Comparative Guide 2020 - Classique Medical Aid ...

 
Comparative Guide 2020 - Classique Medical Aid ...
Comparative
Guide
2020
Comparative Guide 2020 - Classique Medical Aid ...
5 017
                                         When life happens…
                                                                                                                    MEMBERS ON
                                                                                                                    THE BESTMED
                                                                                                                    ONCOLOGY
                                         We are here to assist you!                                                 PROGRAMME
    Contents
                                                                                                   REGISTERED
                                                                                                   MOMS ON
                                                                                                                      6 372
                                                                                BESTMED            THE BESTMED
                                                                                BABIES BORN        MATERNITY           MEMBERS REGISTERED ON
                                                                                                   PROGRAMME           THE BESTMED DIABETIC
                                                                                                                       PROGRAMME

    PERSONALLY YOURS                                     3      Out-of-hospital benefits                  13
      Why Bestmed should be your medical aid of choice    3     Medicine                                  14
      All you need to know about Bestmed Tempo            4     Preventative care benefits                15
                                                                                                                 MEMBERS DID
                                                                Contributions                             15     FREE HEALTH
    BEAT                                                 5                                                       RISK ASSESSMENTS

      Method of Scheme benefit payment                    6   PULSE                                       16
      In-hospital benefits                                6     Method of Scheme benefit payment          16
      Out-of-hospital benefits
      Medicine
      Preventative care benefits
                                                          8
                                                          9
                                                         10
                                                                In-hospital benefits
                                                                Out-of-hospital benefits
                                                                Medicine
                                                                                                          16
                                                                                                          17
                                                                                                          18
                                                                                                                 4 683
      Contributions                                      11     Preventative care benefits                19     MEMBERS REGISTERED ON
                                                                                                                 THE BESTMED HIV/AIDS
                                                                Contributions                             19
    PACE                                                 11                                                      PROGRAMME

      Method of Scheme benefit payment                   12   CHRONIC DISEASE LIST                        21
      In-hospital benefits                               12

2                                                                                                                        COMPARATIVE GUIDE 2020
Comparative Guide 2020 - Classique Medical Aid ...
Why Bestmed should be your medical aid of choice
                                                                                         Additional Benefits
                                                                                 Students are eligible for child dependent rates up to 26 years of age.
         We provide value for money
                                                                                 Extensive maternity benefits.
  Single digit increases over 11 consecutive years.
                                                                                 Health management support programmes include a diabetes programme (HaloCare),
  Our administration costs are between 3 - 5 % cheaper than our competitors      maternity care programme, oncology programme and HIV/AIDS programme
  because we are self-administered.
  Our plan options have 75% less co-payments, compared to our competitors.               FREE access to the Tempo wellness programme
  We have 13 structured plans, designed to suit every life stage and pocket.             with benefits worth up to R4,500
  No automatic self-payment gap on any of our options.
  Excellent preventative care benefits on all our options e.g. female            Our wellness programme is free for all members and employers.
  contraceptives, pneumonia and flu vaccines and more...
                                                                                 Includes free Health Risk Assessments, visits to dieticians and to biokineticists.

                                                                                 Also family interventions, family workshops and baby growth assessments.

          An excellent track record
  We have been offering medical aid since 1964.
                                                                                         Don’t worry, be Appy!
  We are the largest self-administered scheme in South Africa and the fourth
  largest open medical scheme.                                                 The Bestmed App is just one more way that Bestmed is Personally Yours. It’s user-friendly,
                                                                               and has been designed to put all your essential medical information at your fingertips. To
  Four of our options have been selected as the best performers within the
                                                                               make the most of the new features, remove the old App from your phone and download the
  South African medical scheme market (2018 GTC Medical Aid Survey).
                                                                               new version from the App Store or Google Play.
  We have been voted third on the client service satisfaction benchmark by
  the Ask Africa Orange Index 2018.                                            You’ll notice that the updated App has a
  We have a solvency ratio of 32.8%.                                           new icon, and an easy-to-use slide-out
                                                                               menu that lets you:
  There are about 200 000 lives under our care.
                                                                                 Download your tax certificate.

                                                                                 Get automatic updates on Scheme
          An extensive service provider network                                  communications.

                                                                                 Find information on all benefits.
  Access to specialist and hospital networks across South Africa.
  More than 4 000 family practitioners in our network.                           Update your personal details.
  More than 14 500 network provider agreements.                                  Submit your chronic medication claims.
  Country-wide geographical network coverage.
                                                                                 Search for a specialist in your area.
  Search facility via the Bestmed app and website.
COMPARATIVE GUIDE 2020                                                                                                                                                  3
Comparative Guide 2020 - Classique Medical Aid ...
All you need to know about Bestmed Tempo

                      WHAT IS BESTMED TEMPO?
                      Tempo is our preventative care programme. It’s a package of benefits and offerings which
                      gives you access to expert healthcare professionals. Their advice and assistance will help
                      you understand your health risks and improve your quality of life.

                      WHY SHOULD I JOIN THE PROGRAMME?
                      The programme is included in your monthly subscription. It already forms part of your
                      benefit structure and is available to you and your family at no additional cost. By making
                      use of the programme’s benefits you get access to experts who can assist you with practical
                      and reliable advice which will help you change your lifestyle and become the best version
                      of yourself.

                      HOW DO I ACTIVATE THE PROGRAMME?
                      You need to go for a health risk assessment (HRA) at a wellness contracted network
                      pharmacy or you can have it done at your place of employment during a wellness day. Once
                      we’ve received the results of your HRA your Tempo benefits are immediately unlocked.

                      WHICH BENEFITS ARE INCLUDED IN THE PROGRAMME?
                      Tempo benefits start with a free HRA which is available to you and your dependants (18 and
                      older). We also offer a range of screenings and assessments for dependants aged between
                      13 and 17 which includes:
                         A health assessment at a biokineticist.
                         A functional assessment at an occupational therapist .
                      We also offer baby growth and development assessments from a qualified nurse within a
                      pharmacy clinic for those yournger than 3.
                      Once you have the results of your screenings and assessments your family will have access

    Set your TEMPO    to a nutritional assessment at a dietician. In addition to this, adult beneficiaries (18 and
                      older) can also go to a biokineticist three times per year. This will help you determine your
                      current fitness levels as well as help you to plan how to incorporate fitness and activity into
    with a FREE       your daily lives.

    Health Risk       Simultaneously, adult beneficiaries also have access to three consultations with a dietician
                      who will assist you in making healthier food choices.

    Assessment,       The programme also includes access to a number of group interventions and group sessions
                      for all ages aimed at encouraging healthier lifestyle choices. The group interventions are
    not a smoothie!   advertised throughout the year in the different regions.

                      HOW DO I ACCESS AND UTILISE THE PROGRAMME’S BENEFITS?
                      Once you’ve done your HRA at a contracted pharmacy you’ll unlock all the other benefits
                      included in the programme. Invitations to the group interventions or Healthy Living
                      workshops are also limited to those who have done their HRAs.

4                                                                                          COMPARATIVE GUIDE 2020
Comparative Guide 2020 - Classique Medical Aid ...
HOW WILL I, OR MY FAMILY MEMBERS, BENEFIT FROM THE PROGRAMME?
We regard family as the most important core unit when choosing to live a healthier life. It’s
no use focusing on mom and dad but neglecting to include their children in interventions and
discussions. For that reason we’ve started workshops aimed at children too.
In future, based on the number of young beneficiaries who went for their assessments since
the start of the programme – interventions aimed at young beneficiaries can be developed
and included in the benefit structure. Interventions for younger beneficiaries may be added
to Tempo at a later stage depending on how many young dependants have completed their
HRAs.                                                                                                                  BEAT
HOW DOES THIS PROGRAMME DIFFER FROM OTHER WELLNESS PROGRAMMES?
Firstly, the benefit package is included as part of your preventative care benefits. Secondly,
the programme is aimed at the individual within the family structure. Although the
benefits are available to everyone the advice and assistance that professional healthcare
practitioners provide is aimed at you only – so it’s an individualised programme and offering.
It’s not a one-size-fits-all programme and benefits package.

ARE THE BENEFITS ENTIRELY FREE?
Yes. They’re included in the monthly subscription you already pay as a member.

WILL THE PROGRAMME IMPROVE MY HEALTH/LIFE?
Definitely, provided that you make use of the advice and information the specialists provide
you with.

