Comparative guide 2018 - personally yours

 
Comparative guide 2018 - personally yours
Comparative
guide
2018

       personally yours
Comparative guide 2018 - personally yours
Personally
Yours

                                     Our focus is to provide superior healthcare to our members through the legendary Bestmed touch.

                                     We are, after all, a medical scheme for members, by members. Over the years Bestmed has grown
                                     sustainably and has been able to build a reputable name in the industry. But Bestmed is still raising
                                     the bar in the medical aid industry to the point where we have grown our membership to reach the
                                     fourth overall position countrywide.

                                     Bestmed belongs to its members. We deliver a service that gives personal attention to each query
                                     and enquiry that a member has. Members receive personal, individual and undivided attention in all
                                     their dealings with their chosen medical scheme.

                                     It is Bestmed’s every intention to ensure that every member receives the quality service that they
                                     deserve.

                                     As a self-administered scheme, Bestmed now has around 95 000 principal members and provides
                                     healthcare benefits to 200 000 lives. With our extensive experience and exceptional expertise, we
                                     can negotiate with our service providers to offer our members benefits and services that are, rand-
                                     for-rand, the best value compared to other large open medical schemes.

                                     The right fit
                                     To address our members’ desire for choice and flexibility, Bestmed has designed 13 healthcare
                                     options which are structured differently to suit various healthcare needs. We recognise
                                     that members’ healthcare needs will vary depending on age, marital status and different
                                     responsibilities and priorities. So, whether you essentially want to cover hospital costs or require
                                     a more comprehensive offering, covering all healthcare requirements, we have an option for you.

                                     Our Beat, Pace and Pulse benefit options have been designed based on engagements and
                                     conversations with members over our many years of experience. After listening intently to their
                                     concerns, our healthcare experts have translated these insights into benefit options that are
                                     easy to understand and cater for all needs.

                                     Focused on wellness
                                     Your continued health and wellbeing is our primary concern. That is why we encourage all of
                                     our members to live a more preventive, meaningful and productive life through our wellness
                                     programme known as BetterMe. We are here to assist you to become a better version of yourself
                                     through choosing a healthier lifestyle.

                                     Our wellness philosophy is based on five basic wellness pillars. We encourage our members to:

                                     Be Active:         Incorporate exercise as part of your daily routine to promote positive changes.

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

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

                                     Be Happy:          Create and maintain a balance between work, life and home.

                                     Be Fin-fit: Making informed financial decisions in life will ensure financial independence.

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

In line with this vision, Bestmed has adopted a three-pronged approach in order to deliver on its promise, which
includes Corporate Wellness, a Client Service Programme, as well as Administration. Bestmed advisors are responsible
for implementing these service programmes at employer organisations. Today, Bestmed services over 160 employer
organisations, including large corporate businesses, some of South Africa’s biggest universities and a variety of
parastatals.

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

Member advantages of using Bestmed Provider Networks
Making use of the Bestmed provider networks has a number advantages to both providers and members. Some of the
advantages include:
• Provider fees are set and managed as agreed.
• Quality of healthcare services are enhanced.
• Downstream costs are better managed.
• Providers are paid directly and on a weekly basis by the Scheme.
• No or minimum co-payments by the members depending on benefits available.
• A longer lasting medical savings account.
• Network lists, provider names and addresses are available on the website.
• A dedicated provider consultant service is available to the network providers.

Bestmed Designated Service Provider (DSP) Network for Prescribed Minimum
Benefits (PMBs).
The Specialist Network, which includes all the major specialist disciplines is a Designated Service Provider network.
Currently there are around 1 700 specialists on the network who are located across the country with rooms close to or in
many of the general private hospitals. The coverage of this network also continues to grow with more and more providers
joining each month. Bestmed members should therefore be able to easily access the specialists on the network.

Since 1 May 2016 members have been required to use a specialist on the DSP network for services related to their PMB
conditions, and such service will be charged and paid at the agreed DSP rate.

Should a member voluntarily choose not to use a specialist from the DSP network for a PMB, the Scheme will only pay up
to the Scheme rate, and any charges above this rate will be for the member’s account.

                                                                                              Bestmed Comparative Guide 2018   3
Comparative guide 2018 - personally yours
Don’t worry, be Appy!
           The Bestmed App has now been completely updated, with a fresh new look and better features to save
           you time and money.

           It’s more user-friendly, and has been designed to put all your essential medical information at your
           fingertips.

           The new Bestmed App is just one more way that Bestmed is Personally Yours.

           To make the most of the new features, remove the old App from your phone and download the new version
           from the App Store or Google Play.

           You’ll notice that the updated App has a new icon, and an easy-to-use slide-out menu that lets you:
           • Download your tax certificate.
           • Get automatic updates on Scheme communications.
           • Find information on all benefits.
           • Update your personal details.
           • Submit your chronic medication claims.
           • Search for a specialist in your area.

           Remember to remove the old version of the Bestmed App from your smartphone before downloading the
           new version and stay Appy with Dr Bestie.

               Want all your
               medical
               information at
               your fingertips?
               Don’t worry, be Appy!

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Comparative guide 2018 - personally yours
Below is a summary of the current Bestmed Provider networks:
                                      Family practitioners
                                      Family practitioner Pulse1 network
                                      Specialists
                                      Pulse specilaist DSP network
                                      Pathology
                                      Oncology
  Healthcare Provider Networks
                                      Pharmacies
                                      Dentists
                                      Dental network Pulse1 and Pulse2
                                      Dental therapists
                                      Dental technicians
                                      Orthodontists

                                      Audiologists and speech therapists
                                      Physiotherapists
                                      Occupational therapists
                                      Hearing aid acousticians
        Ancillary Networks            Counsellors
                                      Midwives and nursing
                                      Psychologists
                                      Biokineticists
                                      Dieticians

                                      Stents and pacemakers
                                      Orthopaedic prosthesis
                                      Oxygen supply
     Product Supply Networks
                                      Sleep apnoea devices
                                      Stoma Care
                                      Hearing aid devices

                                      Drug and alcohol rehabilitation
                                      Emergency services
                                      Optometry services
         Service Networks             Renal dialysis
                                      Wound therapy
                                      DBC programme
                                      HIV/AIDS Care

The Bestmed Networks apply to all options.

   Bestmed has the
   widest hospital
   network range in
   South Africa.

                                                                           Being self-administered
                                                                           means that we do
                                                                           not use member’s
                                                                           contributions to pay
                                                                           a company to do our
                                                                           administration. This
                                                                           means that more of your
                                                                           money goes into giving
                                                                           you more benefits.

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Comparative guide 2018 - personally yours
Bestmed Managed Care Programmes
      The Managed Health Care Programmes have been developed to assist members by providing additional
      benefits to treat the following specific disease conditions with appropriate treatment, in a cost-effective
      manner. These programmes include: Oncology Care, HIV/AIDS Care, Dialysis Care, Alcohol and Substance
      Abuse Care, Wound Care, Stoma Care, Preventative Care and Maternity Care.

      Oncology Care

      Bestmed’s various Scheme options have specified benefits that define the cover for cancer. These benefits
      are called oncology benefits.

      Bestmed provides oncology benefits applying evidence-based medicine principles and considering
      affordability across the different benefit options. It has therefore appointed the Independent Clinical
      Oncology Network (ICON) for Beat4, Pace1, 2, 3, 4 and Pulse2 as DSP. Beat1, 2, 3 and Pulse1 members
      should make use of the state as DSP where available. Members on Pace3 and Pace4 have access to the
      enhanced ICON protocols where it is clinically appropriate whilst the other options only have access to the
      standard ICON protocols.

