Posted on Jan 8, 2021 by Staff Writer
Bestmed is a non-profit, mutual medical scheme (owned by its members) registered with the Council of Medical Schemes. They have been providing quality healthcare to a large number of South Africans for over 54 years now.
The South African medical aid scheme industry has about 80 players registered with the Council of Medical Schemes.
Among these Bestmed is arguably the fourth largest open medical scheme, serving an average of 6% of the total market.
Bestmed takes pride in being the first and largest self-administered medical scheme in South Africa.
The company reports show that they are spending much lesser on admin costs as compared to other competitors.
This in turn increases the value for money delivered to members in form of plan packages.
Well, in terms of pricing, the Council of Medical Schemes announced (2019) the forecast annual average increase of 9% in all South African medical scheme contributions.
Even though the forecast was made without bearing in mind the impact of COVD-19 in 2020, the medical schemes managed to adequately increase the member contribution within the anticipated range of increase.
From January 2020, medical schemes implemented their various price changes as they had notified, from which we have compiled this piece of work. In this review, we discuss all the plans offered by Bestmed and their respective member contributions for 2020.
Bestmed 2020 plan options
Bestmed has 10 plan options spread out in 3 different categories: the Beat, Pace and the Pulse categories.
Category 1 ( Bestmed Beat)
The Beat category has plans that best fit young individuals or couples who have savings in place. The Beat category has 4 plan options to choose from which are:
The Beat 1 plan best suits young adults or couples who are not expecting much medical attention yet looking at keeping their health status on the check. The plan caters for extensive in-hospital cover as well as preventative care.
Beat 1 comes with a set of hospitals network commended to members by Bestmed. The Scheme expects its members to make an application for preauthorization before staying in a hospital of choice.
The Principal member contribution ranges from R1 454 to R1 617, while additional adult dependents contribute from R1 130 to R1 255 and child dependents pay from R612 to R680.
Beat 1 allows a maximum of 4 child dependents just as all plans offered by Bestmed except the Pulse 1 plan.
This is an ideal plan for young individuals or couples looking for an extensive in-hospital cover with a medical savings account.
Beat 2 also has a set of hospital networks in which members are commended to use. The good part of this plan is that it covers day to day pharmacy bills and dentist rendered services.
Beat 2 comes with a Medical Savings Account which can be used as a payment method for costs such as X-rays and doctor visits made by members.
The Beat 2 principal members contribute from R1 778 to R1 976 while their adult dependents contribute from R1 381 to R1 534 and child dependents contribute from R748 to R832. Just like the Beat 1 plan, the plan also allows a maximum of 4 contributing child dependants.
This plan best caters for young couples or new families that are looking for an extensive in-hospital cover with medical savings and maternity benefits.
The Beat 3 also has a set of hospitals network that members are encouraged to go to. Just like the Beat 2 plan, members capitalise the FP and specialist consultations on their savings accounts.
Principal member contributions start from R2 697 to R2 997 while their adult dependents contribute from R1 918 to R2 130 and child dependents contribute from R1 043 to R1 157.
The Beat 4 plan is designed with a thought of giving value to young or middle-age families with specific healthcare needs including chronic benefits and savings.
The Beat 4 plan has no designated network of hospitals. Members who have signed up for this plan get the opportunity to use the hospital of their choice but are required to follow the Bestmed protocol whenever using a hospital of choice.
Members who have signed up for the Beat 4 plan are not merely benefiting from the PMBs, but they also get Oncology services. Meaning, they are well looked after when it comes to the prevention, diagnosis and the treatment of cancer.
The Beat 4 principal members contribute R4 685 while additional adult dependants contribute R3 869 and additional child dependents contribute R1 158. The plan also has a maximum of 4 contributing child dependants just like the other plans in the same category.
Category 2 (Bestmed Pace)
The plans in the Pace category are designed for families who are looking for a comprehensive medical cover that will give them a range of medical benefits.
The Pace 1 plan provides quality hospital benefits with an extensive day-to-day cover that goes well for healthy and still growing families.
Just like all Pace options, the plan doesn’t have a network of hospitals and members enjoy over-the-counter medicine benefits, Family Practitioner (FP) and Specialist consultations.
On the Pace1 option, in-hospital services are paid from the scheme risk while some out-of-hospital services are paid firstly, from the annual savings.
Once the savings are depleted, services are paid from the day-to-day scheme’s risk benefits and then the available vested savings.
Principal members contribute R3 930 while additional adult dependants contribute R2 760 and additional child dependents contribute R992.