ARE THERE ANY ADDITIONAL BENEFITS FOR CHILDREN OR PREGNANT WOMEN?
You need to register on the Bestmed Maternity Care programme after your first trimester
(12 weeks). After registering your health risk assessment (HRA) will be scheduled. If you are
experiencing a high-risk pregnancy, the information will be sent to our case managers, and
they will help monitor your progress.
If an occupational therapist identifies your child as a high-risk candidate you can liaise
with us for additional benefits according to a treatment plan. This will assist you and your
family in attending to the needs and risks of your child. No child is alike and we’ll rely on the
advice and proposed treatment plan that the provider will submit to us prior to authorising
the additional consultations. Once we have enough information, we’ll develop treatment
protocols which are relevant to children.
                                                                                                    Choose a
DOES THE PROGRAMME OFFER SUPPORT GROUPS?
Yes. We’ve commenced with a number of support groups aimed at dealing with
                                                                                                    network option
childhood obesity. If you wish to be included in these projects please send an email to             for lower
tempo@bestmed.co.za or Elmarie.Jooste@bestmed.co.za. Any other suggestions
regarding support group topics or themes are welcome.
                                                                                                    contributions on
                                                                                                    Beat!
DO THE FREE BENEFITS DIFFER FOR MEMBERS ON DIFFERENT HEALTHCARE OPTIONS?
No. The Tempo benefits are exactly the same on all the options.
We hope you found the answer you’re looking for but, if not, please email us for more
information: tempo@bestmed.co.za
COMPARATIVE GUIDE 2020                                                                                                        5
Comparative Guide 2020 - Classique Medical Aid ...
The Beat range offers flexible hospital benefits with limited savings on some options to pay for out-of-hospital
expenses. This range is ideal for the young, active and just starting out. Beat1, 2 and 3 also offer you the decision to                                  BEAT1                 BEAT2                 BEAT3                 BEAT4
lower your monthly contribution in the form of a Network option.                                                                  Treatment in mental     100% Scheme tariff. Limited to 21 days per beneficiary.
                                                                                                                                  health clinics

        Method of Scheme benefit payment                                                                                          Treatment of
                                                                                                                                  chemical and
                                                                                                                                                          100% Scheme tariff. Limited to 21 days or R30 760 per beneficiary. Subject to
                                                                                                                                                          network facilities.
                                                                                                                                  substance abuse
    BEAT1                             BEAT2                               BEAT3                      BEAT4
                                                                                                                                  Consultations and       100% Scheme tariff. DSP specialist network applicable if the      100% Scheme
 • In-hospital benefits are          • In-hospital benefits are         • In-hospital benefits are   • In-hospital benefits are   procedures              Network option is chosen.                                         tariff.
   paid from Scheme risk.              paid from Scheme risk.             paid from Scheme risk.       paid from Scheme risk.
 • Some preventative care            • Some preventative care           • Some out-of-hospital       • Some out-of-hospital       Surgical procedures     100% Scheme tariff.
   benefits are available              benefits are available             benefits are paid from       benefits are paid from     and anaesthetics
   from Scheme risk.                   from Scheme risk.                  Scheme risk and some         your medical savings       Organ transplants       100% Scheme tariff (PMBs only).
 • Out-of-hospital benefits          • Out-of-hospital benefits           from your medical            account first, once
   are paid from your own              are paid from your                 savings account.             depleted, from your day-   Major medical           No benefit.                                 100% Scheme           100% Scheme
   pocket.                             medical savings account.         • Some preventative care       to-day benefit.            maxillofacial surgery   (PMBs only at DSP day hospitals).           tariff. Limited to    tariff. Limited to
                                                                          benefits are available     • Some preventative care     strictly related to                                                 R12 327 per family.   R12 554 per family.
                                                                                                                                  certain conditions
                                                                          from Scheme risk.            benefits are available
                                                                                                       from Scheme risk.          Dental and oral         PMBs only at DSP      Qualifying PMB        Limited to            Limited to
                                                                                                                                  surgery                 day hospitals.        procedures only at    R7 690 per family.    R9 613 per family.
 • Benefits relating to conditions that meet the criteria for PMBs will be covered in full when using DSPs, this will not
                                                                                                                                                                                DSP day hospitals.
   affect your savings (annual or vested) for applicable options.                                                                                                               Pulp procedures,
                                                                                                                                                                                extractions and
                                                                                                                                                                                restorations in
BEAT NETWORK PLAN OPTION                                                                                                                                                        DSP day hospitals
• Bestmed offers members a choice of network hospitals for in-hospital benefits.                                                                                                (only disabled
                                                                                                                                                                                beneficiaries
• If a member voluntarily chooses not to make use of a hospital within the Beat network, a maximum co-payment of                                                                and beneficiaries
  R11 309 will apply for the use of a non-designated service provider.                                                                                                          aged 0 – 7 years) –
                                                                                                                                                                                limited to R5 000
• The Family Practitioner (FP) consultation benefit is limited to Bestmed network providers.
                                                                                                                                                                                per family.
• Specialist consultations are limited to Bestmed designated service providers.
                                                                                                                                  Prosthesis              100% Scheme tariff.                         100% Scheme           100% Scheme
                                                                                                                                  (subject to preferred   Limited to R75 092 per family.              tariff. Limited to    tariff. Limited to
                                                                                                                                  providers and DSPs,                                                 R75 884 per family    R92 629 per family.
        In-hospital benefits                                                                                                      otherwise limits and
                                                                                                                                  co-payments apply)
The Non-Network option provides you with access to any hospital of your choice. This is the standard option. The
Network option provides you with a list of designated hospitals for you to use and also saves on your monthly
contribution.
Benefits relating to conditions that meet the criteria for PMBs will be covered in full when using DSPs, this will not
affect your savings.

Note: Benefits mentioned below are subject to pre-authorisation and clinical protocols.

                                  BEAT1                       BEAT2                       BEAT3            BEAT4
    Accommodation                 100% Scheme tariff. DSP specialist network applicable if the             100% Scheme
    (hospital stay) and           Network option is chosen.                                                tariff.
    theatre fees

    Take-home medicine            100% Scheme tariff. Medicine limited to 7 days.

6                                                                                                                                                                                                                COMPARATIVE GUIDE 2020
Comparative Guide 2020 - Classique Medical Aid ...
BEAT1                 BEAT2                BEAT3                    BEAT4                                         BEAT1                   BEAT2                BEAT3                 BEAT4
 Prosthesis – Internal   Sub-limits per beneficiary:                Sub-limits per           Sub-limits per         Specialised            100% Scheme tariff. Subject to co-payments.                        100% Scheme
                         • *Functional limited to R13 434.          beneficiary:             beneficiary:           diagnostic imaging                                                                        tariff.
 Note: Sub-limit         • Vascular R29 971.                        • *Functional            • *Functional
 subject to the above                                                                                               Oncology               PMBs only at DSPs.
                         • Pacemaker (dual chamber)                   limited to               limited to
 prosthesis limit.                                                                             R16 172.
                           R40 939.                                   R13 435.                                      Peritoneal dialysis    PMBs only at DSPs.                                                 100% Scheme
                         • Endovascular and catheter-based          • Vascular               • Vascular             and haemodialysis                                                                         tariff. Subject to
 *Functional:
                           procedures – no benefit.                   R30 082.                 R32 005.                                                                                                       pre-authorisation.
 Items utilised
 towards treating or     • Spinal R29 971.                          • Pacemaker              • Pacemaker
                                                                                                                    Confinements           100% Scheme tariff.
 supporting a bodily     • Artificial disk – no benefit.              (dual chamber)           (dual chamber)       (Birthing)
 function.               • Drug-eluting stents – PMBs and DSP         R40 939.                 R53 605.
                           products only.                           • Endovascular and       • Endovascular and     HIV / AIDS             PMBs only at DSPs.        100% Scheme tariff. Subject to pre-authorisation and DSPs.
                         • Mesh R10 518.                              catheter-based           catheter-based
                                                                                                                    Refractive surgery     PMBs only.                                   100% Scheme           100% Scheme
                         • Gynaecology/Urology R8 595.                procedures – no          procedures –         and all types of                                                    tariff. Subject to    tariff. Subject to
                         • Lens implants R6 559 per lens per eye.     benefit.                 no benefit.          procedures to                                                       pre-authorisation     pre-authorisation
                                                                    • Spinal R30 082.        • Spinal R32 005.      improve or stabilise                                                and protocols.        and protocols.
                                                                    • Artificial disk – no   • Artificial disk –    vision (except                                                      Limited to R7 916     Limited to R8 935
                                                                      benefit.                 no benefit.          cataracts)                                                          per eye.              per eye.
                                                                    • Drug-eluting           • Drug-eluting
                                                                                                                    Midwife-assisted       100% Scheme tariff.
                                                                      stents – PMBs            stents R17 982.
                                                                                                                    births
                                                                      and DSP products       • Mesh R11 875.
                                                                      only.                  • Gynaecology/         Supplementary          100% Scheme tariff.
                                                                    • Mesh R10 573.            Urology R8 708.      services
                                                                    • Gynaecology/           • Lens implants
                                                                                                                    Alternatives to        100% Scheme tariff.
                                                                      Urology R8 732.          R6 785 per lens      hospitalisation
                                                                    • Lens implants            per eye.
                                                                      R6 559 per lens                               Emergency              Services rendered by ER24.
                                                                                                                    evacuation
                                                                      per eye.
                                                                                                                    International travel   Up to R10 million and a maximum of 90 days. Services rendered by Bryte Insurance
 Prosthesis – External   No benefit (PMBs only).                                             Limited to R22 279     cover                  and managed by ER24.
                                                                                             per family.
                                                                                                                    Co-payments            Co-payment of R3 619 on all                  Co-payment of         Not applicable.
 Exclusions              Joint replacement surgery                  Joint replacement        Joint replacement                             endoscopic investigations and                R3 619 on all
 (Prosthesis sub-limit   (except for PMBs).                         surgery (except for      surgery (except for                           specialised diagnostic imaging if done       endoscopic
 subject to preferred                                               PMBs).                   PMBs).                                        in a private hospital. Any other facility,   investigations if
 provider, otherwise     PMBs subject to prosthesis limits:
                         • Hip replacement and other major joints                            PMBs subject to                               no co-payment.                               done in a private
 limits and co-                                                     PMBs subject to                                                                                                     hospital. Any other
 payments apply)           R31 553.                                 prosthesis limits:       prosthesis limits:
                                                                                             • Hip replacement                                                                          facility, no co-
                         • Knee replacement R38 903.                • Hip replacement                                                                                                   payment.
                         • Minor joints R12 101.                      and other major          and other major
                                                                      joints R31 779.          joints R32 910.
                                                                    • Knee                   • Knee replacement
                                                                      replacement              R43 721.
                                                                      R39 322.               • Other minor joints
                                                                    • Other minor joints       R13 434.
                                                                      R12 101.