      Members registered on the oncology programme qualify for cancer benefits. Members must forward
      a clinical summary and histology of their cancer, as set out by their treating doctor, to register on the
      programme. This must contain the history, ICD–10 codes, the clinical findings of the doctor as well as the
      test results confirming the cancer and the specific type of cancer.

      HIV/AIDS Care

      Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by
      the human immunodeficiency virus (HIV). By damaging your immune system, this virus interferes with your
      body’s ability to fight the organisms that cause disease.

      HIV/AIDS is a sexually transmitted infection. It can also be spread by contact with infected blood or from
      mother to child during pregnancy, childbirth or breastfeeding. Without medicine, it may take years before
      HIV weakens your immune system to the point that you have full blown AIDS.

      There is currently no cure for HIV/AIDS, but there is medicine available that can dramatically slow down the
      progression of the disease.

      To qualify for benefits, a member or dependant must register on the HIV/AIDS programme. A member must
      forward a clinical summary that has been obtained from the treating doctor to the DSP (LifeSense) as
      appointed by the Scheme. This summary must contain the relevant history, clinical findings, results of the
      HIV/AIDS diagnostic test as well as all the CD4 and viral load test results. Any additional results that have a
      bearing on the clinical picture or the impact the disease has on the patient, must be forwarded. Examples of
      such tests include full blood count, liver function tests and specimens sent for microscopy.

      The programme also makes provision for blood tests to follow the course of the disease and to measure the
      response to treatment, medicine and anti–retrovirals, as well as medicine specifically used to fight the virus.
      The treatment programme covered by the Scheme is based on the HIV/AIDS funding guideline and approved
      treatment depends on the clinical parameters of each individual. The stage of the disease and the results of
      blood tests determine what treatment will be covered and how the individual must be followed up. Cover is
      also provided for mother–to–child transmission in pregnancy and as post–exposure prophylaxis.

      Details can be obtained by contacting LifeSense Managed Care, using the contact details provided on the
      back of this guide. The Clicks and Dis-Chem courier service or retail outlets as well as Medipost courier
      service are the designated service providers for dispensing of HIV medicine.

      Dialysis Care

      Members who require chronic dialysis for end-stage renal disease can register on the dialysis programme.
      Depending on clinical and other parameters, the Scheme will consider funding for peritoneal or
      haemodialysis. Medicines that are used in end-stage renal disease are only covered when the Scheme
      funding guidelines are met. Bestmed has appointed National Renal Care (NRC) as Designated Service
      Provider (DSP) for renal dialysis services for its members on all the benefit options.

      Members registered on the dialysis programme qualify for additional benefits. In order to be registered on
      the programme, patients must obtain a clinical summary of their condition as set out by their treating doctor.
      This must contain the history, ICD-10 codes and clinical findings of the doctor as well as the test results and
      details on any associated disease, e.g. diabetes.

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Alcohol and Substance Abuse Care

Bestmed has contracted various designated service providers (DSPs) to provide rehabilitation
for alcohol and substance abuse. Please note that this benefit is subject to pre-authorisation
and will be funded up to a maximum limit or 21 days, or whichever is depleted first.

Wound Care

Specialised wound care therapy, including dressings and negative-pressure wound therapy
(NPWT) treatment and related nursing services are included in Bestmed’s Provider Network.

Stoma Care

Bestmed has partnered with a supplier for the supply and distribution of stoma and
incontinence care products. Bestmed members who are registered on Stoma Care receive the
following value-added benefits:
  • Members are assisted to obtain the relevant Scheme authorisation for their stoma products.
  • Members are provided with direct contact details for the supplier’s business unit to address
    all their product-related enquiries.
  • Members are provided with a quoting and product sourcing service of the most affordable
    and cost-effective products as not all stoma and incontinence care needs of patients are
    covered in full by the Scheme.
  • Direct submission of claims to Bestmed to ensures that members do not have to pay cash
    up front and claim back from the Scheme.

Preventative Care

At Bestmed we encourage our members to actively pursue a healthier and more active lifestyle
to encourage better health.

In line with this philosophy we have developed preventative care that entitles you, the member,
to undergo a number of screenings, preventative tests and vaccines to encourage better health.

Preventative care is important in making sure you detect medical conditions early and we
can ensure the best care for you in this regard. Bestmed offers preventative care that covers
a number of benefits from the Scheme’s risk benefit, and not your savings. General and
optionspecific exclusions may apply to the various options. Please refer to www.bestmed.co.za
for more details.

Flu vaccines: All members are eligible and annually receive a letter to remind them of this
preventative care benefit when flu vaccines become available. By making use of preferred
provider pharmacies for flu vaccinations, members will have minimum or no co-payments.

Pneumonia vaccines: Bestmed identifies high-risk members, who receive a letter to advise
them that they are eligible for a pneumonia vaccination.

Paediatric immunisations: Bestmed reimburses vaccines for children as listed on the
Department of Health vaccine schedule on all Bestmed options, except for Beat1.

Back and neck preventative treatment: Documentation Based Care (DBC) and workability are
providers for Bestmed’s back and neck treatment programme.

The back and neck programme is completely evidence and outcomes based with a success rate
in excess of 85% after a six-week period of treatment.

The principles applied are those of analysing, correcting and maintaining correct body posture
as well as stabilisation of the spine.

All members are eligible for this benefit. For a member to register on the programme he/she
needs to visit a DBC or Workability clinic and have an assessment done by the clinic who will
then motivate if the member qualifies for this programme. The member can thereafter send the
application to Bestmed for authorisation.

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Comparative guide 2018 - personally yours
Haemophilus influenzae Type B vaccine (HIB titre): This vaccine is administered in the prevention
              of illnesses that are caused by this bacterium – most commonly bacteremia, pneumonia, epiglottitis,
              bacterial meningitis.

              Human papillomavirus vaccine (HPV): The HPV vaccination is administered to assist in the
              prevention of cervical cancer and anal cancer. This benefit is available to all females between nine and
              26 years of age. Please note that protocols and general and option-specific exclusions may apply.

              Female contraceptives: All females of child-bearing age qualify for female contraceptives to the
              value of R1 950 per family per year.

              Preventative dentistry: This benefit includes a general full-mouth examination by a general dentist,
              full-mouth inter-oral radiographs, scaling and polishing, fissure sealing and space maintainers for all
              members. General and option-specific exclusions may apply.

              Mammogram: All females 40 years and older qualify for a mammogram. Please note that protocols as
              well as general and option-specific exclusions may apply. Please refer to www.bestmed.co.za for more
              details.

              Pap smear: All females 18 years and older qualify for a pap smear. Please note that protocols as well
              as general and option-specific exclusions may apply. Please refer to www.bestmed.co.za for more
              details.

              PSA screening: Prostate-specific antigen (PSA) blood test is a cancer screening test. PSA is a
              substance made by cells in the prostate gland (both normal cells and cancer cells). PSA is mostly found
              in semen, but a small amount is also found in the blood. Most healthy men have levels under four
              nanograms per millilitre (ng/mL) of blood. All males older than 50 qualify for a PSA test. Please note
              that protocols and general and option-specific exclusions may apply. Please refer to www.bestmed.
              co.za for more details.

              BetterMe programme (available from 2018)

              Until now the only preventive benefits we have provided in the options with regard to lifestyle
              management programmes, were the inclusion of the health risk assessments for adult beneficiaries.
              We have now decided to include more assessments in the programme that will be of benefit to all
              beneficiaries.

              These additional assessments are aimed at identifying the risk areas of the total family and no longer
              only the adult beneficiaries. By including these, parents will be able to take note of their children’s
              health risks and make the necessary steps and changes in assisting them to address these risk areas.

