know that

Simply ask your

Bestmed can negotiate

4 Bestmed Comparative Guide 2016

Bestmed provides oncology benefits applying evidence-based medicine principles and

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition

Bestmed Comparative Guide 2016 5

Alcohol and Substance Abuse Care

• Free deliveries will be done free of charge.

6 Bestmed Comparative Guide 2016

Preventative dentistry: This benefit includes a general full-mouth examination by a general

Bestmed Comparative Guide 2016 7

• A 24-hour professional medical advice line.

No folly in folic acid. Folic acid

8 Bestmed Comparative Guide 2016

Beat Network Range

Beat1 Beat2 Beat3 Beat4

Cut out herbs before operations.

10 Bestmed Comparative Guide 2016

*Functional: Items utilised

other major joints

Bestmed Comparative Guide 2016 11

Beat1 Beat2 Beat3 Beat4

Maternity benefits No benefit. Savings account. 100% Scheme tariff.

12 Bestmed Comparative Guide 2016

Beat1 Beat2 Beat3 Beat4

Over-the-counter (OTC) medicine No benefit. Savings account. Paid from savings.

Preventative care benefits

Beat1 Beat2 Beat3 Beat4

Bestmed Comparative Guide 2016 13

Beat1 Beat2 Beat3 Beat4

Reimbursement for CDL 100% Scheme tariff

non-CDL 16 Female menopause

14 Bestmed Comparative Guide 2016

Bestmed Comparative Guide 2016 15

Here are seven reasons why:

So don’t delay, download your new and improved

Better living. Better life.

Pace1 Pace2 Pace3 Pace4

R42 950 R43 150 R49 350

18 Bestmed Comparative Guide 2016