 Orthopaedic and         100% Scheme tariff.
 medical appliances

 Pathology               100% Scheme tariff.

 Basic radiology         100% Scheme tariff.

COMPARATIVE GUIDE 2020                                                                                                                                                                                                             7
Comparative Guide 2020 - Classique Medical Aid ...
Out-of-hospital benefits
Note: Benefits below may be subject to pre-authorisation, clinical protocols, preferred providers, designated service
providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP).
Approved PMB’s will be paid from scheme risk.

                                BEAT1                 BEAT2                 BEAT3                 BEAT4
    Overall day-to-day limit    Not applicable.                                                   M = R12 214,
                                                                                                  M1+ = R24 427.

    Family Practitioner         No benefit.           Savings account. FP and specialist          Savings first.
    (FP) and specialist                               consultations only at Bestmed DSPs          Limited to
    consultations                                     at network tariffs.                         M = R3 110,
                                                                                                  M1+ = R5 541.
                                                                                                  (Subject to
                                                                                                  overall day-to-

                                                                                                                          6 inches
                                                                                                  day limit)

    Diabetes primary care       100% of Scheme tariff subject to registration with HaloCare.
    consultation                2 primary care consultations at Dis-Chem Pharmacies limited to R341.90 per
                                consultation.
                                Beat4 option: Paid first from the “FP and specialist consultations” day-to-day
                                                                                                                         of fashion
                                                                                                                        can become
                                benefit, thereafter Scheme risk.

    Basic and specialised       No benefit.           Basic: Preventative benefit or savings      Savings first.
    dentistry                                         account.                                    Limited to
                                                      Specialised: Savings account.
                                                                                                  M = R5 381,
                                                                                                  M1+ =
                                                                                                  R10 808.
                                                                                                                        6 weeks on
                                                      Orthodontic: Subject to pre-

                                                                                                                         crutches!
                                                      authorisation.                              (Subject to
                                                                                                  overall day-
                                                                                                  to-day limit).
                                                                                                  Orthodontics are
                                                                                                  subject to pre-
                                                                                                  authorisation.

    Medical aids, apparatus     No benefit.           Savings account.                            Savings first.
    and appliances                                                                                100% Scheme
    including wheelchairs                                                                         tariff. Limited
    and hearing aids                                                                              to R10 970 per
                                                                                                  family. (Subject
    Hearing aids are subject                                                                      to overall day-to-
    to pre-authorisation.                                                                         day limit)

    Supplementary services      No benefit.           Savings account.                            Savings first.
                                                                                                  Limited to
                                                                                                  M = R4 750,
                                                                                                  M1+ = R9 647.
                                                                                                  (Subject to
                                                                                                  overall day-to-
                                                                                                  day limit)

8                                                                                                                                     COMPARATIVE GUIDE 2020
Comparative Guide 2020 - Classique Medical Aid ...
BEAT1                BEAT2                BEAT3                BEAT4                        Medicine
 Wound care benefit           100% Scheme tariff.                                            Savings first.
 (incl. dressings, negative   Limited to R 3 359 per family.                                 100% Scheme           Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, preferred providers,
 pressure wound therapy                                                                      tariff. Limited       designated service providers, formularies, funding guidelines and the Mediscor Reference Price (MRP). Approved
 -NPWT- treatment and                                                                        to R4 750 per         CDL, PMB and non-CDL chronic medicine costs will be paid from the non-CDL chronic medicine limit first. Thereafter,
 related nursing services                                                                    family. (Subject      approved CDL and PMB chronic medicine costs will continue to be paid (unlimited) from Scheme risk.
 -out-of-hospital)                                                                           to overall
                                                                                                                   Pre-approval for medicine can be obtained from medicine@bestmed.co.za or 086 000 2378.
                                                                                             day-to-day limit)
                                                                                                                   Note: Refer to the Chronic Conditions List at the back of the Comparative Guide.
 Optometry benefit            No benefit.          Savings account.     Benefits available every 24 months
 (PPN capitation provider)                                              from date of service.

                                                                        Network Provider (PPN)
                                                                                                                                            BEAT1                         BEAT2                        BEAT3                         BEAT4
                                                                        Consultation - 1 per beneficiary.            CDL & PMB              100% Scheme tariff. Co-payment of 40% for non-formulary                                  100% Scheme tariff.
                                                                        Frame = R868 covered AND                     chronic                medicine.                                                                                Co-payment of 30%
                                                                        100% of cost of standard lenses              medicine                                                                                                        for non-formulary
                                                                        (single vision OR bifocal OR multifocal)                                                                                                                     medicine.
                                                                        OR Contact lenses = R1 510
                                                                        OR                                           Non-CDL                No benefit.                                                5 conditions.                 9 conditions.
                                                                        Non-network Provider                         chronic                                                                           80% Scheme tariff.            90% Scheme tariff.
                                                                        Consultation - R316 fee at non-              medicine                                                                          Limited to                    Limited to
                                                                        network provider Frame = R579 AND                                                                                              M = R3 280,                   M = R7 204,
                                                                        Single vision lenses = R184 OR                                                                                                 M1+ = R6 673.                 M1+ = R14 408.
                                                                        Bifocal lenses = R431 OR                                                                                                       Co-payment of 35%             Co-payment of 25%
                                                                        Multifocal lenses = R747 OR                                                                                                    for non-formulary             for non-formulary
                                                                        Contact lenses = R1 510                                                                                                        medicine.                     medicine.

 Basic radiology              No benefit.          Savings account.                          Savings first.          Biologicals            PMBs only as per funding protocol.
 and pathology                                                                               Limited to              and other              Subject to pre-approval.
                                                                                             M = R3 110,             high-cost
                                                                                             M1+ = R6 333.           medicine
                                                                                             (Subject to
                                                                                             overall day-to-         Acute                  No benefit.                   Savings account.                                           Savings first.
                                                                                             day limit)              medicine                                                                                                        Limited to
                                                                                                                                                                                                                                     M = R2 748,
 Specialised diagnostic       100% Scheme tariff.                       100% Scheme          100% Scheme                                                                                                                             M1+ = R5 552.
 imaging                      Limited to R5 089 per family,             tariff. Limited      tariff. Limited to                                                                                                                      (Subject to overall
                              (excluding PET scans).                    to R10 688 per       R16 172 per                                                                                                                             day-to-day limit)
                                                                        family (excluding    family.
                                                                        PET scans).                                  Over-the-              No benefit.                   Savings account.                                           *Member choice:
                                                                                                                     counter (OTC)                                        Subject to available savings.                              1. R650 OTC limit
 Oncology                     PMBs only at DSPs.                                                                     medicine                                                                                                           OR
                                                                                                                                                                                                                                     2. Access to full
 Peritoneal dialysis and      PMBs only at DSPs.                                             100% Scheme             Includes                                                                                                           savings for OTC
 haemodialysis                                                                               tariff. Subject to      sunscreen,                                                                                                         purchases (after
                                                                                             pre-authorisation.      vitamins and                                                                                                       R650 limit) =
                                                                                                                     minerals with                                                                                                      self-payment gap
 HIV / AIDS                   PMBs only at          100% Scheme tariff. Subject to pre-authorisation and DSPs.
                                                                                                                     nappi codes                                                                                                        accumulation.
                              DSPs.
                                                                                                                     on Scheme                                                                                                          Subject to
 Rehabilitation services      No benefit.          Savings account.                          Vested savings.         formulary                                                                                                          available savings.
 after trauma
                                                                                                                   *The Default OTC choice is 1. R650 OTC limit. Members wishing to choose the other option are welcome to contact Bestmed
                                                                                                                   Note: Generic medicines are always available at a lower cost than the original brand and are just as effective. Bestmed recommends using these
                                                                                                                   generic alternatives to avoid incurring additional costs.