              Health risk assessments (biometric screening and lifestyle questionnaire): These assessments
              will be done by either the network pharmacies or onsite at your employer organisation during their
              wellness days or similar events. All beneficiaries older than 21 will have access to this assessment.
              Having this assessment done – will unlock the following further assessments that are all part of the
              BetterMe preventive benefit package. All assessments should be done at contracted providers.

              Fitness assessment: All beneficiaries 13 years and older will be able to undergo a detailed fitness
              assessment once a year at a registered BASA accredited biokineticist.

              Nutritional assessment: Families will have access to one nutritional assessment at a contracted
              dietician to assess their current status of their diet.

              Occupational therapist assessment: Each beneficiary ages 3 to 12 years will qualify for one
              complete assessment.

              Baby growth assessments: Each beneficiary ages 0 months to 35 months will qualify for three
              consultations at a Bestmed contracted pharmacy clinic per year. During these consultations the
              baby’s height and weight will be measured and captured in order to monitor the child’s health and
              development. This new offering will replace the Infant Care programme.

              Based on the results received from all the contracted providers doing the assessments, families will be
              able to receive a detailed report indicating what their health status or health risks are and how they
              should go about in addressing these, should it be required.

              For more information regarding the BetterMe programme, please send an email to
              betterme@bestmed.co.za or fax to 012 472 6787.

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Maternity Care

Our Maternity Care programme is designed to give you information and support during your
pregnancy.

Registering on this programme will give you the following support and benefits:
  • A 24-hour help line.
  • Weekly e-mails with helpful tips about your pregnancy, your baby’s development and how
    to deal with unpleasant pregnancy symptoms.
  • During your pregnancy you will receive a welcome pack and other small surprises:
       • Baby bag.
       • Pregnancy guide.
       • Discount vouchers.
       • Various baby items.
  • Register on the Maternity Care programme simply by sending an e-mail to
    info@babyhealth.co.za or you can call us on 086 111 1936.

* Please note that you may only register on the Maternity Care programme after the 12th week of pregnancy.

         Bestmed is the
         only Scheme that
         covers midwife-
         assisted births
         at 100% of
         Scheme tariff, on
         all options.

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Beat

   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 starting
   out.                          Beat1, 2 and 3 also
                                 offer you the decision
                                 to lower your monthly
                                 contribution in the form
                                 of a Network option.
Method of Scheme benefit payment
                         Beat1                                     Beat2                                       Beat3                                      Beat4
           •    In-hospital services are paid       •   In-hospital services are paid from      •   In-hospital services are paid from    •    In-hospital services are paid from
                from Scheme risk.                       Scheme risk.                                Scheme risk.                               Scheme risk.
           •    Some preventative care              •   Some preventative care services         •   Some day-to-day services are paid     •    Some out-of-hospital services are
                services are available from             are available from Scheme risk.             from Scheme risk and some from             paid from your medical savings

                                                                                                                                                                                    Beat
                Scheme risk.                                                                        your medical savings account.              account first, once depleted, from
Beat

                                                    •   Out-of-hospital services are paid
           •    Out-of-hospital services are            from your medical savings account.      •   Some preventative care services            your day-to-day benefit.
                paid from your own pocket.                                                          are available from Scheme risk.       •    Some preventative care services
                                                                                                                                               are available from Scheme risk.

       Beat Network plan option
       •       Bestmed offers members a choice of network hospitals for in-hospital benefits.
       •       If a member voluntarily chooses not to make use of a hospital within the Beat network, a maximum co-payment of R10 000 will apply for the use of a non-
               designated service provider.
       •       The Family Practitioner (FP) consultation benefit is limited to Bestmed network providers.
       •       Specialist consultations are limited to Bestmed designated service providers.

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

                                                                Beat1                           Beat2                           Beat3                           Beat4
           Accommodation (hospital stay)                                                 100% Scheme tariff.                                              100% Scheme tariff.
           and theatre fees                                  DSP specialist network applicable if the discounted Network option is chosen.
           Take-home medicine                                                                100% Scheme tariff. Medicine limited to 7 days.
           Treatment in mental health clinics                                          100% Scheme tariff. Limited to 21 days per beneficiary.
           Treatment of chemical and                                                                    100% Scheme tariff.
           substance abuse                                                   Limited to 21 days or R27 200 per beneficiary. Subject to network facilities.
           Consultations and procedures                                                  100% Scheme tariff.                                              100% Scheme tariff.
                                                             DSP specialist network applicable if the discounted Network option is chosen.
           Surgical procedures and anaesthetics                     100% Scheme tariff. Day clinics.                                      100% Scheme tariff.
           Organ transplants                                                                         100% Scheme tariff (only PMBs).
           Major medical maxillofacial surgery                No benefit. (PMBs only at DSP day hospitals).                100% Scheme tariff.            100% Scheme tariff.
           strictly related to certain conditions                                                                        Limited to R10 900 per           Limited to R11 100
                                                                                                                                 family.                      per family.
           Dental and oral surgery                            No benefit. (PMBs only at DSP day hospitals).                 Limited to R6 800              Limited to R8 500
                                                                                                                                per family.                    per family.

                        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.
                                                                                                                                  Are you scheduled
                                                                                                                                  for a medical
                                                                                                                                  procedure in the
                                                                                                                                  near future? Be
                                                                                                                                  sure to obtain pre-
                                                                                                                                  authorisation before
                                                                                                                                  you go.

                                                                                                                                      Bestmed Comparative Guide 2018        11
In-hospital benefits (continued)
                                                       Beat1                               Beat2                              Beat3                           Beat4
       Prosthesis (Subject to preferred                100% Scheme tariff. Limited to R66 400                           100% Scheme tariff.           100% Scheme tariff.
       provider, otherwise limits and co-                          per family.                                        Limited to R67 100 per          Limited to R81 900
       payments apply)                                                                                                        family.                     per family.
Beat

       Prosthesis – Internal                Sub-limits per beneficiary:                                           Sub-limits per beneficiary:     Sub-limits per beneficiary:
                                            •    *Functional limited to R11 880.                                  •   *Functional limited to      •   *Functional limited to
       Note: Sub-limit subject to                                                                                     R11 880.                        R14 300.
                                            •    Vascular R26 500.
       the above prosthesis limit.
                                            •    Pacemaker (dual chamber) R36 200.                                •   Vascular R26 600.           •   Vascular R28 300.

       *Functional: Items utilised          •    Endovascular and catheter-based procedures - no                  •   Pacemaker (dual             •   Pacemaker (dual
       towards treating or supporting            benefit.                                                             chamber) R36 200.               chamber) R47 400.
       a bodily function                    •    Spinal R26 500.                                                  •   Endovascular and            •   Endovascular and
                                                                                                                      catheter-based                  catheter-based
                                            •    Artificial disk - no benefit.                                        procedures - no benefit.        procedures - no benefit.
                                            •    Drug-eluting stents - no benefit.                                •   Spinal R26 600.             •   Spinal R28 300.
                                            •    Mesh R9 300.                                                     •   Artificial disk - no        •   Artificial disk -
                                            •    Gynaecology/Urology R7 600.                                          benefit.                        no benefit.
                                            •    Lens implants R5 800 per lens.                                   •   Drug-eluting stents - no    •   Drug-eluting stents
                                                                                                                      benefit.                        R15 900.
                                                                                                                  •   Mesh R9 350.                •   Mesh R10 500.
                                                                                                                  •   Gynaecology/Urology         •   Gynaecology/Urology
                                                                                                                      R7 720.                         R7 700.
                                                                                                                  •   Lens implants R5 800        •   Lens implants R6 000
                                                                                                                      per lens.                       per lens.