The plan also has a maximum of 4 contributing child dependants just like the other plans in the Pace category.
The Pace 2 option is a comprehensive cover structured in a way that best fits established families who are looking at being covered in and out of the hospital.
This option has great value because members have freedom of choice when it comes to hospitals, doctors and specialists.
The method of benefit payment in the Pace2 option follows the same sequence as in Pace1; payments for in-hospital services are made from the Scheme risk benefits.
While some of the out-of-hospital services are paid from the annual savings first and once depleted will be paid from the day-to-day benefit then available vested savings.
The contribution range for Pace2 is R5 566 for principal members, R5 458 for adult dependants while contribution for child dependants is from R1 227.
This is an option that is favourable for mature families with a range of healthcare needs.
If you have a mature family with a diverse range of medical needs that includes comprehensive chronic benefits and excellent hospital cover then you might have to go for this option.
Members signed up for the Pace3 option get excellent value benefits as they do not make co-payments or automatic self-payment gaps.
Family Practitioner and Specialist consultations are part of the package. Bestmed also maintains the same method of benefit payment method as outlined in the Beat category and all Pace options.
The principal members contribute R6 390 while adult dependants contribute R5 144 and R1 099 for child dependants.
This is the most comprehensive option in the Pace category, created to ensure maximum cover for hospital expenses and provide extensive benefits.
Pace 4 is suitable for families who may have above average medical costs and want comfort and peace of mind knowing their medical aid fully covers them on all costs.
In the Pace 4 plan, the Family practitioner, Specialist Consultations, Basic and Specialised Dentistry are not paid from the savings account as done in other plans. Rather these services are allocated a limited amount that is subject to day to day benefits.
As we have said it, Pace4 requires a family prepared to maintain above-average contributions towards their medical cover. Therefore the Pace4 principal members contribute a higher premium of R7 983 which is the same amount for adult dependants while child dependants contribute R1 870.
Category 3 (Bestmed Pulse)
The Pulse category has two options that can be custom structured to suit members’ income while meeting their medical cover expectations. Bestmed uses a number of hospital networks to offer plans that adapt to members’ incomes.
The Pulse 1 is recommended for an individual looking for a medical cover that is adaptable to their income, who does not mind using designated service providers (DSPs) allocated by Bestmed.
This option offers primary healthcare services and some preventative care benefits including private hospital cover.
On the Pulse1 plan, in-hospital services and some preventative care services are paid from the scheme risk-benefit. The Bestmed Pulse1 network also covers most out-of-hospital services.
This is the only plan that doesn’t have a limit on the contributing child dependants that can be added to the plan.
The principal member contribution range starts from R1 626 to R2 344, R1 545 to R2 109 for adult dependants and R 978 to R1 172 for child dependants. The contribution settled for is determined by the members’ income and influenced by the choice DSPs in the plan.
Pulse 2 is a network option dedicated to older individuals in their prime looking for a dedicated cover that best caters for their specific needs.
Members are provided with unlimited cover for hospitalisation at a network of hospitals (usually Netcare) and primary care services at a network of service providers.
Just like the Pulse 1 plan, this option offers unlimited Family Practitioner and Specialist Consultations. It also does not have Medical Savings Accounts for its members hence covers are paid from the scheme risk benefits.
The contribution range for principal members and adult dependents is R5 770 while child dependants contribute R1 371.
Advantages of taking up a plan with Bestmed
Bestmed is a self-administered scheme and their administration costs are about 3 – 5% lesser than other medical scheme companies in South Africa. The scheme claims to have plan options that have 75% lesser co-payments, compared to their competitors.
Their plans are packaged to accommodate almost every class in society since they have 10 plans to choose from.
On top of the freedom of choice, the plans are coupled with extensive service provider networks, that include Netcare hospitals and Dischem pharmacies.
Bestmed has an excellent services track record since they started offering medical aid for over 54 years.
During these years, they have emerged as the largest self-administered scheme in South Africa and the fourth largest open medical scheme.
Disadvantages of using Bestmed
Even though Bestmed has provided medical aid for more than 5 decades, they have not been able to introduce innovative preventative measures as many have expected.
Their preventative benefits are not even close to par with other rivals like the Discovery Medical Scheme. Discovery ensures members’ healthy living and seems to be able to track progress with its members in an exciting way.
From the research we conducted on the services offered by Bestmed, it is safe to conclude that the scheme is credible and very reliable.
Considering the years they have been in the industry they have had lesser complaints from their clients as compared to their competitors, Bestmed has constantly proved to be a go-to scheme if you looking for consistency in good services providing.
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