Bestmed Beat plan medical scheme review 2021

Posted on Jan 6, 2021 by Staff Writer

Rateweb | South Africa

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The Bestmed Beat series of plans comprise of four medical aid plans the Beat 1, Beat 2, Beat 3 and the Beat 4 option. The Bestmed Beat plan category best suits young individuals who are looking for an extensive in-hospital cover with fringe benefits.

In this overview, we will look closely at the Bestmed’s Beat scheme category. We will shed to light the attributes of each plan in the category so that you get a better understanding before signing up.

Beat 1

The BestMed Beat plan 1 hospital plan is designed to suit mid-income earners who need extensive individual hospital cover.

Even though it’s not the cheapest entry-level plan around, it is no brainer that Beat 1 is among the best medical cover plans available. This is because it offers more in-hospital benefits and a few out of hospital benefits you can’t get in other schemes.

The Beat 1 contributions

The Bestmed Beat 1 plan has two options; the standard plan which does not have a hospitals network and the network option. 

The standard plan allows you to receive care from any medical institution of your choice.

The following is Beat 1 member contributions:

  • R1 617 For the Principal Member
  • R1 255 per Adult Dependent
  • R680 per Child Dependent

Though the network plan locks you to a preset range of medical care providers (hospitals), it lowers your monthly premiums.

Here are the Beat 1 network option 2020 rates:

  • R1 454 for the Principal Member
  • R1 130 per Adult Dependent
  • R612 per Child Dependent

Bestmed Beat 1 value benefits

  • Preventative care benefits.
  • Contraceptive benefit.
  • Wound care benefit.
  • International travel cover

The Beat 1 in-hospital benefits

Every time you exceed the scheme tariff’s limit, you will be liable for copayments which you will have to pay from your pocket.

The following has coverage at the 100% scheme tariff rate:

  • Surgical procedures and anaesthetics
  • Organ transplants (PMBs only)
  • Orthopaedic and medical appliances
  • Prosthesis (Subject to a preferred provider, otherwise limited to R75 092 per family and copayments apply)
  • Pathology and basic radiology
  • Mental health and the 21 days of Substance Abuse Treatment
  • The Specialised diagnostic imaging is subject to copayments
  • Confinements (Birthing)
  • Midwife-assisted births
  • supplementary services and alternatives to hospitalisation

Out-of-Hospital, Preventative and Chronic Cover

Out-of-hospital benefits such as a Family Practitioner (FP) or Specialist visits are paid in full by you, directly to the service provider.

The plan covers 43 chronic conditions, provides yearly flu vaccines, biometric screening and spinal/back rehabilitation cover.

All benefits are subject to pre-authorization, clinical protocols, demands of preferred providers or designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP).

The following is 100% covered on scheme’s tariff:

  • Diabetes primary care consultation which is subject to registration with HaloCare. It has 2 primary care consultations at DisChem Pharmacies limited to R341.90 per consultation.
  • Wound care benefit, that incudes dressings, negative pressure wound therapy NPWT treatment and related nursing service. The wound care services are limited to R3 359 per family
  • The specialized diagnostic imaging are covered up to R5 089 per family

Bestmed Beat 2

The Bestmed Beat plan 2 option is ideal for a young couple that is looking for extensive hospital cover with day to day medical benefits. If you choose this option, it will allow you to secure your health by getting adequate preventative measures even though you might not necessarily have health complications yet.

The beat 2 provides extensive hospital cover and a medical savings account. The savings account allows you to take care of your day to day medical bills like pharmacy bills.

 The Beat 2 contributions

Just like the Beat 1 category, Bestmed Beat 2 also has two options; the standard plan and Network option.