       Prosthesis – External                                                               No benefit                                                  Limited to R19 700
                                                                                                                                                           per family.
       Exclusions (Prosthesis               Joint replacement surgery (except for PMBs).                          Joint replacement surgery       Joint replacement surgery
       sub-limit subject to preferred       PMBs subject to prosthesis limits:                                    (except for PMBs).              (except for PMBs).
       provider, otherwise limits and                                                                             PMBs subject to prosthesis      PMBs subject to prosthesis
                                            •    Hip replacement and other major joints R27 900.
       co-payments apply)                                                                                         limits:                         limits:
                                            •    Knee replacement R34 400.                                        • Hip replacement and           • Hip replacement and
                                            •    Minor joints R10 700.                                                other major joints              other major joints
                                                                                                                      R28 100.                        R29 100.
                                                                                                                  •   Knee replacement            •   Knee replacement
                                                                                                                      R34 770.                        R38 660.
                                                                                                                  •   Other minor joints          •   Other minor joints
                                                                                                                      R10 700.                        R11 880.
       Orthopaedic and medical appliances                                                               100% Scheme tariff.
       Pathology                                                                                        100% Scheme tariff.
       Diagnostic imaging                                                                               100% Scheme tariff.
       Specialised diagnostic imaging               100% Scheme tariff. Subject to co-payments.                                         100% Scheme tariff.
       Oncology                                                     PMB Only (DSP: State hospitals where available)                                   100% Scheme tariff.
                                                                                                                                                      Oncology programme.
       Peritoneal dialysis and                                                   No benefit. PMBs only at DSPs.                                       100% Scheme tariff.
       haemodialysis                                                                                                                                    Subject to pre-
                                                                                                                                                         authorisation
       Confinements                                                                                     100% Scheme tariff.
       Refractive surgery                                              No benefit.                                   100% Scheme tariff.             100% Scheme tariff.
                                                                                                                        Subject to pre-           Subject to pre-authorisation
                                                                                                                  authorisation and protocols.     and protocols. Limited to
                                                                                                                  Limited to R7 000 per eye.           R7 900 per eye.
       Midwife-assisted births                                                                          100% Scheme tariff.
       Supplementary services                                                                           100% Scheme tariff.
       Alternatives to hospitalisation                                                                  100% Scheme tariff.
       Emergency evacuation                                                       100% Scheme tariff. Pre-authorised and rendered by ER24.
       Co-payments                              Co-payment of R3 200 on all endoscopic investigations                     Co-payment of                  Not applicable.
                                                and specialised diagnostic imaging if done in a private             R3 200 on all endoscopic
                                                      hospital. Any other facility, no co-payment.                 investigations if done in a
                                                                                                                   private hospital. Any other
                                                                                                                     facility, no co-payment.

           12   Bestmed Comparative Guide 2018
Out-of-hospital benefits
Note: Benefits mentioned below are subject to Scheme tariff, and may also be subject to pre-authorisation and clinical protocols.

                                               Beat1                       Beat2                            Beat3                             Beat4
 Overall day-to-day limit                                                  Not applicable.                                       M = R10 800, M1+ = R21 600.

                                                                                                                                                                     Beat
 Family Practitioner (FP) and                 No benefit.            Savings first. FP and specialist consultations only at                Savings first.
 specialist consultations                                                     Bestmed DSPs at network tariffs.                        Limited to M = R2 750,
                                                                                                                                 M1+ = R4 900. (Subject to overall
                                                                                                                                         day-to-day limit)
 Basic and specialised dentistry              No benefit.               Basic: Preventative benefit or savings account.                    Savings first.
                                                                                 Specialised: Savings account.                        Limited to M = R4 650,
                                                                          Orthodontic: Subject to pre-authorisation.             M1+ = R9 340. (Subject to overall
                                                                                                                                  day-to-day limit). Orthodontics
                                                                                                                                 are subject to pre-authorisation.
 Medical aids, apparatus and                  No benefit.                                Savings account.                            Savings first. 100% Scheme
 appliances including wheelchairs                                                                                                    tariff. Limited to R9 700 per
 and hearing aids                                                                                                                     family. (Subject to overall
                                                                                                                                             day-to-day limit)
 Supplementary services                       No benefit.                                Savings account.                                  Savings first.
                                                                                                                                      Limited to M = R4 200,
                                                                                                                                 M1+ = R8 530. (Subject to overall
                                                                                                                                         day-to-day limit)
 Wound care benefit (incl.                                              100% Scheme tariff.                                          Savings first. 100% Scheme
 dressings, negative pressure                                      Limited to R 2 970 per family.                                    tariff. Limited to R4 200 per
 wound therapy treatment and                                                                                                          family. (Subject to overall
 related nursing services - out-of-                                                                                                          day-to-day limit)
 hospital)
 Optometry benefit                            No benefit.               Savings account.                                 Consultation R365.
 (PPN capitation provider)                                                                                                Frame R550 AND
                                                                                                                    Single-vision lenses R175 OR
                                                                                                                       Bifocal lenses R380 OR
                                                                                                                       Multifocal lenses R695.
                                                                                                                       Contact lenses R1 420
 Diagnostic imaging                           No benefit.                                Savings account.                                  Savings first.
 and pathology                                                                                                                        Limited to M = R2 750,
                                                                                                                                 M1+ = R5 600. (Subject to overall
                                                                                                                                         day-to-day limit)
 Specialised diagnostic imaging                         100% Scheme tariff.                           100% Scheme tariff.                100% Scheme tariff.
                                                    Limited to R4 500 per family.                    Limited to R9 450 per          Limited to R14 300 per family.
                                                                                                            family.
 Oncology                                                                     PMB only                                                  Oncology programme.
                                                                                                                                        100% Scheme tariff.
 Maternity benefits                           No benefit.               Savings account.                                100% Scheme tariff.
                                                                                                            2 sonars and up to 12 antenatal consultations.
 Rehabilitation services                      No benefit.                                Savings account.                                  Vested savings.
 after trauma

                                                                                                                      Bestmed Comparative Guide 2018         13
Medicine
       Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, formularies, funding guidelines and the Mediscor Reference Price (MRP).
       Approved CDL, PMB and non-CDL chronic medicine costs will be paid from the non-CDL chronic medicine limit first. Once the limit is depleted, CDL and PMB
       chronic medicine will be unlimited from Scheme risk.
       Note: Refer to the Chronic Conditions List at the back of the Comparative Guide.

                                                          Beat1                            Beat2                              Beat3                            Beat4
Beat

        CDL & PMB chronic medicine                          100% Scheme tariff. Co-payment of 40% for non-formulary medicine.                             100% Scheme tariff.
                                                                                                                                                        Co-payment of 30% for
                                                                                                                                                        non-formulary medicine.
        Non-CDL chronic medicine                                           No benefit.                                       5 conditions.                    9 conditions.
                                                                                                                 75% Scheme tariff. Limited to     85% Scheme tariff. Limited to
                                                                                                                  M = R2 900, M1+ = R5 900.        M = R6 370, M1+ = R12 740.
                                                                                                                     Co-payment of 40% for              Co-payment of 30% for
                                                                                                                     non-formulary medicine.            non-formulary medicine.
        Biologicals and other                                                                                 No benefit.
        high-cost medicine
        Acute medicine                                    No benefit.                                     Savings account.                               Savings first. Limited to
                                                                                                                                                       M = R2 430, M1+ = R4 910.
                                                                                                                                                           (Subject to overall
                                                                                                                                                            day-to-day limit)

        Over-the-counter (OTC) medicine                   No benefit.                                     Savings account.                          *Member choice: 1. R550 OTC
        See benefit option rules                                                                                                                   limit OR 2. Access to full PMSA
                                                                                                                                                   for OTC purchases (after R550
                                                                                                                                                      limit) = self-payment gap
                                                                                                                                                             accumulation.

       *The default OTC choice is 1. R550 OTC limit. Members wishing to choose the other option are welcome to contact Bestmed.

