One of the key factors to consider when choosing a medical scheme is ‘affordability’. The Bestmed’s Pulse 1 premiums are determined by your personal income; hence, the monthly premiums tend to be affordable for members.
The Pulse range has two options, and both are for members who are prepared to use the scheme’s Designated Service Providers (DSPs).
Even though Bestmed’s pulse range covers you on their DSPs, the scheme also gives a comprehensive hospital cover and preventative care benefits.
As mentioned, Bestmed’s pulse range is a good option when you stick to their DSPs, since the scheme pays off in and out of hospital benefits from the scheme risk.
Just like most medical schemes, Bestmed has special rates on these DSPs, creating value for less at the end of the day.
Moreover, some preventative care services are paid from the scheme risk-benefit on both plans. The Pulse 2 even covers the day-to-day services from the risk-benefit.
Using the scheme’s DSPs saves you a lot of money compared using to using non-designated service providers.
In case you think the scheme only offers substandard healthcare providers, it might help you to know that included in the hospitals’ network is Netcare hospital, the largest private healthcare provider ahead of Lifecare hospitals.
All benefits relating to conditions that meet the criteria for PMBs are always covered in full when using the DSPs.
Emergency consultations done at hospitals which are not designated by Bestmed with your Family Practitioners are paid by you upfront and then later claimed back from the available out-of-network benefit.
The Bestmed’s Pulse range benefits are realised when you familiarise yourself with the Designated Service Providers (DSPs) and networks.
This way you will realise the lucrative benefits of the scheme which can make you avoid up to R11 309 in co-payments.
The DSP hospital network consists of all Netcare hospitals in South Africa. In places where there are no Netcare hospitals, Bestmed contracts other hospitals as DSPs( Designated Service Providers.
All benefits in the Pulse range are subject to pre-authorisations and clinical protocols. These are the steps followed in the hospital authorisation process:
In case you admitted to a non-DSP hospital due to an emergency condition, Bestmed will transfer you to a DSP nearby once you stabilise.
Below are some of the in-hospital medical events paid 100% scheme tariff from the scheme benefit in both Pulse 1 and Pulse 2:
In Pulse 1, primary care services and the Scheme benefits are subjected to treatment protocols, preferred providers, DSPs, dental procedure codes, pathology and radiology lists of codes and medicine formularies as accepted by the Scheme.
Pulse 1 members get as many consultations as necessary. Benefits also cover a selected minor trauma treatment such as stitching of wounds. Medicine for acute ailments is also covered, however, it is subject to the Bestmed Pulse1 formulary.
In Pulse 2, out-of-hospital benefits are paid at 100% Scheme tariff. All Pulse 2 members should use Bestmed Pulse Specialist DSPs.
To get the list of service providers, members can find them on the company’s website www.bestmed.co.za or call in to get information on the Pulse Specialist DSP closest to you.
Below are some of the medical events with their respective scheme benefits:
Medicine benefits in both Bestmed’s Pulse options may be subject to pre-authorisation, clinical protocols, preferred providers, designated service providers, formularies, funding guidelines and the Mediscor Reference Price (MRP).
Approved CDL, PMB and non-CDL chronic medicine costs are paid from the non-CDL chronic medicine limit first. Thereafter, approved CDL and PMB chronic medicine costs will continue to be paid (unlimited) from Scheme risk.
Approved PMB biological and Non-PMB biological medicine costs are paid from the Biological limit first. Once the limit is depleted, only PMB biological medicine costs will continue to be paid unlimited from Scheme risk.
Below are some of the medicine benefits:
Bestmed’s Pulse preventative benefits may be subject to pre-authorisation, clinical protocols, preferred providers, designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP).
Below are covered Preventative benefits:
The Pulse range contributions are determined by your income level. There are 3 categories of contributions in each option.
Below is the total contributions for all Pulse 1 income levels.
Total contribution for income from R0 – R5 500 is:
Principal member – R1 626
Adult dependant – R1 545
Child dependant- R978
Total contribution for income from R5 501 to R8 500 is:
Principal member – R1 953
Adult dependant – R1 856
Child dependant – R1 172
Total contribution for income above R8 500 is:
Principal member – R2 344
Adult dependant – R2 109
Child dependant – R1 172
Contributions for Pulse 2 members 2020
Principal member – R5 770
Adult dependant – R5 770
Child dependant – R1 371
You can only add up to 4 child beneficiaries in your Pulse 2 medical plan and the rest will be added as beneficiaries for free.
Bestmed is associated with reputable service providers such that, even if members’ choices are limited, the available options still offer value. Along with other leading medical schemes such as Bonitas, it provides value for money medical schemes.