Bestmed Pace 3 (for less than R103 400 p.a)

Quick Summary

Monthly contributions from R9,336 • Savings account + day-to-day benefits • No self-payment gaps • 29 chronic conditions covered • International travel cover

Can you afford comprehensive medical aid? Use our free budget calculator to see how Pace 3 fits into your monthly expenses and take control of your financial life.

What is the Bestmed Pace 3 Plan?

Pace3 offers comprehensive cover for members that have diverse medical needs. It includes comprehensive chronic benefits and excellent hospital cover.

The Pace range offers comprehensive in-hospital and out-of-hospital benefits. These options all have additional day-to-day benefits to cover extensive out-of-hospital expenses. This range is ideal for those seeking comprehensive cover. You have no self-payment gaps on all Pace options.

Whether you're an established family with ongoing healthcare needs, managing chronic conditions, or simply want the peace of mind that comes with maximum coverage, Pace 3 provides extensive benefits with the flexibility of free choice of providers—no network restrictions.

How does the Bestmed Pace 3 Plan work?

Certain out-of-hospital benefits are first covered by the yearly savings and, once depleted, by the day-to-day benefit. Once the day-to-day benefit is depleted, claims can be paid from the available vested savings.

The three-tier benefit structure explained:

1. Annual Medical Savings Account (MSA):

• Bestmed allows a certain percentage of the total annual contribution, in accordance with your selection of the benefit option, towards the medical savings account, and avails it in advance at the beginning of a benefit year or prorated if you joined during the year
• First tier of payment for most out-of-hospital expenses
• You manage and control how you spend these funds
• Unused funds which accumulate in your medical savings account at the end of a benefit year will be carried over to the credit of your vested medical savings

2. Day-to-Day Benefits:

• On Bestmed's Beat4, Pace1, Pace2 and Pace3 options, day-to-day benefits become available once the PMSA is depleted
• Second tier kicks in after savings are used
• Covers essential services at specified limits
• No need to worry once savings run out

3. Vested Savings:

• Any vested credit in your vested medical savings may be used to pay for out-of-hospital expenses, e.g. day-to-day benefits which have been paid at Scheme tariff or should you, for instance, have reached your out-of-hospital/day-to-day overall annual limit or the sub-limits
• Third tier for additional expenses
• Accumulated unused savings from previous years
• Members can give permission to pay for claims from the vested savings account
• Earns interest on positive balances

Hospital benefits: In-hospital expenses are paid from your medical savings account first and, once depleted, are paid from your day-to-day benefit. However, comprehensive hospital cover ensures unlimited PMB coverage at 100% Scheme tariff.

No self-payment gaps: You have no self-payment gaps on all Pace options. This means comprehensive cover without worrying about shortfalls between what the scheme pays and what providers charge.

Understanding the difference between medical schemes and hospital insurance helps clarify why comprehensive plans like Pace 3 offer superior value over basic hospital options.

What are the benefits of the Bestmed Pace 3 Plan?

The Pace 3 plan offers unlimited in-hospital coverage up to 100% of the scheme tariff, oncology coverage, international travel coverage, out-of-hospital benefits, preventative care, a Tempo wellness program, and more.

In-Hospital Benefits:

• Accommodation (hospital stay) and theatre fees: 100% Scheme tariff
• Take-home medicine: 100% Scheme tariff if claimed on day of discharge (maximum 7 days treatment or R200 from pharmacy)
• Treatment in mental health clinic: Approved PMBs at DSPs (21 days per beneficiary per year in-hospital OR 15 contact sessions for out-patient psychotherapy)
• Treatment of chemical and substance abuse: Benefits limited to PMB conditions (21 days' stay for in-hospital management per beneficiary per annum)
• Consultations and procedures: 100% Scheme tariff
• Surgical procedures and anaesthetics: 100% Scheme tariff
• Organ transplants: 100% Scheme tariff (PMBs only)
• Stem cell transplants: 100% Scheme tariff (PMBs only)
• Major medical maxillo-facial surgery: 100% Scheme tariff
• Dental and oral surgery (in or out of hospital): Limited to R24,419 per family per annum