                 Preventative care benefits
       Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, formularies, funding guidelines and the Mediscor Reference Price (MRP).

                                                   Beat1                                  Beat2                               Beat3                             Beat4
        Preventative care            •   Flu vaccines.                        •   Flu vaccines.                  •   Flu vaccines.                 •    Flu vaccines.
        benefits                     •   Pneumonia vaccines.                  •   Pneumonia vaccines.            •   Pneumonia vaccines.           •    Pneumonia vaccines.
                                     •   Female contraceptives -              •   Paediatric immunisations.      •   Paediatric immunisations.     •    Paediatric immunisations.
        Note: Refer to Scheme            R1 950 per family per year.          •   Female contraceptives -        •   Female contraceptives -       •    Female contraceptives -
        rules for funding
                                     •   DBC programme.                           R 1 950 per family per             R1 950 per family per year.        R1 950 per family per year.
        criteria applicable to
                                     •   Pap smear – ages 18 and                  year.                          •   DBC programme.                •    DBC programme.
        each preventative
                                         above, every 24 months.              •   DBC programme.                 •   Preventative dentistry.       •    Preventative dentistry.
        care benefit.
                                                                              •   Preventative dentistry.            (incl. gloves and sterile          (incl. gloves and sterile
                                                                                  (incl. gloves and sterile          equipment)                         equipment).
                                                                                  equipment)                     •   Pap smear – ages 18 and       •    Haemophilus influenzae
                                                                              •   Pap smear – ages 18 and            above, every 24 months.            Type B vaccine. (HIB).
                                                                                  above, every 24 months.                                          •    Mammogram.
                                                                                                                                                   •    HPV vaccinations.
                                                                                                                                                   •    PSA Screening - ages
                                                                                                                                                        50 years and above, every
                                                                                                                                                        24 months.
                                                                                                                                                   •    Pap smear – ages 18 and
                                                                                                                                                        above, every 24 months

        BetterMe wellness                                   •   Health risk assessment (biometric screening) at contracted pharmacy or on-site at employer.
        benefits                               •       Fitness assessment at a contracted BASA biokineticist - 1 per beneficiary per year (ages older than 13 years).
                                                                                      •   Nutritional assessment - 1 per family per year.
        Note: Biometric
        screening activates                                       •     Occupational therapy assessment - 1 per beneficiary per year (ages 3-12 years).
        the other assessment                       •    Baby growth assessment at a contracted pharmacy clinic - 3 per beneficiary per year (ages 0-35 months).
        benefits.

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

            14   Bestmed Comparative Guide 2018
Contributions
                                                                Beat1                                Beat2                                 Beat3                       Beat4
                       Non-Network (NN)/
                                                          NN                  N                 NN                 N                 NN                  N                NN
                          Network (N)
                                Risk                    R1 363            R1 226             R1 398             R1 259            R2 123             R1 909             R3 334

                                                                                                                                                                                      Beat
PRINCIPAL MEMBER              Savings                     R0                 R0               R287               R258               R435              R392               R588
                               Total                   R1 363             R1 226             R1 685            R1 517              R2 558            R2 301             R3 922
                                Risk                    R1 058             R953              R1 087              R978              R1 508            R1 358             R2 753
ADULT DEPENDANT               Savings                     R0                 R0               R223               R200               R309              R278               R486
                               Total                   R1 058              R953              R1 310            R1 178              R1 817            R1 636             R3 239
                                Risk                     R573              R516               R589               R530               R819              R738               R824
CHILD DEPENDANT               Savings                     R0                 R0               R121               R109               R168              R151               R146
                               Total                    R573               R516               R710               R639              R987               R889               R970
                     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; BetterMe = 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;
                   PMSA = Personal Medical Savings Account; PPN = Preferred Provider Negotiator; PSA = Prostate Specific Antigen.

                   For a more detailed overview of your benefit option and to receive a membership guide please contact service@bestmed.co.za

                   Disclaimer: All the 2018 product information appearing in this brochure is provided without a representation or warranty whatsoever, whether expressed
                   or implied and no liability pertaining thereto will attach to Bestmed Medical Scheme. All information regarding the 2018 benefit options and accompanying
                   services including information in respect of the terms and conditions or any other matters is subject to prior approval of the Council for Medical Schemes (CMS)
                   and may change without notice having due regard to the CMS’s further advices. Bestmed accepts no liability whatsoever for any loss whether direct, indirect or
                   consequential arising from information provided in this brochure or any actions and/or transactions resulting therefrom.

                   Please visit www.bestmed.co.za for the complete liability and responsibility disclaimer for Bestmed Medical Scheme as well as our terms and conditions.

                                                                                                                               Bestmed Comparative Guide 2018                15
Pace

       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 seeking
       comprehensive cover.
Method of Scheme benefit payment
             Pace1                                Pace2                                   Pace3                                             Pace4
 •   In-hospital services are paid from Scheme risk benefit. Some out-of-hospital services are paid from          •   In-hospital services, out-of-hospital services and
     the annual savings first and once depleted will be paid from the day-to-day benefit.                             preventative care services are paid from Scheme
 •   Once the day-to-day benefit is depleted, services can be paid from the available vested savings.                 risk benefit.
     Some preventative care services are available from Scheme risk benefit.                                      •   Once out-of-hospital risk benefits are depleted,
                                                                                                                      further claims will be paid from savings.

         In-hospital benefits
Note: All benefits mentioned below are subject to pre-authorisation and clinical protocols.

                                                   Pace1                                Pace2                          Pace3                           Pace4
 Accommodation (hospital stay) and
                                                                                                100% Scheme tariff.
 theatre fees
 Take-home medicine                                                               100% Scheme tariff. 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.
 substance abuse                                                  Limited to 21 days or R27 200 per beneficiary. Subject to network facilities.
 Consultations and procedures                                                                   100% Scheme tariff.
 Surgical procedures and
                                                                                                100% Scheme tariff.
 anaesthetics
 Organ transplants                           100% Scheme tariff.                                                  100% Scheme tariff.
                                                (Only PMBs)
 Major medical maxillofacial                 100% Scheme tariff.                                                  100% Scheme tariff.
 surgery strictly related to certain         Limited to R11 000
 conditions                                      per family.