COMPARATIVE GUIDE 2020                                                                                                                                                                                                                                          9
Comparative Guide 2020 - Classique Medical Aid ...
Preventative care benefits                                                                                                                BEAT1                       BEAT2                        BEAT3                        BEAT4
                                                                                                                      Tempo                       Individual Health Risk Assessments (Adults aged 18 and older) – Biometric screening
Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, preferred providers,
                                                                                                                      Programme                   and lifestyle questionnaire to be completed at a network pharmacy or onsite at selected
designated service providers, formularies, funding guidelines and the Mediscor Reference Price (MRP).                 (Wellness)                  employers (1 per year).
                                                                                                                      Note: Completing            Child dependant assessments
                                                                                                                      your Health Risk
                        BEAT1                  BEAT2                   BEAT3                   BEAT4                                              • Ages 13-17 years: Assessment done by a contracted biokineticist (wellness network
                                                                                                                      Assessment
                                                                                                                                                     provider) – 1 per beneficiary per year.
                                                                                                                      (HRA) unlocks
 Preventative care      • Flu vaccines.        • Flu vaccines.         • Flu vaccines.         • Flu vaccines.                                    • Ages 3-12 years: Assessment done by a contracted occupational therapist (wellness
                                                                                                                      the other Tempo
 benefits               • Pneumonia            • Pneumonia             • Pneumonia             • Pneumonia                                           network provider) – 1 per beneficiary per year.
                                                                                                                      benefits.
                          vaccines.              vaccines.               vaccines.               vaccines.            One parent                  • Ages 0-2 years: Baby growth and development assessments done at a contracted
 Note: Refer to         • Female               • Paediatric            • Paediatric            • Paediatric           must complete                  pharmacy clinic – 3 assessments per year.
 Scheme rules for                                                                                immunisations.
                          contraceptives –       immunisations.          immunisations.                               their HRA in                Family assessments - Nutrition
 funding criteria
                          R2 205 per           • Female                • Female                • Female               order to unlock             • Family nutritional assessment done at a contracted dietician (wellness network provider)
 applicable to each
                          beneficiary per        contraceptives –        contraceptives –        contraceptives –     assessments                    – 1 per family per year.
 preventative
                          year.                  R2 205 per              R2 205 per              R2 205 per           for beneficiaries
 care benefit.                                                                                                                                     Fitness and nutritional interventions (beneficiaries 18 and older)
                        • Back and neck          beneficiary per         beneficiary per         beneficiary per      younger than 18.
                                                                                                                                                  • 3 individualised consultations per year at a contracted biokineticist (wellness provider
                          preventative           year.                   year.                   year.                                               network).
                          programme.           • Back and neck         • Back and neck         • Back and neck                                    • 3 individualised consultations per year at a contracted dietician (wellness provider
                        • Pap smear – ages       preventative            preventative            preventative                                        network).
                          18 and above,          programme.              programme.              programme.
                          every 24 months.     • Preventative          • Preventative          • Preventative         Maternity                   100% Scheme tariff. Subject to the                       100% Scheme tariff. Subject to the
                        • HPV                    dentistry.              dentistry.              dentistry.           Benefits                    following benefits:                                      following benefits:
                          vaccinations.        • Pap smear – ages      • Pap smear – ages      • Haemophilus
                                                 18 and above,           18 and above,           influenzae Type                                  Consultations:                                           Consultations:
                                                 every 24 months.        every 24 months         B vaccine (HIB).                                 • 6 antenatal consultations at a FP OR                   • 9 antenatal consultations at a FP OR
                                               • HPV                   • HPV                   • Mammogram.–                                         gynaecologist OR midwife.                                gynaecologist OR midwife.
                                                 vaccinations.           vaccinations..          ages 40 and                                      Ultrasounds:                                             • 1 post-natal consultation at a FP OR
                                               • Mammogram             • Mammogram               above, every 24                                  • 1 x 2D ultrasound scan at 1st trimester                   gynaecologist OR midwife.
                                                 – ages 40 and           – ages 40 and           months.                                             (between 10 to 12 weeks) at a FP OR                   Ultrasounds:
                                                 above, every 24         above, every 24       • HPV                                                 gynaecologist OR radiologist.                         • 1 x 2D ultrasound scan at 1st trimester
                                                 months.                 months.                 vaccinations.                                    • 1 x 2D ultrasound scan at 2nd trimester                   (between 10 to 12 weeks) at a FP OR
                                               • PSA Screening         • PSA Screening         • PSA Screening                                       (between 20 to 24 weeks) at a FP OR                      gynaecologist OR radiologist.
                                                 – ages 50 years         – ages 50 years         – ages 50 years                                     gynaecologist OR radiologist.                         • 1 x 2D ultrasound scan at 2nd trimester
                                                 and above, every        and above, every        and above, every                                                                                             (between 20 to 24 weeks) at a FP OR
                                                 24 months               24 months               24 months.                                                                                                   gynaecologist OR radiologist.
                                                                                               • Pap smear – ages                                                                                          Supplements:
                                                                                                 18 and above,                                                                                             • Antenatal iron supplements - 9 fills
                                                                                                 every 24 months                                                                                              subject to formulary.
                                                                                                                                                                                                           • Antenatal folic acid – 9 fills subject to
                                                                                                                                                                                                              formulary.

                                                                                                                    Disclaimer on exclusions: General and option-specific exclusions apply. Please refer to www.bestmed.co.za for more details.

10                                                                                                                                                                                                                          COMPARATIVE GUIDE 2020
Contributions
                                           BEAT1                          BEAT2                          BEAT3                   BEAT4
  Non-Network (NN) /                       NN              N              NN             N               NN             N        NN
  Network (N)

  Medical Savings Account                             N/A                           16%                            16%            14%

  Principal          Risk                  R1 617          R1 454         R1 660         R1 494          R2 518         R2 266   R4 029

                                                                                                                                                                PACE
  Member
                     Savings               R0              R0             R316           R284            R479           R431     R656

                     Total                 R1 617          R1 454         R1 976         R1 778           R2 997        R2 697   R4 685

  Adult              Risk                  R1 255          R1 130         R1 289         R1 160          R1 789         R1 611   R3 328
  Dependant
                     Savings               R0              R0             R245           R221            R341           R307     R541

                     Total                 R1 255         R1 130          R1 534         R1 381          R2 130         R1 918   R3 869

  Child              Risk                  R680           R612            R699           R628            R972           R876     R996
  Dependant
                     Savings               R0             R0              R133           R120            R185           R167     R162

                     Total                 R680           R612            R832           R748            R1 157         R1 043   R1 158

  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; FP = Family Practitioner or Doctor; TEMPO = 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 Benefit; PPN = Preferred Provider Negotiator; PSA = Prostate Specific Antigen.

                                                                                                                                          Did you know that
                                                                                                   Chat to us                             Bestmed’s Pace
                                                                                                   directly                               option range does
                                                                                                   using our Chat                         not have co-payment
                                                                                                   Now service on                         or automatic self-
                                                                                                   the Bestmed                            payment gaps?
                                                                                                   website.

COMPARATIVE GUIDE 2020                                                                                                                                                 11
The Pace range offers more comprehensive in-hospital and out-of-hospital benefits. These options all have
additional savings accounts to cover extensive out-of-hospital expenses. This range is ideal for families and those                            PACE1                 PACE2                 PACE3                   PACE4
seeking comprehensive cover.                                                                                             Major medical         100% Scheme           100% Scheme tariff.
                                                                                                                         maxillofacial         tariff. Limited to
                                                                                                                         surgery strictly      R12 440 per
      Method of Scheme benefit payment                                                                                   related to certain    family.
                                                                                                                         conditions
 PACE1                    PACE2                     PACE3                    PACE4                                       Dental and oral       Limited to            Limited to            Limited to              Limited to
 • In-hospital benefits are paid from Scheme risk benefit. Some              • In-hospital benefits, out-of-hospital     surgery               R7 690 per family.    R12 780 per family.   R16 059 per family.     R19 225 per family.
   out-of-hospital benefits are paid from the annual savings first             benefits and preventative care            Prosthesis            100% Scheme           100% Scheme           100% Scheme tariff.     100% Scheme
   and once depleted will be paid from the day-to-day benefit.                 benefits are paid from Scheme risk.       (subject to           tariff. Limited to    tariff. Limited to    Limited to              tariff. Limited to
 • Once the day-to-day benefit is depleted, benefits can be paid             • Once out-of-hospital risk benefits are    preferred provider,   R85 948 per           R110 376 per          R110 942 per            R128 018 per
   from the available vested savings. Some preventative care                   depleted, further claims will be paid     otherwise limits      family.               family.               family.                 family.
   benefits are available from Scheme risk benefit.                            from savings.                             and co-payments
                                                                                                                         apply)
 • Benefits relating to conditions that meet the criteria for PMBs will be covered in full when using DSPs, this will
   not affect your savings (annual or vested).                                                                           Prosthesis –          Sub-limits per        Sub-limits per        Sub-limits per          Sub-limits per
                                                                                                                         Internal              beneficiary:          beneficiary:          beneficiary:            beneficiary:
                                                                                                                                               • *Functional         • *Functional         • *Functional           • *Functional
                                                                                                                         Note: Sub-limit         limited to            limited to            limited to              limited to
                                                                                                                         subject to the          R15 437.              R16 794.              R18 094.                R18 773.
      In-hospital benefits                                                                                               above prosthesis
                                                                                                                         limit.
                                                                                                                                               • Vascular            • Vascular            • Vascular              • Vascular
                                                                                                                                                 R31 325.              R41 391.              R41 505.                R47 498.
Note: All benefits mentioned below are subject to pre-authorisation and clinical protocols.                              *Functional:          • Pacemaker           • Pacemaker           • Pacemaker             • Pacemaker
                                                                                                                         Items utilised          (dual chamber)        (dual chamber)        (dual chamber)          (dual chamber)
Benefits relating to conditions that meet the criteria for PMBs will be covered in full when using DSPs, this will not
                                                                                                                         towards treating or     R53 492.              R59 655.              R59 655.                R59 655.
affect your savings.
                                                                                                                         supporting a bodily   • Endovascular        • Spinal including    • Spinal including      • Spinal including
                                                                                                                         function                and catheter-         artificial disc       artificial disc         artificial disc
                          PACE1                   PACE2                   PACE3                     PACE4                                        based procedures      R55 335.              R55 440.                R64 014.
                                                                                                                                                 – no benefit.       • Drug-eluting        • Drug-eluting          • Drug-eluting
 Accommodation            100% Scheme tariff.                                                                                                  • Spinal R31 325.       stents R18 094.       stents R18 094.         stents R21 318.
 (hospital stay) and                                                                                                                           • Artificial disk –   • Mesh R18 094.       • Mesh R18 094.         • Mesh R18 773.
 theatre fees                                                                                                                                    no benefit.         • Gynaecology/        • Gynaecology/          • Gynaecology/
 Take-home                100% Scheme tariff. Medicine limited to 7 days.                                                                      • Drug-eluting          Urology               Urology                 Urology
 medicine                                                                                                                                        stents – PMBs         R13 514.              R13 571.                R15 494.
                                                                                                                                                 and DSP             • Lens implants       • Lens implants         • Lens implants
 Treatment in             100% Scheme tariff. Limited to 21 days per beneficiary.                                                                products only         R11 604               R11 604                 R17 156
 mental health
                                                                                                                                               • Mesh R11 761.         per lens per eye.     per lens per eye.       per lens per eye.
 clinics
                                                                                                                                               • Gynaecology/        • Joint               • Joint replacements:   • Joint
 Treatment of             100% Scheme tariff.                                                                                                    Urology R8 482.       replacements:       - Hip replacement         replacements:
 chemical and             Limited to 21 days or R30 760 per beneficiary. Subject to network facilities.                                        • Lens implants       - Hip replacement       and other major       - Hip replacement
 substance abuse                                                                                                                                 R6 447 per lens       and other major       joints R49 760.         and other major
                                                                                                                                                 per eye.              joints R49 703.     - Knee replacement        joints R57 280.
 Consultations and        100% Scheme tariff.
 procedures                                                                                                                                                          - Knee replacement      R57 959.              - Knee replacement
                                                                                                                                                                       R57 676.            - Minor joints            R66 328.
 Surgical                 100% Scheme tariff.                                                                                                                        - Minor joints          R21 430.              - Minor joints
 procedures and                                                                                                                                                        R21 430.                                      R21 318.
 anaesthetics
                                                                                                                         Prosthesis –          Limited to            Limited to            Limited to              Limited to
 Organ transplants        100% Scheme             100% Scheme tariff.                                                    External              R21 827               R26 011               R26 124                 R29 517
                          tariff. (Only PMBs)                                                                                                  per family.           per family.           per family.             per family.