The Beat 2 standard plan contributions are as follows;

  • R1 976 For the Principal Member
  • R1 534 per Adult Dependent
  • R832 per Child Dependent

While the network option has following discounted contributions;

  • R1 778 For the Principal Member
  • R1 381 per Adult Dependent
  • R748 per Child Dependent

Bestmed Beat 2 value benefits

  • Preventative care benefits
  • Contraceptive benefit
  • Wound care benefit
  • Preventative dentistry

In hospital benefits

Pre-authorization, clinical protocols, designated service providers (DSPs) and formularies may apply. Members (Network option) who decide to use a hospital not part of Beat 2 hospital network may pay up to R11 309 in co-payments.

The following has coverage at the 100% scheme tariff rate:

  • anaesthetics
  • Orthopaedic and medical appliances
  • Prosthesis (Subject to the preferred provider, otherwise copayments apply also its limited to R75 092 per family)
  • Pathology and basic radiology
  • The Specialised diagnostic imaging is subject to copayments
  • Confinements (Birthing) and midwife-assisted births
  • supplementary services and alternatives to hospitalisation

Out of hospital benefits

Most out-of-hospital expenses, such as visits to a Family Practitioner (FP) or Specialist, are paid from your medical savings account.

In an event that you don’t exhaust your savings account funds, the balance is then carried forward to the following financial year.

The following are benefits in the Bestmed Beat 2 option

  • FP and Specialist consultations – paid using the savings account, also note that FP and Specialist consultations only at Bestmed DSPs at network tariffs
  • Diabetes primary care consultation – 100% of Scheme tariff subject to registration with HaloCare. You are allowed 2 primary care consultations at DisChem Pharmacies limited to R341.90 per consultation.
  • There is basic and specialised dentistry – these are paid from the savings account, also subject to pre-authorization
  • Supplementary services, apparatus and appliances are also paid from the savings account

Bestmed Beat 3

Bestmed Beat plan 3 value-for-money prime option, best designed for young individuals and new families. Since the family is still growing, Beat 3 offers substantial maternity benefits, extensive in-hospital cover at private hospitals and chronic benefits.

The plan also offers some preventative care benefits that are meant to ensure that you are well taken care of.

Contribution range

There is a standard Beat 3 plan that does not restrict you from choosing a service provider and also the network option which has recommended service providers.

The Beat 3 standard option has following contributions;

  • R2 997 For the Principal Member
  • R2 130 per Adult Dependent
  • R1 157 per Child Dependent

While the Beat 3 network option is as follows;

  • R2 697 For the Principal Member
  • R1 918 per Adult Dependent
  • R1 043 per Child Dependent

The Beat 3 value benefits

  • Preventative care benefits
  • Optometry
  • Preventative dentistry
  • Maternity benefits

In hospital benefits

All in-hospital benefits referred to in the section below require pre-authorisation.

Clinical protocols, demands from the preferred providers and designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP) may apply.

The following has coverage at the 100% scheme tariff rate:

  • Accommodation (hospital stay) and theatre fees
  • Take-home medicine is limited to 5 days’ medication
  • Consultations and procedures
  • Treatment in mental health clinics is limited to 21 days per beneficiary
  • Organ transplants, surgical procedures and anaesthetic

Out of hospital benefits

Out of all the Beat plans, Beat 3 stands out in terms of Out of Hospital benefits as it has some services covered at 100% scheme tariff.

Members subscribed with the Network option are required to make use of the scheme contracted service providers.

The following are medical events and their respective benefits in the Bestmed Beat 3 option:

  • FP and Specialist consultations – paid from the savings account, also Bestmed’s DSPs are recommended.
  • Diabetes primary care consultation is 100% of Scheme tariff subject to registration with HaloCare. 2 primary care consultations at DisChem Pharmacies limited to R341.90 per consultation
  • Basic and specialised dentistry – Preventative benefit or savings account for basic and Savings account. Orthodontic: Subject to pre-authorisation for the specialised
  • Supplementary services, medical aids, apparatus and appliances benefit are paid from the savings account
  • Wound care benefits are also on 100% Scheme tariff, however, they are limited to R3 359 per family.