                                                                                                                                                                            Pace
 Dental and oral surgery                      Limited to R6 800                   Limited to R11 300              Limited to R14 200              Limited to R17 000
                                                  per family.                         per family.                     per family.                     per family.
 Prosthesis (Subject to preferred            100% Scheme tariff.                  100% Scheme tariff.             100% Scheme tariff.            100% Scheme tariff.
 provider, otherwise limits and              Limited to R76 000                   Limited to R97 600              Limited to R98 100             Limited to R113 200
 co-payments apply)                              per family.                          per family.                     per family.                     per family.
 Prosthesis – Internal                  Sub-limits per beneficiary:         Sub-limits per beneficiary:       Sub-limits per beneficiary:    Sub-limits per beneficiary:
                                        •   *Functional limited to          •    *Functional limited to       •   *Functional limited to     •   *Functional limited to
 Note: Sub-limit subject to                 R13 650.                             R14 850.                         R16 000.                       R16 600.
 the above prosthesis limit.            •   Vascular R27 700.               •    Vascular R36 600.            •   Vascular R36 700.          •   Vascular R42 000.
                                        •   Pacemaker (dual                 •    Pacemaker (dual              •   Pacemaker (dual            •   Pacemaker (dual
 *Functional: Items utilised
                                            chamber) R47 300.                    chamber) R52 750.                chamber) R52 750.              chamber) R52 750.
 towards treating or supporting
 a bodily function                      •   Endovascular and                •    Spinal R36 600.              •   Spinal R36 700.            •   Spinal R42 000.
                                            catheter-based                  •    Artificial disk R16 000.     •   Artificial disk            •   Artificial disk R18 850.
                                            procedures - no benefit.                                              R16 000.
                                                                            •    Drug-eluting stents                                         •   Drug-eluting stents
                                        •   Spinal R27 700.                      R16 000.                     •   Drug-eluting stents            R18 850.
                                        •   Artificial disk - no benefit.   •    Mesh R16 000.                    R16 000.                   •   Mesh R16 600.
                                        •   Drug-eluting stents -           •    Gynaecology/Urology          •   Mesh R16 000.              •   Gynaecology/Urology
                                            no benefit.                          R11 950.                     •   Gynaecology/Urology            R13 700.
                                        •   Mesh R10 400.                   •    Lens implants R10 260            R12 000.                   •   Lens implants R15 170
                                        •   Gynaecology/Urology                  per lens.                    •   Lens implants                  per lens.
                                            R7 500.                         •    Joint replacements:              R10 260 per lens.          •   Joint replacements:
                                        •   Lens implants R5 700                 1. Hip replacement and       •   Joint replacements:            1. Hip replacement and
                                            per lens.                               other major joints            1. Hip replacement                other major joints
                                                                                    R43 950.                         and other major                R50 650.
                                                                                 2. Knee replacement                 joints R44 000              2. Knee replacement
                                                                                    R51 000.                      2. Knee replacement               R58 650.
                                                                                 3. Minor joints R18 950.            R51 250.                    3. Minor joints R18 850.
                                                                                                                  3. Minor joints
                                                                                                                     R18 950.

                                                                                                                             Bestmed Comparative Guide 2018          17
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.

                                                                                                                      Did you know
                                                                                                                      that Bestmed’s
                                                                                                                      Pace option range
                                                                                                                      does not have
                                                                                                                      co-payment or
                                                                                                                      automatic self-
                                                                                                                      payment gaps?

                In-hospital benefits (continued)
Pace

                                                     Pace1                          Pace2                           Pace3                        Pace4
       Prosthesis – External                     Limited to R19 300             Limited to R23 000           Limited to R23 100              Limited to R26 100
                                                      per family.                   per family.                  per family.                      per family.
       Exclusions (Prosthesis            Joint replacement surgery                                                Not applicable.
       sub-limit subject to preferred    (except for PMBs). PMBs
       provider, otherwise limits and    subject to prosthesis limits:
       co-payments apply)                •   Hip replacement and
                                             other major joints
                                             R28 200.
                                         •   Knee replacement
                                             R37 500.
                                         •   Minor joints R11 650.
       Orthopaedic and medical                                                              100% Scheme tariff.
       appliances
       Pathology                                                                            100% Scheme tariff.
       Diagnostic imaging                                                                   100% Scheme tariff.
       Specialised diagnostic imaging                                                       100% Scheme tariff.
       Oncology                               Oncology programme.                                Oncology programme. 100% Scheme tariff.
                                               PMBs only at DSPs.
       Peritoneal dialysis and                   PMBs only at DSPs.                                          100% Scheme tariff.
       haemodialysis
       Confinements                                                                         100% Scheme tariff.
       Refractive surgery                100% Scheme tariff. Limited to        100% Scheme tariff.               100% Scheme tariff. Limited to R8 500 per eye.
                                               R7 560 per eye.                  Limited to R7 900
                                                                                     per eye.
       Midwife-assisted births                                                              100% Scheme tariff.
       Supplementary services                                                               100% Scheme tariff.
       Alternatives to hospitalisation                                                      100% Scheme tariff.
       Emergency evacuation                                               100% Scheme tariff. Pre-authorised and rendered by ER24.
       Co-payments                                                                             Not applicable.

           18   Bestmed Comparative Guide 2018
Out-of-hospital benefits
Note: Benefits mentioned below are subject to Scheme tariff, and may also be subject to pre-authorisation and clinical protocols.

                                         Pace1                               Pace2                              Pace3                             Pace4
 Overall day-to-day limit              M = R9 180,                        M = R12 960,                       M = R16 200,                       M = R30 200,
                                      M1+ = R18 360.                     M1+ = R25 920.                     M1+ = R33 480.                     M1+ = R48 700.
 FP and specialist                    Savings first.                      Savings first.                     Savings first.               Limited to M = R4 750,
 consultations                   Limited to M = R1 890,              Limited to M = R3 700,               100% Scheme tariff.            M1+ = R7 700. (Subject to
                                M1+ = R3 800. (Subject to           M1+ = R7 500. (Subject to         M = R3 700, M1+ = R7 500.           overall day-to-day limit)
                                 overall day-to-day limit)           overall day-to-day limit)         (Subject to overall day-to-
                                                                                                               day limit)
 Basic and specialised                  Savings first.                     Savings first.                     Savings first.              Limited to M = R10 250,
 dentistry                     Basic: Preventative benefit or     Basic: Preventative benefit or     Basic: Preventative benefit or     M1+ = R17 300. (Subject to
                                      savings account.                   savings account.                   savings account.              overall day-to-day limit)
                               Limit once savings exceeded.       Limit once savings exceeded.       Limit once savings exceeded.       Orthodontic: Subject to pre-
                               Specialised: Savings account       Specialised: Savings account       Specialised: Savings account              authorisation.
                                         then limit.                        then limit.                        then limit.
                                 Orthodontic: Subject to            Orthodontic: Subject to            Orthodontic: Subject to
                                     pre-authorisation.                 pre-authorisation.                 pre-authorisation.
                                  Limited to M = R3 400,             Limited to M = R5 700,           100% Scheme tariff. Limited
                                M1+ = R6 900. (Subject to          M1+ = R11 400. (Subject to                to M = R6 150,
                                  overall day-to-day limit)          overall day-to-day limit)        M1+ = R11 450. (Subject to
                                                                                                        overall day-to-day limit)
 Medical aids, apparatus       Savings first. 100% Scheme          Savings first. 100% Scheme         Savings first. 100% Scheme         100% Scheme tariff. Limited
 and appliances                tariff. Limited to R9 700 per       tariff. Limited to R8 800 per      tariff. Limited to R8 800 per     to R8 800 per family. (Subject
 including wheelchairs        family. (Subject to overall day-    family. (Subject to overall day-   family. (Subject to overall day-     to overall day-to-day limit).
 and hearing aids                        to-day limit)                       to-day limit).                     to-day limit).

                                                                      Limit on wheelchairs of           Limit on wheelchairs of            Limit on wheelchairs of
                                                                      R11 900 per family per            R11 900 per family per             R11 900 per family per
                                                                            48 months.                        48 months.                         48 months.