Prosthesis Coverage:

• Prosthesis (subject to preferred provider): 100% Scheme tariff, limited to R162,601 per family per annum
• External prosthesis: Limited to R37,491 per family per annum (includes artificial limbs limited to 1 limb every 60 months)

Advanced Diagnostics & Treatment:

• Pathology: 100% Scheme tariff
• Basic radiology: 100% Scheme tariff
• Specialised diagnostic imaging (MRI, CT, isotope studies): 100% Scheme tariff, limited to R45,000 per family per annum combined in and out-of-hospital (co-payment R1,500 per scan, not applicable for PMBs)
• PET scans: Limited to 1 scan per beneficiary per annum, not subject to above limit and co-payment
• Oncology programme: 100% Scheme tariff, subject to pre-authorisation and DSPs with access to extended protocols
• Peritoneal dialysis and haemodialysis: 100% Scheme tariff

Maternity & Specialised Services:

• Confinements (birthing): 100% Scheme tariff
• Midwife-assisted births: 100% Scheme tariff
• Breast surgery for cancer: Treatment of unaffected breast limited to PMB provisions
• Medically necessary breast reduction surgery: 100% Scheme tariff, R58,046 per family per annum for surgeon and anaesthetist
• Refractive surgery: 100% Scheme tariff, limited to R12,210 per eye
• HIV/AIDS: 100% Scheme tariff

Additional Hospital Benefits:

• Orthopaedic and medical appliances: 100% Scheme tariff, limited to R15,000 per family per annum
• Supplementary services: 100% Scheme tariff
• Alternatives to hospitalisation: 100% Scheme tariff
• Advanced illness benefit: 100% Scheme tariff, limited to R139,308 per beneficiary per annum
• Day procedures: 100% network or Scheme tariff at DSP day hospitals (R2,746 co-payment if done in acute hospital not a day hospital)

International Travel Cover:

• Holiday travel: Limited to 90 days and R5,000,000 per family (R1,000,000 for USA travel)
• Business travel: Limited to 60 days and R5,000,000 per family (R1,000,000 for USA travel)

Out-of-Hospital Day-to-Day Benefits:

• Overall day-to-day limit: M = R43,380, M1+ = R69,954
• GP and Specialist consultations: Limited to M = R6,823, M1+ = R11,061
• Basic and specialised dentistry: Limited to M = R15,066, M1+ = R25,428
• Orthodontic dentistry: 100% Scheme tariff, limited to R12,770 per event for beneficiaries up to 18 years
• Medical aids, apparatus and appliances: Limited to R12,640 per family (includes artificial limb repairs)
• Wheelchairs: Limited to R17,094 per family every 48 months
• Hearing aids: Limited to R35,000 per beneficiary every 24 months
• Insulin pump (excluding consumables): 100% Scheme tariff, limited to R50,806 per beneficiary every 24 months
• Continuous/Flash Glucose Monitoring (CGM/FGM): 100% Scheme tariff, limited to R29,022 per family per annum
• Supplementary services: Limited to M = R6,823, M1+ = R13,430
• Wound care benefit: Limited to R16,663 per family

Optometry Benefits:

Benefits available every 24 months:

• Network Provider (PPN): Consultation - 1 per beneficiary; Frame = R1,260; 100% of standard lenses; Lens enhancement = R750 OR Contact lenses = R2,620
• Non-network Provider: Consultation - R400; Frame = R945; Single vision lenses = R215; Bifocal = R460; Multifocal = R1,040; Lens enhancement = R563 OR Contact lenses = R2,620

Radiology & Pathology:

• Basic radiology and pathology: 100% Scheme tariff, limited to M = R6,823, M1+ = R13,430
• Specialised diagnostic imaging: 100% Scheme tariff, limited to R45,000 per family per annum combined (R1,500 co-payment per scan except for involuntary non-DSP PMB use)