12                                                                                                                                                                                                       COMPARATIVE GUIDE 2020
PACE1                 PACE2                 PACE3                  PACE4                     Out-of-hospital benefits
 Exclusions             Joint replacement     Not applicable.                                                  Note: Benefits below may be subject to pre-authorisation, clinical protocols, preferred providers, designated service
 (Prosthesis            surgery (except for                                                                    providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP).
 sub-limit subject to   PMBs).
 preferred provider,    PMBs subject to                                                                        Approved PMB’s will be paid from scheme risk.
 otherwise limits       prosthesis limits:
 and co-payments        • Hip replacement
 apply)                                                                                                                                    PACE1                  PACE2                  PACE3                  PACE4
                           and other major
                           joints R31 891.                                                                      Overall day-to-day         M = R10 382,           M = R14 656,           M = R18 321,           M = R34 153,
                        • Knee                                                                                  limit                      M1+ = R20 763.         M1+ = R29 313.         M1+ = R37 863.         M1+ = R55 075.
                           replacement
                                                                                                                FP and specialist          Savings first.         Savings first.         Savings first.         Limited to
                           R42 409.
                                                                                                                consultations              Limited to             Limited to             Limited to             M = R5 372,
                        • Minor joints                                                                                                     M = R2 138,            M = R4 185,            M = R4 185,            M1+ = R8 708.
                           R13 175.                                                                                                        M1+ = R4 297.          M1+ = R8 482.          M1+ = R8 482.          (Subject to overall
                                                                                                                                           (Subject to overall    (Subject to overall    (Subject to overall    day-to-day limit)
 Orthopaedic and        100% Scheme tariff.
                                                                                                                                           day-to-day limit)      day-to-day limit)      day-to-day limit)
 medical appliances

 Pathology              100% Scheme tariff.
                                                                                                                Diabetes primary           100% of Scheme tariff subject to registration with HaloCare.
 Basic radiology        100% Scheme tariff.                                                                     care consultation          2 primary care consultations at Dis-Chem Pharmacies limited to R341.90 per
                                                                                                                                           consultation. Paid first from the “FP and specialist consultations” day-to-day benefit,
 Specialised            100% Scheme tariff.                                                                                                thereafter Scheme risk.
 diagnostic imaging
                                                                                                                Basic and specialised      Savings first.         Savings first.         Savings first.         Limited to
 Oncology               PMBs only at DSPs.    Oncology programme. 100% Scheme tariff.                           dentistry                  Basic:                 Basic:                 Basic:                 M = R11 861,
                                                                                                                                           Preventative           Preventative           Preventative           M1+ = R20 020.
 Mammary surgery        No benefit.           100% Scheme tariff. Limited to R35 000.                                                      benefit or savings     benefit or savings     benefit or savings     (Subject to overall
 (Breast cancer                               Subject to pre-authorisation for symmetrising surgery on                                     account. Limit once    account. Limit once    account. Limit once    day-to-day limit)
 patient)                                     unaffected breast.                                                                           savings exceeded.      savings exceeded.      savings exceeded.      Orthodontic:
                                                                                                                                           Specialised:           Specialised:           Specialised:           Subject to pre-
 Peritoneal dialysis    PMBs only at DSPs.    100% Scheme tariff.                                                                          Savings account        Savings account        Savings account        authorisation.
 and haemodialysis                                                                                                                         then limit.            then limit.            then limit.
 HIV / AIDS             100% Scheme tariff. Subject to pre-authorisation and DSPs.                                                         Orthodontic:           Orthodontic:           Orthodontic:
                                                                                                                                           Subject to             Subject to             Subject to
 Confinements           100% Scheme tariff.                                                                                                pre-authorisation.     pre-authorisation.     pre-authorisation.
 (Birthing)                                                                                                                                Limited to             Limited to             Limited to
                                                                                                                                           M = R3 934,            M = R6 596,            M = R7 107,
 Refractive surgery     100% Scheme           100% Scheme           100% Scheme tariff.                                                    M1+ = R7 985.          M1+ = R13 192.         M1+ = R13 250.
 and all types          tariff. Limited to    tariff. Limited to    Limited to R9 613 per eye.                                             (Subject to overall    (Subject to overall    (Subject to overall
 of procedures          R8 550 per eye.       R8 934 per eye.                                                                              day-to-day limit)      day-to-day limit)      day-to-day limit)
 to improve or
 stabilise vision
 (except cataracts)                                                                                             Medical aids,              Savings first.         Savings first.         Savings first.         100% Scheme
                                                                                                                apparatus and              100% Scheme            100% Scheme            100% Scheme            tariff. Limited to
 Midwife-assisted       100% Scheme tariff.
                                                                                                                appliances including       tariff. Limited        tariff. Limited to     tariff. Limited to     R9 952 per family.
 births
                                                                                                                wheelchairs and            to R10 970 per         R9 952 per family.     R9 952 per family.     (Subject to overall
 Supplementary          100% Scheme tariff.                                                                     hearing aids               family. (Subject to    (Subject to overall    (Subject to overall    day-to-day limit).
 services                                                                                                                                  overall day-to-day     day-to-day limit).     day-to-day limit).     Limit on
                                                                                                                Hearing aids are           limit)                 Limit on               Limit on               wheelchairs of
 Alternatives to        100% Scheme tariff.                                                                     subject to pre-                                   wheelchairs of         wheelchairs of         R13 458 per family
 hospitalisation                                                                                                authorisation.             Hearing aids can       R13 458 per family     R13 458 per family     per 48 months.
                                                                                                                                           be claimed every       per 48 months.         per 48 months.         Limit on hearing
 Emergency              Services rendered by ER24.                                                                                         24 months.             Limit on hearing       Limit on hearing       aids of R34 379
 evacuation                                                                                                                                                       aids of R27 425        aids of R30 874        per beneficiary per
 International travel   Up to R10 million and a maximum of 90 days. Services rendered by Bryte Insurance and                                                      per beneficiary per    per beneficiary per    24 months.
 cover                  managed by ER24.                                                                                                                          24 months.             24 months.