                                                                     Limit on hearing aids of           Limit on hearing aids of           Limit on hearing aids of
                                                                   R24 250 per beneficiary per        R27 300 per beneficiary per        R30 400 per beneficiary per

                                                                                                                                                                          Pace
                                                                           24 months.                         24 months.                         24 months.
 Supplementary services               Savings first.                      Savings first.                     Savings first.               Limited to M = R4 750,
                                 Limited to M = R3 700,              Limited to M = R4 650,             Limited to M = R2 260,           M1+ = R9 350. (Subject to
                                M1+ = R7 700. (Subject to           M1+ = R9 350. (Subject to          M1+ = R4 750. (Subject to          overall day-to-day limit)
                                 overall day-to-day limit)           overall day-to-day limit)          overall day-to-day limit)

 Wound care benefit             Savings first. 100% Scheme         Savings first. 100% Scheme         Savings first. 100% Scheme           Limited to R11 600 per
 (incl. dressings, negative     tariff. Limited to R3 050 per      tariff. Limited to R5 800 per      tariff. Limited to R9 000 per       family. (Subject to overall
 pressure wound therapy          family. (Subject to overall        family. (Subject to overall        family. (Subject to overall            day-to-day limit)
 treatment and related                  day-to-day limit)                  day-to-day limit)                  day-to-day limit)
 nursing services - out-of-
 hospital)
 Optometry benefit                   Consultation R365                  Consultation R365                  Consultation R365                  Consultation R365
 (PPN capitation provider)           Frame R550 AND                     Frame R550 AND                     Frame R550 AND                     Frame R550 AND
                               Single vision lenses R175 OR            Single vision lenses               Single vision lenses               Single vision lenses
                                  Bifocal lenses R380 OR                     R175 OR                            R175 OR                            R175 OR
                                  Multifocal lenses R695             Bifocal lenses R380 OR             Bifocal lenses R380 OR             Bifocal lenses R380 OR
                                  Contact lenses R1 420              Multifocal lenses R695             Multifocal lenses R695             Multifocal lenses R695
                                                                     Contact lenses R1 420              Contact lenses R1 420              Contact lenses R1 710
 Diagnostic imaging             Savings first. 100% Scheme          Savings first. 100% Scheme         Savings first. 100% Scheme        100% Scheme tariff. Limited
 and pathology                 tariff. Limited to M = R2 750,      tariff. Limited to M = R2 750,     tariff. Limited to M = R3 000,    to M = R4 750, M1+ = R9 350.
                                 M1+ = R5 500. (Subject to           M1+ = R5 500. (Subject to          M1+ = R5 950. (Subject to         (Subject to overall day-to-
                                  overall day-to-day limit)           overall day-to-day limit)          overall day-to-day limit)                day limit)
 Maternity benefits                                              100% Scheme tariff. 2 sonars and up to 12 antenatal consultations.

 Specialised diagnostic             100% Scheme tariff.                                  MRI/CT scans: Maximum of 3 scans per beneficiary.
 imaging                       Limited to R12 300 per family.                           PET scan: 1 scan per beneficiary. 100% Scheme tariff.
 Rehabilitation services              Vested savings.                                                     100% Scheme tariff.
 after trauma
 Oncology                          Oncology programme.                                          Oncology programme. 100% Scheme tariff.
                                       (PMBs only)

                                                                                                                         Bestmed Comparative Guide 2018         19
Medicine
       Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, formularies, funding guidelines and the Mediscor Reference Price (MRP).
       Approved CDL, PMB and non-CDL chronic medicine costs will pay from the non-CDL chronic medicine limit first. Once the limit is depleted, CDL and PMB chronic
       medicine will be unlimited from Scheme risk.
       Note: Refer to the Chronic Conditions List at the back of the Comparative Guide.

                                                    Pace1                                 Pace2                             Pace3                             Pace4
        CDL & PMB chronic                   100% Scheme tariff.                     100% Scheme tariff.                100% Scheme tariff.              100% Scheme tariff.
        medicine                          Co-payment of 35% for                   Co-payment of 30% for              Co-payment of 25% for            Co-payment of 20% for
                                          non-formulary medicine.                 non-formulary medicine.            non-formulary medicine.          non-formulary medicine.
        Non-CDL chronic                         7 conditions.                          18 conditions.                     19 conditions.                   26 conditions.
        medicine                             85% Scheme tariff.                      85% Scheme tariff.                85% Scheme tariff.               85% Scheme tariff.
                                           Limited to M = R5 600,                  Limited to M = R7 700,            Limited to M = R12 420,          Limited to M = R16 750,
                                              M1+ = R11 200.                          M1+ = R15 400.                     M1+ = R24 840.                   M1+ = R33 650.
                                          Co-payment of 35% for                   Co-payment of 30% for              Co-payment of 25% for            Co-payment of 20% for
                                          non-formulary medicine.                 non-formulary medicine.            non-formulary medicine.          non-formulary medicine.
        Biologicals and other                   No benefit.                        Limited to R140 000                Limited to R280 000               Limited to R414 400
        high-cost medicine                                                            per beneficiary.                   per beneficiary.                  per beneficiary.
        Acute medicine                         Savings first.                          Savings first.                     Savings first.               Limited to M = R7 500,
                                          Limited to M = R1 980,                  Limited to M = R4 100,             Limited to M = R1 300,               M1+ = R11 650.
                                         M1+ = R4 100. (Subject to               M1+ = R8 200. (Subject to          M1+ = R3 200. (Subject to       (10% co-payment) (Subject to
                                          overall day-to-day limit).              overall day-to-day limit).         overall day-to-day limit).       overall day-to-day limit).
        Over-the-counter                 *Member choice: 1. R550 OTC limit OR 2. Access to full PMSA for OTC purchases (after R550                        Savings account.
        (OTC) medicine                                           limit) = self-payment gap accumulation.
        See benefit option rules

       *The default OTC choice is 1. R550 OTC limit. Members wishing to choose the other option are welcome to contact Bestmed.

                 Preventative care benefits
Pace

       Note: Benefits mentioned below may be subject to pre-authorisation, clinical protocols, formularies, funding guidelines and the Mediscor Reference Price (MRP).

                                                    Pace1                                 Pace2                             Pace3                             Pace4
       Preventative care             •   Flu vaccines.                       •   Flu vaccines.                  •   Flu vaccines.
                                     •   Pneumonia vaccines.                 •   Pneumonia vaccines.            •   Pneumonia vaccines.
       Note: Refer to Scheme
                                     •   Paediatric immunisations.           •   Paediatric immunisations.      •   Paediatric immunisations.
       rules for funding
                                     •   Female contraceptives –             •   Female contraceptives –        •   Female contraceptives – R1 950 per family per year.
       criteria applicable to each
                                         R1 950 per family per year.             R1 950 per family per year.    •   DBC programme.
       preventative
                                     •   DBC programme.                      •   DBC programme.                 •   Preventative dentistry. (incl. gloves and sterile equipment).
       care benefit.
                                     •   Preventative dentistry.             •   Preventative dentistry.        •   Haemophilus influenzae Type B vaccine. (HIB).
                                         (incl. gloves and sterile               (incl. gloves and sterile
                                         equipment).                             equipment).                    •   Mammogram.

                                     •   Haemophilus influenzae              •   Haemophilus influenzae         •   PSA screening - ages 50 and above, every 24 months.
                                         Type B vaccine. (HIB).                  Type B vaccine. (HIB).         •   HPV vaccines.
                                     •   Mammogram.                          •   Mammogram.                     •   Bone densitometry.
                                     •   HPV vaccines.                       •   PSA screening – ages           •   Pap smear – ages 18 and above, every 24 months.
                                     •   Pap smear – age 18 and                  50 and above, every 24
                                         above, every 24 months.                 months.
                                                                             •   HPV vaccines.
                                                                             •   Bone densitometry.
                                                                             •   Pap smear – age 18 and
                                                                                 above, every 24 months.

        BetterMe wellness                                    •   Health risk assessment (biometric screening) at contracted pharmacy or on-site at employer.
        benefits                                •       Fitness assessment at a contracted BASA biokineticist - 1 per beneficiary per year (ages older than 13 years)
                                                                                      •   Nutritional assessment - 1 per family per year
        Note: Biometric
        screening activates                                        •   Occupational therapy assessment - 1 per beneficiary per year (ages 3-12 years)
        the other assessment                        •     Baby growth assessment at a contracted pharmacy clinic - 3 per beneficiary per year (ages 0-35 months)
        benefits.