Managed Healthcare Programs:

• Back and Neck Preventative Programme: 100% of contracted fee
• Oncology programme: 100% Scheme tariff with extended protocols
• HIV/AIDS: 100% Scheme tariff
• Peritoneal dialysis and haemodialysis: 100% Scheme tariff
• Rehabilitation services after trauma: 100% Scheme tariff

Chronic Condition Management:

• CDL and PMB chronic medicine: 100% Scheme tariff (10% co-payment for non-formulary medicine)
• Non-CDL chronic medicine: 29 conditions at 100% Scheme tariff, limited to M = R24,058, M1+ = R48,335 (10% co-payment for non-formulary medicine)
• Biological medicine: Limited to R595,247 per beneficiary
• Other high-cost medicine: 100% Scheme tariff

Acute Medication:

• Acute medicine: Limited to M = R10,260, M1+ = R15,938 (10% co-payment for non-formulary medicine)
• Over-the-counter (OTC) medicine: Subject to available savings, 100% Scheme tariff

Learn more about which preventative screenings are covered by medical schemes and maximise these benefits.

Are contributions tax-deductible?

Medical aid contributions may qualify for tax credits under South African tax law. You can claim a portion of your medical aid contributions as a tax credit on your annual tax return, subject to SARS regulations and limits.

The tax credit system allows you to reduce your monthly tax liability, making comprehensive medical aid more affordable. Consult with a tax professional or visit the SARS website for current information on medical aid tax credits and how they apply to your specific situation.

Features

Comprehensive Three-Tier Coverage:

• Annual medical savings account for out-of-hospital expenses
• Day-to-day benefits once savings depleted
• Vested savings for additional coverage
• Interest earned on positive savings balances

Hospital Excellence:

• Unlimited PMB hospital cover at 100% Scheme tariff
• Free choice of hospitals and doctors (no network restrictions)
• Comprehensive prosthesis coverage (R162,601 per family)
• Advanced illness benefit (R139,308 per beneficiary)

Extensive Chronic Care:

• 29 non-CDL chronic conditions covered
• All 26 PMB CDL conditions included
• Biological medicine limit (R595,247 per beneficiary)
• Low co-payments (10%) for non-formulary medicines

Family-Friendly Policies:

• Pay for a maximum of three children (additional children at no cost)
• Dependants under 24 years regarded as child dependants
• Comprehensive maternity and pediatric care
• Orthodontic benefits for children up to 18 years
• Childhood immunizations and screenings

International & Emergency:

• R5 million international travel cover (R1 million USA)
• 24/7 emergency services through Netcare 911
• Holiday and business travel coverage
• 90-day holiday and 60-day business travel limits

No Self-Payment Gaps:

• No self-payment gaps on all Pace options
• Comprehensive cover without provider shortfalls
• Free choice of specialists and doctors
• Peace of mind with maximum protection

Monthly Contributions and Key Information

The table below sets out the Bestmed Pace 3 plan contributions and comprehensive benefit details:

Note: Contribution rates shown reflect 2025 pricing and are subject to annual adjustments. M = Main member only; M1+ = Main member plus one or more dependants. Always verify current rates directly with Bestmed before joining.

Budget Planning: With contributions from R9,336 per month plus a savings account to manage, comprehensive planning is essential. Use the JustMoney Budget Calculator to ensure medical aid fits comfortably within your overall financial strategy.

Important Requirements and Authorisation Rules

Pre-authorisation is mandatory: Members must get pre-approval for all planned operations at least fourteen (14) days before the event. GEMS Medical Aid In emergencies, the member, authorised representative, or hospital must notify Bestmed as soon as feasible or on the first business day after admission.

Why pre-authorisation matters:

• Ensures treatment is covered under your plan

• Prevents unexpected out-of-pocket costs

• Enables case management support

• Confirms provider and treatment protocols

• Avoids claim denials and delays

Benefits subject to protocols: The following benefits may be subject to pre-authorization, clinical protocols, preferred providers (PPs), designated service providers (DSPs), formularies, funding criteria, the Mediscor Reference Price (MRP), and the exclusions listed in Annexure C of the published Regulations.