COMPARATIVE GUIDE 2020                                                                                                                                                                                                             13
PACE1                 PACE2                 PACE3                 PACE4                                                  PACE1                     PACE2                      PACE3                      PACE4
 Insulin pump            No benefit.                                                       100% Scheme             Oncology                       PMBs only at DSPs.        Oncology programme. 100% Scheme tariff.
 (excluding                                                                                tariff.
 consumables)                                                                                                      Peritoneal dialysis            PMBs only at DSPs.        100% Scheme tariff.
                                                                                           Limited to              and haemodialysis
                                                                                           R40 000 per
                                                                                           beneficiary every
                                                                                           24 months.
                                                                                           Subject to pre-             Medicine
                                                                                           authorisation.
                                                                                                                 Benefits mentioned below may be subject to pre-authorisation, clinical protocols, preferred providers, designated
 Supplementary           Savings first.        Savings first.        Savings first.        Limited to
                                                                                                                 service providers, formularies, funding guidelines and the Mediscor Reference Price (MRP). Refer to the Chronic
 services                Limited to            Limited to            Limited to            M = R5 372,
                         M = R4 195,           M = R5 260,           M = R2 566,           M1+ = R10 574.        Conditions List at the back of the Comparative Guide.
                         M1+ = R8 708.         M1+ = R10 574.        M1+ = R5 372.         (Subject to overall   Note: Approved CDL, PMB and non-CDL chronic medicine costs will be paid from the non-CDL chronic medicine limit
                         (Subject to overall   (Subject to overall   (Subject to overall   day-to-day limit)     first. Thereafter, approved CDL and PMB chronic medicine costs will continue to be paid (unlimited) from Scheme risk.
                         day-to-day limit)     day-to-day limit)     day-to-day limit)
                                                                                                                 Note: Approved PMB biological and Non-PMB biological medicine costs will be paid from the Biological limit first.
 Wound care benefit      Savings first.        Savings first.        Savings first.        Limited to            Once the limit is depleted, only PMB biological medicine costs will continue to be paid unlimited from Scheme risk.
 (incl. dressings,       100% Scheme           100% Scheme           100% Scheme           R13 118 per
 negative pressure       tariff. Limited to    tariff. Limited to    tariff. Limited to    family. (Subject to
 wound therapy           R3 450 per family.    R6 559 per family.    R10 178 per           overall day-to-day                                      PACE1                     PACE2                      PACE3                     PACE4
 -NWPT- treatment        (Subject to overall   (Subject to overall   family. (Subject to   limit)                  CDL & PMB chronic               100% Scheme               100% Scheme                100% Scheme               100% Scheme
 and related nursing     day-to-day limit)     day-to-day limit)     overall day-to-day                            medicine                        tariff. Co-payment        tariff. Co-payment         tariff. Co-payment        tariff. Co-payment
 services –                                                          limit)                                                                        of 35% for                of 30% for                 of 25% for                of 20% for
 out-of-hospital)                                                                                                                                  non-formulary             non-formulary              non-formulary             non-formulary
 Optometry benefit       Benefits available every 24 months from date of service.                                                                  medicine.                 medicine.                  medicine.                 medicine.
 (PPN capitation                                                                                                   Non-CDL chronic                 7 conditions.             18 conditions.             19 conditions.            28 conditions.
 provider)               Network Provider (PPN)                                                                    medicine                        90% Scheme tariff.        90% Scheme tariff.         90% Scheme tariff.        90% Scheme tariff.
                         Consultation - 1 per beneficiary.                                                                                         Limited to                Limited to                 Limited to                Limited to
                         Frame = R868 covered AND                                                                                                  M = R6 333,               M = R8 708,                M = R14 046,              M = R18 942,
                         100% of cost of standard lenses (single vision OR bifocal OR multifocal) OR Contact                                       M1+ = R12 666.            M1+ = R17 416.             M1+ = R28 092.            M1+ = R38 055.
                         lenses = R1 510                                                                                                           Co-payment                Co-payment                 Co-payment                Co-payment
                         OR                                                                                                                        of 30% for                of 25% for                 of 20% for                of 15% for
                         Non-network Provider                                                                                                      non-formulary             non-formulary              non-formulary             non-formulary
                         Consultation - R316 fee at non-network provider Frame = R579 AND                                                          medicine.                 medicine.                  medicine.                 medicine.
                         Single vision lenses = R184 OR
                         Bifocal lenses = R431 OR                                                                  Biologicals and other           PMBs only -               Limited to                 Limited to                Limited to
                         Multifocal lenses = R747 OR                                                               high-cost medicine              subject to pre-           R158 221                   R316 652                  R468 645
                         Contact lenses = R1 510                                                                                                   approval.                 per beneficiary.           per beneficiary.          per beneficiary.
 Basic radiology         Savings first.        Savings first.        Savings first.        100% Scheme             Acute medicine                  Savings first.            Savings first.             Savings first.            Limited to
 and pathology           100% Scheme           100% Scheme           100% Scheme           tariff. Limited to                                      Limited to                Limited to                 Limited to                M = R8 482,
                         tariff. Limited to    tariff. Limited to    tariff. Limited to    M = R5 372,                                             M = R2 240,               M = R4 637,                M = R1 471,               M1+ = R13 175.
                         M = R3 110,           M = R3 110,           M = R3 393,           M1+ = R10 574.                                          M1+ = R4 637.             M1+ = R9 273.              M1+ = R3 619.             (10% co-payment)
                         M1+ = R6 220.         M1+ = R6 220.         M1+ = R6 729.         (Subject to overall                                     (Subject to overall       (Subject to overall        (Subject to overall       (Subject to overall
                         (Subject to overall   (Subject to overall   (Subject to overall   day-to-day limit)                                       day-to-day limit).        day-to-day limit).         day-to-day limit).        day-to-day limit).
                         day-to-day limit)     day-to-day limit)     day-to-day limit)
                                                                                                                   Over-the-counter                *Member choice: 1. R650 OTC limit OR 2. Access to full savings                 Savings account.
 Specialised             100% Scheme           MRI/CT scans: Maximum of 3 scans per beneficiary.                   (OTC) medicine                  for OTC purchases (after R650 limit) = self-payment gap
 diagnostic imaging      tariff. Limited       PET scan: 1 scan per beneficiary. 100% Scheme tariff.                                               accumulation. Subject to available savings.
                         to R13 911 per                                                                            Includes sunscreen,
                         family.                                                                                   vitamins and minerals
                                                                                                                   with nappi codes on
 Rehabilitation          Vested savings.       100% Scheme tariff.                                                 Scheme formulary
 services after trauma

 HIV / AIDS              100% Scheme tariff. Subject to pre-authorisation and DSPs.                              *The Default OTC choice is 1. R650 OTC limit. Members wishing to choose the other option are welcome to contact Bestmed

14                                                                                                                                                                                                                  COMPARATIVE GUIDE 2020
Preventative care benefits                                                                                                                   PACE1                         PACE2                         PACE3                        PACE4
                                                                                                                         Maternity                   100% Scheme tariff. Subject to the following benefits:
Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, preferred providers,
                                                                                                                         Benefits
designated service providers, formularies, funding guidelines and the Mediscor Reference Price (MRP).
                                                                                                                                                     Consultations:
                        PACE1                   PACE2                    PACE3                   PACE4                                               • 9 antenatal consultations at a FP OR gynaecologist OR midwife.
                                                                                                                                                     • 1 post-natal consultation at a FP OR gynaecologist OR midwife.
 Preventative care      • Flu vaccines.         •   Flu vaccines.                                                                                    Ultrasounds:
                        • Pneumonia             •   Pneumonia vaccines.                                                                              • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a FP OR
 Note: Refer to           vaccines.             •   Paediatric immunisations.                                                                           gynaecologist OR radiologist.
 Scheme rules for       • Paediatric            •   Female contraceptives – R2 205 per beneficiary per year.                                         • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a FP OR
 funding criteria
                          immunisations.        •   Back and neck preventative programme.                                                               gynaecologist OR radiologist.
 applicable to each
                        • Female                •   Preventative dentistry.                                                                          Supplements:
 preventative
 care benefit.            contraceptives –      •   Haemophilus influenzae Type B vaccine. (HIB).                                                    • Antenatal iron supplements - 9 fills subject to formulary.
                          R2 205 per            •   Mammogram.                                                                                       • Antenatal folic acid – 9 fills subject to formulary.
                          beneficiary per       •   PSA screening – ages 50 and above, every 24 months.
                          year.                 •   HPV vaccinations.                                                  Disclaimer on exclusions: General and option-specific exclusions apply.
                        • Back and neck         •   Bone densitometry.                                                 Please refer to www.bestmed.co.za for more details.
                          preventative          •   Pap smear – ages 18 and above, every 24 months.
                          programme.
                        • Preventative                                                                                       Contributions
                          dentistry.
                        • Haemophilus                                                                                                                                     PACE1                   PACE2                     PACE3               PACE4
                          influenzae Type B
                          vaccine. (HIB).                                                                                Medical Savings Account                          19%                     14%                       14%                 3%
                        • Mammogram.                                                                                     Principal Member                Risk             R3 183                  R4 786                    R5 495              R7 743
                        • HPV vaccinations.
                        • Pap smear – age                                                                                                                Savings          R747                    R780                      R895                R240
                          18 and above,
                                                                                                                                                         Total            R3 930                  R5 566                    R6 390              R7 983
                          every 24 months.
                        • PSA screening                                                                                  Adult Dependant                 Risk             R2 236                  R4 694                    R4 424              R7 743
                          – ages 50 and
                                                                                                                                                         Savings          R524                    R764                      R720                R240
                          above, every 24
                          months.                                                                                                                        Total            R2 760                  R5 458                    R5 144              R7 983

 Tempo                  Individual Health Risk Assessments (Adults aged 18 and older) – Biometric screening              Child Dependant                 Risk             R804                    R1 055                    R945                R1 813
 Programme              and lifestyle questionnaire to be completed at a network pharmacy or onsite at selected
 (Wellness)                                                                                                                                              Savings          R188                    R172                      R154                R57
                        employers (1 per year).
                        Child dependant assessments                                                                                                      Total            R992                    R1 227                    R1 099              R1 870
 Note: Completing
                        • Ages 13-17 years: Assessment done by a contracted biokineticist (wellness network
 your Health Risk                                                                                                        Maximum contribution                                                                           4
                           provider) – 1 per beneficiary per year.
 Assessment                                                                                                              child dependant*
 (HRA) unlocks          • Ages 3-12 years: Assessment done by a contracted occupational therapist (wellness
 the other Tempo           network provider) – 1 per beneficiary per year.                                               Recognition of a child dependant                                        Under 21, unless a registered student.
 benefits.              • Ages 0-2 years: Baby growth and development assessments done at a contracted
                           pharmacy clinic – 3 assessments per year.
                                                                                                                       *You only pay for a maximum of four children. All other children join as beneficiaries of the Scheme free of charge.
 One parent             • Family assessments - Nutrition
 must complete          • Family nutritional assessment done at a contracted dietician (wellness network provider) –   ABBREVIATIONS
 their HRA in              1 per family per year.                                                                      DBC = Documentation Based Care (Back Rehabilitation Programme); DSP = Designated Service Provider; FP = Family
 order to unlock                                                                                                       Practitioner or Doctor; TEMPO = Biometric Screenings; HIB = Haemophilus influenzae Type B vaccine; HPV = Human
                        • Fitness and nutritional interventions (beneficiaries 18 and older)
 assessments
                        • 3 individualised consultations per year at a contracted biokineticist (wellness provider     Papilloma Virus; M = Member; M1+ = Member and family; MRI/CT scans = Magnetic Resonance Imaging/Computed
 for beneficiaries
 younger than 18.          network).                                                                                   Tomography scans; MRP = Mediscor Reference Price; NP = Network Provider; PET scan = Positron Emission
                        • 3 individualised consultations per year at a contracted dietician (wellness provider         Tomography scan; PMB = Prescribed Minimum Benefits; PPN = Preferred Provider Negotiators; PSA = Prostate
                           network).                                                                                   Specific Antigen.
The Pulse range is ideally suitable for you if:
                             • You are seeking a plan option that is based on your income (Pulse1).
                             • You are comfortable with making use of designated service providers (DSPs) within our Pulse network.
                             • You are looking for unlimited comprehensive cover for hospitalisation and the added benefit of preventative care.