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

            20   Bestmed Comparative Guide 2018
Contributions
                                                          Pace1                        Pace2                            Pace3                              Pace4
                              Risk                         R2 650                       R3 976                           R4 565                             R6 410
PRINCIPAL MEMBER            Savings                         R662                         R701                             R805                               R198
                              Total                        R3 312                       R4 677                          R5 370                              R6 608
                              Risk                         R1 860                       R3 898                           R3 674                             R6 410
ADULT DEPENDANT             Savings                         R465                         R688                             R648                               R198
                              Total                        R2 325                       R4 586                          R4 322                              R6 608
                              Risk                          R669                         R876                             R784                              R1 502
CHILD DEPENDANT             Savings                         R167                         R155                             R139                                R46
                              Total                         R836                        R1 031                            R923                              R1 548
                   Maximum contribution
                                                                                                                 4
                     child dependant*
                    Recognition of a child                                                   Under 21, unless a registered student.
                        dependant

                   *You only pay for a maximum of four children. All other children join as beneficiaries of the Scheme free of charge.

                   Abbreviations
                   DBC = Documentation Based Care (Back Rehabilitation Programme); DSP = Designated Service Provider; FP = Family Practitioner or
                   Doctor; BetterMe = Biometric Screenings; HIB = Haemophilus influenzae Type B vaccine; HPV = Human Papilloma Virus; M = Member;
                   M1+ = Member and family; MRI/CT scans = Magnetic Resonance Imaging/Computed Tomography scans; MRP = Mediscor Reference Price;
                   NP = Network Provider; PET scan = Positron Emission Tomography scan; PMB = Prescribed Minimum Benefits; PMSA = Personal Medical
                   Savings Account; PPN = Preferred Provider Negotiators; PSA = Prostate Specific Antigen.

                   For a more detailed overview of your benefit option and to receive a membership guide please contact service@bestmed.co.za

                   Disclaimer: All the 2018 product information appearing in this brochure is provided without a representation or warranty whatsoever, whether expressed
                   or implied and no liability pertaining thereto will attach to Bestmed Medical Scheme. All information regarding the 2018 benefit options and accompanying
                   services including information in respect of the terms and conditions or any other matters is subject to prior approval of the Council for Medical Schemes (CMS)

                                                                                                                                                                                      Pace
                   and may change without notice having due regard to the CMS’s further advices. Bestmed accepts no liability whatsoever for any loss whether direct, indirect or
                   consequential arising from information provided in this brochure or any actions and/or transactions resulting therefrom.

                   Please visit www.bestmed.co.za for the complete liability and responsibility disclaimer for Bestmed Medical Scheme as well as our terms and conditions.

  Chat to us directly
  using our Chat
  Now service on the
  Bestmed website.

                                                                                                                Medicine formulary – This is a
                                                                                                                list of prescription medicines
                                                                                                                (both generic and brand name)
                                                                                                                for which the Scheme will
                                                                                                                pay. Make sure you familiarise
                                                                                                                yourself with this list when
                                                                                                                doctors prescribe medicine to
                                                                                                                you.

                                                                                                                             Bestmed Comparative Guide 2018               21
Pulse

        The Pulse range is ideally
        suitable for you if:
        • You are seeking a plan option
         that is based on your income.
        • You are comfortable with
         making use of designated
         service providers (DSPs)
         within our network.
        • You are looking for unlimited
         comprehensive cover for
         hospitalisation and the added
         benefit of preventative care.
Method of Scheme benefit payment
                                   Pulse1                                                                                    Pulse2
•   In-hospital services are paid from Scheme risk.                                     •   In-hospital services are paid from Scheme risk.
•   Some preventative care services are available from Scheme risk.                     •   Some day-to-day services and preventative care services are available
•   Some out-of-hospital services are paid from Scheme risk.                                from Scheme risk.

•   Only Pulse specialist DSP network.                                                  •   Some out-of-hospital services are paid from Scheme risk.
                                                                                        •   Only Pulse specialist DSP network.

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

                                                                             Pulse1                                                     Pulse2
Accommodation (hospital stay) and theatre fees                                          100% Scheme tariff at a Netcare DSP hospital.
Take-home medicine                                         100% Scheme tariff. Medicine limited to 3 days.            100% Scheme tariff. Medicine limited to 7 days.
Treatment in mental health clinics                                                  100% Scheme tariff. Limited to 21 days per beneficiary.
Treatment of chemical and substance abuse                         100% Scheme tariff (only PMBs).                                  100% Scheme tariff.
                                                                 Limited to 21 days per beneficiary.                  Limited to 21 days or R27 200 per beneficiary.
                                                                    Subject to network facilities.                             Subject to network facilities.
Consultations and procedures                                                                           100% Scheme tariff.
Surgical procedures and anaesthetics                                    100% Scheme tariff.                                        100% Scheme tariff.
                                                          Excluded from benefits: functional nasal surgery,
                                                            surgery for medical conditions e.g. Epilepsy,
                                                             Parkinson’s disease and procedures where
                                                                        stimulators are used.
Organ transplants                                                                              100% Scheme tariff (only PMBs).
Major medical maxillo-facial surgery strictly                                No benefit.                                           100% Scheme tariff.
related to certain conditions
Dental and oral surgery                                                      No benefit.                                           100% Scheme tariff.
Prosthesis (Subject to preferred provider,                              100% Scheme tariff.                                        100% Scheme tariff.
otherwise limits and co-payments apply)                            Limited to R44 700 per family.                             Limited to R89 500 per family.
Prosthesis – Internal                                 Sub-limits per beneficiary:                                 Sub-limits per beneficiary:
                                                      •    *Functional R9 500.                                    •   *Functional R14 850.
Note: Sub-limit subject to the                        •    Vascular R22 150.                                      •   Vascular R34 600.
above prosthesis limit                                •    Pacemaker (dual chamber) R36 200.                      •   Pacemaker (dual chamber) R46 900.
                                                      •    Endovascular and catheter-based procedures -           •   Spinal R34 600.
*Functional: Items utilised                                no benefit.                                            •   Artificial disk R15 200.
towards treating or supporting                        •    Spinal R22 150.                                        •   Drug-eluting stents R15 200.
a bodily function                                     •    Artificial disk - no benefit.                          •   Mesh R15 200.
                                                      •    Drug-eluting stents - no benefit.                      •   Gynaecology/Urology R11 300.
                                                      •    Mesh R8 100.                                           •   Lens implants R9 700 per lens.
                                                      •    Gynaecology/Urology R6 690.                            •   Joint replacements:
                                                      •    Lens implants R4 650 per lens.                              1. Hip replacement and other major joints
                                                                                                                          R41 400.
                                                                                                                       2. Knee replacement R48 350.
                                                                                                                       3. Minor joints R18 000.
Prosthesis – External                                                        No benefit.                                      Limited to R21 600 per family.
Exclusions (Prosthesis sub-limit subject to           Joint replacement surgery (except for PMBs).                                    Not applicable.
preferred provider, otherwise limits and              PMBs subject to prosthesis limits:
co-payments apply)                                    • Hip replacement and other major joints R22 700.
                                                      •    Knee replacement R28 700.
                                                      •    Minor joints R10 750.
Orthopaedic and medical appliances                        100% Scheme tariff. Limited to R5 500 per family.                        100% Scheme tariff.
Pathology                                                                                              100% Scheme tariff.
                                                                                                                                                                        Pulse

Diagnostic imaging                                                                                     100% Scheme tariff.
Specialised diagnostic imaging                                                                         100% Scheme tariff.
Oncology                                                    PMBs at DSP state facilities where available.               Oncology programme. 100% Scheme tariff.
Peritoneal dialysis and haemodialysis                                    PMBs only at DSPs.                                  100% Scheme tariff. Only at DSPs.
Confinements                                                                                           100% Scheme tariff.
Refractive surgery                                                           No benefit.                              100% Scheme tariff. Limited to R7 950 per eye.
Midwife-assisted births                                                                                100% Scheme tariff.

                                                                                                                           Bestmed Comparative Guide 2018          23
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