Chronic medication requirements: Members will not incur co-payments for PMB pharmaceuticals on the formulary for which no generic substitute exists. However, a 10% co-payment applies for non-formulary medicines across all categories.

Managing your three-tier benefits: Plan your healthcare spending strategically:

1. Use your annual savings account first for most out-of-hospital expenses

2. Day-to-day benefits kick in automatically once savings depleted

3. Vested savings available for additional expenses or benefit shortfalls

4. Prescribed minimum benefits (PMBs) and co-payments are not funded from the PMSA 

For comprehensive guidance, read our article on what to ask your medical scheme before a procedure.

Who Should Consider This Plan?

The Pace 3 Plan is ideal for:

• Established families with diverse healthcare needs who require comprehensive in-hospital and out-of-hospital coverage.
• Members with chronic conditions needing extensive chronic medication coverage, including 29 non-CDL conditions and biological medicine benefits.
• Healthcare-conscious individuals who want the peace of mind that comes with no self-payment gaps and comprehensive coverage.
• Members requiring specialised care such as diabetes management with insulin pumps and glucose monitoring systems.
• Families with children needing orthodontic care, pediatric services, and comprehensive family coverage.
• International travelers (business or leisure) who want extensive emergency medical coverage abroad.
• Members who value choice and want free selection of hospitals, doctors, and specialists without network restrictions.
• Those managing savings who appreciate the flexibility of a three-tier benefit structure with annual savings, day-to-day benefits, and vested savings.

The benefit of choosing Bestmed Pace 3 is that it offers some of the highest benefits and coverage among the Bestmed Pace plans, including unlimited in-hospital benefits and comprehensive coverage for out-of-hospital medical services.

Not sure if this is the right plan? Read our guide on how to choose medical aid and explore 5 questions to ask when choosing a medical scheme.

Understanding Your Medical Savings Account

Bestmed Medical Scheme offers personal medical savings accounts (PMSAs), otherwise referred to as 'medical savings', 'annual savings' or just 'savings', on certain benefit options. 

How your Pace 3 savings work:

• Annual allocation: Bestmed allows a certain percentage of the total annual contribution towards the medical savings account, and avails it in advance at the beginning of a benefit year or prorated if you joined during the year. 
• What you can use it for: You are responsible for managing the use of your medical savings account, since you are entitled to claim for all healthcare services at 100% of the Scheme tariff, subject to sufficient funds being available at the date on which a claim is processed. 
• Unused savings: No, you don't lose it. It becomes a part of the following year's savings or will be added to your vested savings, depending on your benefit option. 
• Interest earned: Yes, members with positive balances (whether active or resigned) earn interest on the net positive balance of the annual personal medical savings and vested savings accounts. 
• If you resign: If a member resigns from Bestmed and decides not to join another scheme, the member will receive the balance of funds, including interest earned. 
• Vested savings usage: Beneficiaries may request payment of services such as co-payments to be paid from their vested savings, depending on their benefit option. Day-to-day benefits can also be paid from the vested savings account. 

Frequently Asked Questions

How do the three tiers of benefits work?
First, you use your annual medical savings account for most out-of-hospital expenses. Once depleted, day-to-day benefits automatically become available. Finally, accumulated vested savings can cover additional expenses or benefit shortfalls.

What happens to unused savings?
Unused annual savings roll over to your vested savings account at year-end, where they accumulate and earn interest. These funds remain yours even if you change plans or resign from the scheme.

Can I upgrade my plan later?
Yes, you can upgrade during annual enrollment periods or following qualifying life events like marriage, childbirth, or significant health changes.

Are there network restrictions?
No, Pace 3 has no network restrictions. You have free choice of any registered hospital, doctor, or specialist in South Africa without penalties or reduced benefits.

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