                                   Method of Scheme benefit payment
                              PULSE1                                                       PULSE2

                     PULSE    • In-hospital benefits are paid from Scheme risk.
                              • Some preventative care benefits are available from
                                                                                           • In-hospital benefits are paid from Scheme risk.
                                                                                           • Some day-to-day benefits and preventative care
                                Scheme risk.                                                 benefits are available from Scheme risk.
                              • Some out-of-hospital benefits are paid from                • Some out-of-hospital benefits are paid from
                                Scheme risk.                                                 Scheme risk.
                              • Only Pulse specialist DSP network.                         • Only Pulse specialist DSP network.

                              • Benefits relating to conditions that meet the criteria for PMBs will be covered in full when using DSPs.

                                   In-hospital benefits
                             All benefits below are subject to pre-authorisations and clinical protocols and designated hospital networks.

                                                                        PULSE1                                 PULSE2
                              Accommodation (hospital stay)             100% Scheme tariff at a DSP hospital.
                              and theatre fees

                              Take-home medicine                        100% Scheme tariff.                    100% Scheme tariff.
                                                                        Medicine limited to 3 days.            Medicine limited to 7 days.

                              Treatment in mental health                100% Scheme tariff. Limited to 21 days per beneficiary.
                              clinics

                              Treatment of chemical and                 100% Scheme tariff (only PMBs).        100% Scheme tariff. Limited to 21
                              substance abuse                           Limited to 21 days per beneficiary.    days or R30 760 per beneficiary.
                                                                        Subject to network facilities.         Subject to network facilities.

                              Consultations and procedures              100% Scheme tariff.

     Unlimited FP             Surgical procedures and
                              anaesthetics
                                                                        100% Scheme tariff. Excluded
                                                                        from benefits: functional nasal
                                                                                                               100% Scheme tariff.

                                                                        surgery, surgery for medical
     consultations                                                      conditions e.g. Epilepsy,
                                                                        Parkinson’s disease and

     on our Pulse                                                       procedures where stimulators
                                                                        are used.

     Network!                 Organ transplants                         100% Scheme tariff (only PMBs).

                              Major medical maxillofacial               No benefit.                            100% Scheme tariff.
                              surgery strictly related to certain
                              conditions

                              Dental and oral surgery                   No benefit.                            100% Scheme tariff.

16                                                                                                                  COMPARATIVE GUIDE 2020
PULSE1                               PULSE2                                                                      PULSE1                                PULSE2
 Prosthesis (subject to preferred      100% Scheme tariff.                  100% Scheme tariff.                  Midwife-assisted births                100% Scheme tariff.
 provider, otherwise limits and        Limited to R50 552 per family.       Limited to R101 216 per family.
 co-payments apply)                                                                                              Supplementary services                 100% Scheme tariff.

 Prosthesis – Internal                 Sub-limits per beneficiary:          Sub-limits per beneficiary:          HIV / AIDS                             PMBs only at DSPs                     100% Scheme tariff. Subject to
                                       • *Functional R10 744.               • *Functional R16 794.                                                                                            pre-authorisation and DSPs.
 Note: Sub-limit subject to the        • Vascular R25 049.                  • Vascular R39 129.                  Alternatives to hospitalisation        100% Scheme tariff.
 above prosthesis limit                • Pacemaker (dual chamber)           • Pacemaker (dual chamber)
                                         R40 939.                             R53 040.                           Emergency evacuation                   Services rendered by ER24
 *Functional: Items utilised
                                       • Endovascular and catheter-based    • Spinal R39 129.                    International travel cover             Up to R10 million and a maximum of 90 days. Services rendered by Bryte
 towards treating or supporting
 a bodily function                       procedures – no benefit.           • Artificial disk R17 190.                                                  Insurance and managed by ER24.
                                       • Spinal R25 049.                    • Drug-eluting stents R17 190.
                                       • Artificial disk – no benefit.      • Mesh R17 190.                      Co-payments                            Co-payment where procedure has        Co-payment of up to R11 309
                                                                                                                                                        been clinically approved:             per event for voluntary use of a
                                       • Drug-eluting stents – PMBs and     • Gynaecology/Urology R12 780.
                                                                                                                                                        • R3 619 on all laparoscopic          non-DSP hospital.
                                         DSP products only.                 • Lens implants R10 970 per lens
                                                                                                                                                          procedures,
                                       • Mesh R9 161.                         per eye.
                                                                                                                                                        • R3 619 on prostate procedures,
                                       • Gynaecology/Urology R7 566.        • Joint replacements:
                                                                                                                                                        • R3 619 on procedures for
                                       • Lens implants R5 260 per lens      - Hip replacement and other major
                                                                                                                                                          prolapse/incontinence,
                                         per eye.                             joints R46 819.
                                                                                                                                                        • R3 619 on arthroscopy other
                                                                            - Knee replacement R54 679.
                                                                                                                                                          than acute trauma,
                                                                            - Minor joints R20 356.
                                                                                                                                                        • R3 619 on endoscopy
 Prosthesis – External                 No benefit (PMBs only).              Limited to R24 427 per family.                                                investigations done primarily in
                                                                                                                                                          hospital
 Exclusions (Prosthesis sub-limit      Joint replacement surgery (except    Not applicable.
                                                                                                                                                        • Co-payment of up to R11 309
 subject to preferred provider,        for PMBs).
 otherwise limits and                  PMBs subject to prosthesis                                                                                         per event for voluntary use of
 co-payments apply)                    limits:                                                                                                            a non-DSP hospital.
                                       • Hip replacement and other major
                                          joints R25 672.
                                       • Knee replacement R32 457.                                                    Out-of-hospital benefits
                                       • Minor joints R12 157.
                                                                                                                Note: Granting of benefits under the primary care services and the Scheme benefits shall be subject to treatment
 Orthopaedic and medical               100% Scheme tariff.                  100% Scheme tariff.
                                                                                                                protocols, preferred providers, DSPs, dental procedure codes, pathology and radiology lists of codes and medicine
 appliances                            Limited to R6 220 per family.
                                                                                                                formularies as accepted by the Scheme.
 Basic radiology and pathology         100% Scheme tariff.

 Specialised diagnostic imaging        100% Scheme tariff. Subject to pre-authorisation.                                                                PULSE1                                PULSE2

 Oncology                              PMBs only at DSPs.                   Oncology programme. 100%             Overall day-to-day limit               N/A                                   M = R13 854, M1+ = R27 537.
                                                                            Scheme tariff.                       FP consultations                       Unlimited FP visits. Subject to       Unlimited FP visits at Bestmed FP
 Peritoneal dialysis and               PMBs only at DSPs.                   100% Scheme tariff. Only at DSPs.                                           Bestmed Pulse1 FP networks.           network providers.
 haemodialysis
                                                                                                                 Diabetes primary care                  100% of Scheme tariff subject to registration with HaloCare.
 Confinements (Birthing)               100% Scheme tariff.                                                       consultation                           2 primary care consultations at Dis-Chem Pharmacies limited to
                                                                                                                                                        R341.90 per consultation.
 Mammary surgery                       No benefit.                          100% Scheme tariff. Limited
 (Breast cancer patients)                                                   to R35 000 subject to pre-
                                                                            authorisation for symmetrising                                              Pulse2 option: Paid first from the day-to-day benefit, thereafter Scheme
                                                                            surgery on unaffected breast..                                              risk.