Bestmed Beat 4

Bestmed Beat plan 4 is a superior mix option for young to middle-aged families with specific healthcare needs. It offers comprehensive in-hospital benefits at private hospitals. There is a good amount of day-to-day medical cover for consultations, dentistry, chronic medications and a range of preventative care benefits

It is the only plan with only one standard option among the Beat category. Beat 4 does not have the Network option hence members who take up this plan have the privilege to choose any hospital of their choice.

The Beat 4 contribution range

  • R4 685 For the Principal Member
  • R3 869 per Adult Dependent
  • R1 158 per Child Dependent

Value benefits in the Beat 4 plan

  • No automatic self-payment gaps
  • Preventative care benefits
  • Family Practitioner (FP) and specialist consultations
  • Optometry
  • Dentistry
  • Maternity benefits

Beat 4 in-hospital benefits

Likewise, all in-hospital benefits in Bestmed’s Beat 4 require pre-authorisation. Clinical protocols, demands from the preferred providers, and designated service providers (DSPs), formularies, funding guidelines and the Mediscor Reference Price (MRP) may also apply.

Almost all medical events covered by the Beat 4 plan have 100% benefit in the scheme tariff. Below we list all medical events with 100% scheme tariff:

  • Accommodation (hospital stay) and theatre fees
  • Take-home medicine, even though it is limited to 7 days only
  • Treatment in mental health clinics is limited to 21 days per beneficiary
  • Treatment of chemical and substance abuse is limited to 21 days or R30 760 per beneficiary and subject to network facilities
  • Consultations and procedures
  • Surgical procedures and anaesthetics
  • A prosthesis is subject to a preferred provider, otherwise, limits and co-payments apply. They also limited to R92 629 per family
  • Pathology, orthopaedic and medical appliances
  • Basic radiology and specialised diagnostic imaging
  • Peritoneal dialysis and haemodialysis, Confinements (Birthing), HIV/AIDS, Midwife-assisted births, supplementary services and alternatives to hospitalization

Out of hospital benefits

Most Beat 4 out of hospital benefits are paid from the savings account first. Once the savings account is depleted, benefits will then be paid from the Scheme’s day-to-day benefits with applicable limits.

If you have a treatment plan for a registered Chronic Disease List (CDL) or Prescribed Minimum Benefit (PMB) condition, the services in the treatment plan will be paid from the applicable day-to-day limit first.

Once the limit is depleted, claims will continue to be paid from the Scheme risk, up to the maximum quantity specified in the treatment plan.

Below are some out of hospital benefits in the Beat 4 plan:

  • Peritoneal dialysis and haemodialysis on 100% scheme tariff and subject to pre-authorisation
  • Rehabilitation services after trauma benefited from the vested savings
  • Basic and specialised dentistry
  • Basic and specialised dentistry

Competitive advantages of the Bestmed Beat category

  • Beat 1, 2 and 3 allow you to lower your monthly premiums by choosing the network option. Even though you lose the freedom of choosing your desired hospital, the plans have extensive in-hospital benefits that are one of the best in the market.
  • Both the standard and network options give good in-hospital cover with fringe benefits
  • The Beat 4 scheme has a generous amount of day-to-day medical cover for consultations, dentistry, chronic medications and a range of preventative care benefits

Competitive Disadvantages of the Bestmed Beat category

The Beat category does not cater for older individuals and families requiring more cover for day-to-day expenses and certain diseases. The Pace range will be more beneficial to suit these needs.

Conclusion

Bestmed has a range of plans that can suit any member of the society looking for a medical cover. The Beat category offers entry-level schemes from Beat 1 to a superior hybrid option (Beat 4) for young to middle-aged families with specific healthcare needs.

Choosing a scheme that serves you best will require you to consider several factors like; your health and financial status. Otherwise Bestmed provides good medical cover packages.

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