Changes to the Bestmed Rules
Summary of the approved changes to the Rules of BestmedThe following changes to the Rules of the Scheme have been approved by the Council for Medical Schemes (CMS) with effect 1 January and 1 February 2014, respectively. Bestmed would like to keep our members informed of any changes that could impact on their healthcare needs, and this includes interim amendments to the registered Rules.
Changes with effect from 1 January 2014
- Changes to the Substantive Rules:
Definitions were changed and/or enhanced on the following rules:
- Rule 4.26 Designated service provider;
- Rule 4.47 Network option; and
- Rule 4.54 Preferred hospital provider network.
1.2 Changes to Annexure B of the Rules (benefit options):
- Conditions for Scheme benefit payment on all 10 benefit options to mention designated service providers and network option services.
- Biometric screening wording change on all 10 benefit options by substituting the names of specific providers with “selected Bestmed Preferred Providers”.
- Payment of Homeopathic remedies under Pace1 and Pace2 – should no nappi code be provided, then payment shall be made from the Bonus Account and not the IMSA.
- On Pace2, Pace3, Pace4 and Pulse2 provision is made for the repair of a hearing aid within the hearing aid limit.
- Acute medicine on Pace3 is changed to pay at 100% of cost, (previously 90%).
- Changes to Pulse1, Rule 8.2 in Annexure B8 to provide for conditions stipulated in the contract between the parties.
- Changes to Pulse2, Rule 9.2 in Annexure B9 to align benefits with the conditions stipulated in the contract between the two parties.
- General exclusions, Annexure C was updated to provide for exclusions in the new CareCross contract.
Changes with effect from 1 February 2014
- Changes to Annexure B of the Rules (Benefit options):
- Changes to Pulse1, Rule 8.2.2 and Rule 8.2.8 brought in line with the provisions of the Act in respect of PMBs.
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