 Refractive surgery and all types      No benefit (PMBs only).              100% Scheme tariff. Limited to       Casualty and out-of-network FP         Limited to R1 357 per family per      Limited to R1 471 per family per
 of procedures to improve or                                                R8 990 per eye.                      visits                                 year.                                 year.
 stabilise vision (except cataracts)

COMPARATIVE GUIDE 2020                                                                                                                                                                                                              17
PULSE1                               PULSE2                                                                         PULSE1                                 PULSE2
 Specialist consultations           Specialist consultations must        Specialist consultations must be        Basic radiology and                    Subject to Provider Network.           Subject to NP protocols and tariff
                                    be referred by a Pulse1 Network      referred by Network Provider.           pathology                              Pulse1 Protocols and tariff lists      lists. (Subject to overall day-to-
                                    Provider. Limited to M = R1 131,     Limited to M = R3 054, M1+ = R5                                                apply. Referral by Pulse1 Network      day limit). Referral by NP required.
                                    M1+ = R 1 697.                       881.                                                                           Provider required.                     Subject to pre-authorisation.
                                    Subject to Pulse Specialist DSP      Subject to overall day-to-day limit.
                                    network. R500 penalty for non-       Subject to Pulse specialist DSP         Specialised diagnostic imaging         No benefit.                            Subject to pre-authorisation.
                                    referral to specialists in PMB       network.                                                                                                              MRI/CT scans: A maximum of
                                    cases.                                                                                                                                                     3 scans per beneficiary.
                                                                                                                                                                                               PET scans: 1 scan per beneficiary.
 Basic and specialised dentistry    Basic dentistry: Subject to          Specialised dentistry is subject to
                                    Bestmed Pulse Dental Network.        pre-authorisation.                      HIV / AIDS                             PMBs only at DSPs.                     100% Scheme tariff. Subject to
                                    Specialised dentistry: No benefit.   Limited to                                                                                                            pre-authorisation and DSPs.
                                                                         M = R6 955,
                                                                                                                 Peritoneal dialysis and                PMBs only at DSPs.                     100% Scheme tariff. Only at DSPs.
                                                                         M1+ = R8 821
                                                                                                                 haemodialysis
                                                                         Subject to overall day-to-day limit.
                                                                                                                 Oncology                               PMBs only at DSPs.                     Oncology programme. 100%
 Medical aids, apparatus and        No benefit.                          Limited to R9 839 per family. Limit
                                                                                                                                                                                               Scheme tariff.
 appliances including wheelchairs                                        on wheelchairs of R12 666 per
 and hearing aids                                                        family, per 48 months.                  Rehabilitation services after          No benefit.
                                                                         Limit on hearing aids of R27 368        trauma
                                                                         per beneficiary per 24 months
                                                                         subject to pre-authorisation,
                                                                         quotation, audiogram and
                                                                         motivation).
                                                                                                                     Medicine
 Supplementary services             No benefit.                          Limited to
                                                                         M = R4 071,                            Benefits mentioned below may be subject to pre-authorisation, clinical protocols, preferred providers, designated
                                                                         M1+ = R8 086.                          service providers, formularies, funding guidelines and the Mediscor Reference Price (MRP). Refer to the Chronic
                                                                         (Subject to overall day-to-day         Conditions List at the back of the Comparative Guide.
                                                                         limit)
                                                                                                                Note: Approved CDL, PMB and non-CDL chronic medicine costs will be paid from the non-CDL chronic medicine limit
 Wound care benefit (incl.          No benefit.                          Limited to R9 500 per family.          first. Thereafter, approved CDL and PMB chronic medicine costs will continue to be paid (unlimited) from Scheme risk.
 dressings, negative pressure
 wound therapy treatment                                                                                        Note: Approved PMB biological and Non-PMB biological medicine costs will be paid from the Biological limit first.
 -NWPT- and related nursing                                                                                     Once the limit is depleted, only PMB biological medicine costs will continue to be paid unlimited from Scheme risk.
 services – out-of-hospital)

 Optometry benefit                  Benefits available every 24          Benefits available every 24                                                    PULSE1                                 PULSE2
 (PPN capitation provider)          months from date of service at       months from date of service.
                                                                                                                 CDL & PMB chronic medicine             100% Scheme tariff.                    100% Scheme tariff.
                                    PPN provider only.
                                                                                                                                                        40% co-payment on                      25% co-payment on
                                                                         Network Provider (PPN)
                                    Consultation - only PPN providers.                                                                                  non-formulary medicine.                non-formulary medicine.
                                                                         Consultation - 1 per beneficiary.
                                    Frame = R237 covered AND             Frame = R868 covered AND                Non-CDL chronic medicine               No benefit.                            16 conditions.
                                    100% of cost of standard lenses      100% of cost of standard lenses                                                                                       90% Scheme tariff.
                                    (single vision OR bifocal OR         (single vision OR bifocal OR                                                                                          Limited to M = R6 559,
                                    multifocal) OR                       multifocal) OR Contact lenses =                                                                                       M1+ = R13 118.
                                    Contact lenses = R600                R1 510                                                                                                                Co-payment of 20% for
                                                                         OR                                                                                                                    non-formulary medicine.
                                                                         Non-network Provider
                                                                         Consultation - R316 fee at non-         Biologicals and other high-cost        PMBs only - subject to                 Limited to R149 279 per
                                                                         network provider Frame = R579           medicine                               pre-approval.                          beneficiary.
                                                                         AND
                                                                         Single vision lenses = R184 OR          Acute medicine                         100% Scheme tariff.                    100% Scheme tariff.
                                                                         Bifocal lenses = R431 OR                                                       Subject to Bestmed formulary.          Limited to M = R4 354,
                                                                         Multifocal lenses = R747 OR                                                                                           M1+ = R8 821. (Subject to overall
                                                                         Contact lenses = R1 510                                                                                               day-to-day limit)

18                                                                                                                                                                                                   COMPARATIVE GUIDE 2020
PULSE1                                  PULSE2                                                                                     PULSE1                                            PULSE2
 Over-the-counter (OTC) medicine     Limited to R368 per family.             Limited to R579 per family.               Maternity Benefits                               100% Scheme tariff. Subject to the following benefits:

 Includes sunscreen, vitamins and                                                                                                                                       Consultations:
 minerals with nappi codes on                                                                                                                                           • 9 antenatal consultations at a FP OR gynaecologist OR midwife.
 Scheme formulary                                                                                                                                                       • 1 post-natal consultation at a FP OR gynaecologist OR midwife.
                                                                                                                                                                        Ultrasounds:
                                                                                                                                                                        • 1 x 2D ultrasound scan at 1st trimester (between 10 to 12 weeks) at a
       Preventative care benefits                                                                                                                                          FP OR gynaecologist OR radiologist.
                                                                                                                                                                        • 1 x 2D ultrasound scan at 2nd trimester (between 20 to 24 weeks) at a
Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, preferred providers,                                                               FP OR gynaecologist OR radiologist.
designated service providers, formularies, funding guidelines and the Mediscor Reference Price (MRP).                                                                   Supplements:
                                                                                                                                                                        • Antenatal iron supplements - 9 fills subject to formulary.
                                                                                                                                                                        • Antenatal folic acid – 9 fills subject to formulary.
                                     PULSE1                                  PULSE2
                                                                                                                     Disclaimer on exclusions: General and option specific exclusions apply. Please refer to www.bestmed.co.za for more details.
 Preventative care                   •   Flu vaccines.
                                     •   Pneumonia vaccines.
 Note: Refer to Scheme rules for     •   Paediatric immunisations.
 funding criteria applicable to      •   Back and neck preventative programme.                                             Contributions
 each preventative care benefit.
                                     •   Female contraceptives R2 205 per beneficiary per year.
                                     •   HPV vaccinations (Females 9-26 years)                                                                                    PULSE1                                                                               PULSE2

 Tempo Programme (Wellness)          Individual Health Risk Assessments (Adults aged 18 and older) –                   Income level                               R0 – R5 500 p.m.           R5 501 – R8 500 p.m.             > R8 501 p.m.            N/A
                                     Biometric screening and lifestyle questionnaire to be completed at a              Medical Savings Account                                                          N/A                                            N/A
 Note: Completing your Health        network pharmacy or onsite at selected employers (1 per year).
 Risk Assessment (HRA) unlocks       Child dependant assessments                                                       Principal                Risk              R1 626                     R1 953                           R2 344                   R5 770
 the other Tempo benefits.                                                                                             Member
                                     • Ages 13-17 years: Assessment done by a contracted biokineticist
                                                                                                                                                Savings           R0                         R0                               R0                       R0
                                        (wellness network provider) – 1 per beneficiary per year.
 One parent must complete
 their HRA in order to unlock        • Ages 3-12 years: Assessment done by a contracted occupational                                            Total             R1 626                     R1 953                           R2 344                   R5 770
 assessments for beneficiaries          therapist (wellness network provider) – 1 per beneficiary per year.
                                                                                                                       Adult                    Risk              R1 545                     R1 856                           R2 109                   R5 770
 younger than 18                     • Ages 0-2 years: Baby growth and development assessments done at a
                                                                                                                       Dependant
                                        contracted pharmacy clinic – 3 assessments per year.                                                    Savings           R0                         R0                               R0                       R0
                                     • Family assessments - Nutrition
                                                                                                                                                Total             R1 545                     R1 856                           R2 109                   R5 770
                                     • Family nutritional assessment done at a contracted dietician (wellness
                                        network provider) – 1 per family per year.                                     Child                    Risk              R978                       R1 172                           R1 172                   R1 371
                                     • Fitness and nutritional interventions (beneficiaries 18 and older)              Dependant
                                     • 3 individualised consultations per year at a contracted biokineticist                                    Savings           R0                         R0                               R0                       R0
                                        (wellness provider network).                                                                            Total             R978                       R1 172                           R1 172                   R1 371
                                     • 3 individualised consultations per year at a contracted dietician (wellness
                                        provider network).                                                             Maximum contribution child                 Not applicable.                                                                4
                                                                                                                       dependant*

                                                                                                                       Recognition of a child                     Not applicable.                                             Under 21, unless a registered
                                                                                                                       dependant                                                                                              student.

                                                                                                                     *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; FP =
                                                                                                                     Family Practitioner or Doctor; TEMPO= Biometric Screenings; 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; PSA = Prostate
                                                                                                                     Specific Antigen.
COMPARATIVE GUIDE 2020                                                                                                                                                                                                           19
You can also read