Bestmed Medical Scheme
Maximise your benefit - Visit an In Network Provider
To confirm that you or a dependent is entitled to optical benefit, SMS your request to 45119 with the following details:
Benefit,MembershipNumber,Surname,BirthDateDependent,MainMemberID,DependantNumber, UniqueMedicalAidKey
Example: SMS 45119 Message details: Benefit 277323232 Botha 19721220 7212205065089 0 84
Important information:
Replace each comma with a space in your SMS, ensure the details are accurate and only one space is between each requirement. Kindly make sure the birthdate is in the correct format as per the example. The information will return within 1 minute on a new SMS. The full benefit breakdown per dependent is available by logging in to the PPN website or a guideline is given below. The Schemes unique medical aid key is 84.
Beat 3 / Network
2022 Optical Benefit:
Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.
Member can claim either Spectacles OR Contact Lenses
Forensic protocols and AI screening included in design
The benefits is a guideline and scheme rules apply
Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
Network: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350
- IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 860.00
- OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 645
AND
- One pair of either Single Vision or Bifocal or Multifocal clear standard lenses
- Contact lenses: R 1 630.00 per beneficiary
- Contact lens re-examination every 6 months after initial consultation
Beat 4
2022 Optical Benefit:
Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.
Member can claim either Spectacles OR Contact Lenses
Forensic protocols and AI screening included in design
The benefits are a guideline and scheme rules apply
Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
One Comprehensive ConsultationNetwork: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350
- IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 950
- OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 713
- One pair of either Single Vision or Bifocal or Multifocal clear standard lenses
- Contact lenses: R 1 720 per beneficiary
Pace 1
2022 Optical Benefit:
Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.
Member can claim either Spectacles OR Contact Lenses
Forensic protocols and AI screening included in design
The benefits are a guideline and scheme rules apply
Negotiated Tariff: PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
One Comprehensive ConsultationNetwork: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350
- IN NETWORK : Frame and Lens Enhancement benefit up to the value of R 950
- OUT OF NETWORK/REFUND VALUE : Frame and Lens Enhancement benefit up to the value of R 713
- One pair of either Single Vision or Bifocal or Multifocal clear standard lenses
- Contact lenses: R 1 720 per beneficiary
Pace 2
2022 Optical Benefit:
Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.
Member can claim either Spectacles OR Contact Lenses
Forensic protocols and AI screening included in design
The benefits are a guideline and scheme rules apply
Negotiated Tariff: PPN 1(Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
One Comprehensive ConsultationNetwork: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350
- IN NETWORK : Frame R990 and Lens Enhancement benefit up to the value of R 750
- OUT OF NETWORK/REFUND VALUE : Frame R743 and Lens Enhancement benefit up to the value of R 563
- One pair of either Single Vision or Bifocal or Multifocal clear standard lenses
- Contact lenses: R 1 880 per beneficiary
Pace 3
2022 Optical Benefit:
Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.
Member can claim either Spectacles OR Contact Lenses
Forensic protocols and AI screening included in design
The benefits are a guideline and scheme rules apply
Negotiated Tariff: PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
One Comprehensive ConsultationNetwork: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350
- IN NETWORK : Frame R990 and Lens Enhancement benefit up to the value of R 750
- OUT OF NETWORK/REFUND VALUE : Frame R743 and Lens Enhancement benefit up to the value of R 563
- One pair of either Single Vision or Bifocal or Multifocal clear standard lenses
- Contact lenses: R 1 880 per beneficiary
Pace 4
2022 Optical Benefit
Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.
Member can claim either Spectacles OR Contact Lenses
Forensic protocols and AI screening included in design
The benefits are a guideline and scheme rules apply
Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate. The same product out of network may result in co-payments if an out of network provider dispenses at industry rates.)
One Comprehensive ConsultationNetwork: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350
- IN NETWORK : Frame R990 and Lens Enhancement benefit up to the value of R 750
- OUT OF NETWORK/REFUND VALUE : Frame R743 and Lens Enhancement benefit up to the value of R 563
- One pair of either Single Vision or Bifocal or Multifocal clear standard lenses
- Contact lenses: R 2 220 per beneficiary
Rhythm 1
2022 Optical Benefit
Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.
Member can pay for materials 9Spectacles OR Contact Lenses) and submit the claim accordingly for Tax purposes
Forensic protocols and AI screening included in design at network providers
Benefits are a guideline and scheme rules apply
Negotiated Tariff : PPN 1 (Lenses are dispensed in network at an agreed network rate to assist member with their material payments. The same product out of network may result in higher material values dispensed at industry rates.)
One Composite ConsultationNetwork: One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
OR
Out of Network: Refraction to the value of R350
Materials are not funded by the scheme but claims can be submitted for tax purposes
Rhythm 2
2022 Optical Benefit (Network Benefits Only)
Each beneficiary is entitled to the following benefits within a 2 year benefit cycle subject to the last claiming date.
Member can claim either Spectacles OR Contact Lenses
Forensic protocols and AI screening included in design
The benefits are a guideline and scheme rules apply
Negotiated Tariff : PPN 1 (Lenses are dispensed at an agreed network rate.)
One Comprehensive Consultation (Refraction, Tonometry, Visual Field Screening and AI)
- Frame and Lens Enhancement benefit up to the value of R 235
- One pair of either Single Vision or Bifocal clear standard lenses
Contact lenses: R 655 per beneficiary
