Bestmed: Mental Health Care Benefits and Support
TherapyRoute
Clinical Editorial
Cape Town, South Africa
❝Bestmed, a well-established South African medical aid known for its straightforward approach, offers consistent mental health coverage across all plans, complemented by its Tempo wellness programme.❞
Bestmed is a well-established medical aid in South Africa with a market share of 3.8%. It is known for its straightforward approach to healthcare and its focus on preventative care.
This article will provide a detailed look at Bestmed's mental health coverage, based on their 2024 and 2025 policy documents. We will explore their benefit structure, the Tempo wellness programme, and how you can access care.
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Table of Contents | Jump Ahead
Bestmed's Simple and Consistent Approach to Mental Health
A Closer Look at Your Bestmed Mental Health Benefits
How to Access Your Bestmed Mental Health Benefits
Network vs Non-Network Providers: A Detailed Comparison
How to Claim for Therapy Sessions
The Verdict: Is Bestmed a Good Choice for Mental Health?
Global Helplines & Emergency Services
Bestmed's Simple and Consistent Approach to Mental Health
Bestmed's mental health benefits are designed to be clear and easy to understand. Instead of complex programmes and varying benefit limits, Bestmed offers a consistent level of cover across all its plans. This makes it easier for members to know exactly what they are covered for.
The Core Benefit: In-Hospital or Out-Patient Care
The cornerstone of Bestmed's mental health offering is a choice between in-hospital and out-patient care. All Bestmed members are entitled to either:- 21 days of in-hospital treatment at a mental health facility per year, OR
- 15 out-patient consultations with a mental health professional per year.
This clear, session-based structure is a major advantage, as it removes the uncertainty that can often come with more complex benefit designs.
The Tempo Wellness Programme: Support for All
In addition to this core benefit, all Bestmed members have access to the Tempo wellness programme. This programme includes an Emotional Wellbeing Journey, which provides members with access to a range of resources and support to help them manage their mental health. This is a valuable benefit that is available to all members, regardless of their plan.A Closer Look at Your Bestmed Mental Health Benefits
Bestmed's mental health benefits are consistent across all their plans. Here is a breakdown of what you can expect.In-Hospital Treatment
If you choose the in-hospital option, you are covered for up to 21 days at a network psychiatric facility. This benefit is available to all members on all plans. As with all medical aids, you will need to get pre-authorization from Bestmed before being admitted.Out-of-Hospital Treatment
If you opt for out-of-hospital care, you are entitled to 15 consultations with a mental health professional per year. This can include psychologists, psychiatrists, and other registered counsellors. This benefit is also available to all members on all plans.Medication
Chronic medication for mental health conditions is covered under the Chronic Medication Benefit. You will need to register your condition with Bestmed to access this benefit. The scheme has a list of covered conditions and a formulary that you will need to adhere to.
Prescribed Minimum Benefits (PMBs) - Covered on ALL Plans
|
PMB Code |
Condition |
Coverage |
Professional Context |
|---|---|---|---|
| 902T | Major affective disorders, including unipolar and bipolar depression | Unlimited hospital + 15 outpatient sessions | Executive function support and mood stabilisation |
| 907T | Schizophrenic and paranoid delusional disorders | Unlimited hospital + ongoing treatment | Comprehensive psychiatric care with privacy protection |
| 908T | Anorexia Nervosa and Bulimia Nervosa | Hospital care + 15 outpatient sessions | Stress-related eating disorder support |
| 182T | Abuse or dependence on psychoactive substances, including alcohol | Hospital rehabilitation + outpatient support | Confidential addiction treatment for professionals |
| 901T | Acute stress disorder accompanied by recent significant trauma | Hospital care + 12 outpatient sessions | Workplace trauma and acute stress intervention |
| 903T | Attempted suicide, irrespective of cause | Hospital care + outpatient support | Crisis intervention with professional discretion |
How to Access Your Bestmed Mental Health Benefits
- Choose Your Benefit: The first step is to decide whether you want to use the in-hospital or out-patient benefit. You cannot use both in the same year.
- Get Pre-Authorisation: For any planned hospital admissions, make sure you get pre-authorisation from Bestmed.
- Use Network Providers: To minimise your out-of-pocket expenses, use providers in the Bestmed network.
- Explore the Tempo Programme: All members have access to the Tempo wellness programme. Make sure you explore the resources available through the Emotional Wellbeing Journey.
Network vs Non-Network Providers: A Detailed Comparison
Your choice between a network and a non-network provider has significant financial and administrative implications. Here’s a detailed breakdown to help you make an informed decision:| Feature | Network Providers (DSPs) | Non-Network Providers |
|---|---|---|
| :--- | :--- | :--- |
| Cost | Lower out-of-pocket costs. You are only responsible for a small co-payment, if any. | Higher out-of-pocket costs. You are responsible for the full fee upfront. |
| Billing | The provider bills Bestmed directly (bulk-billing). | You pay the provider and then claim back from Bestmed. |
| PMB Coverage | Full cover for PMB conditions, with no co-payments. | You may be liable for a co-payment of up to 20% of the cost of treatment. |
| Rates | Charge at or close to the Bestmed Rate. | Can charge significantly above the Bestmed Rate, and you are responsible for the difference. |
What is a Designated Service Provider (DSP)? A DSP is a healthcare provider (doctor, hospital, or pharmacy) that has a special agreement with Bestmed to provide services at a pre-negotiated rate. For PMB conditions, you must use a DSP to get full cover. If you choose to use a non-DSP for a PMB condition, you may have to pay a significant co-payment.
Why We Recommend Network Providers For most members, using a network provider is the most cost-effective and hassle-free option. You will have lower out-of-pocket costs, less paperwork, and access to the full range of your benefits. While non-network providers offer more choice, this comes at a significant financial cost.
How to Claim for Therapy Sessions
Understanding the claims process can save you time and ensure you get reimbursed quickly:Option 1: Network Provider (Recommended)
- Book with a network provider who accepts Bestmed
- Show your Bestmed card at the appointment
- Provider submits claim directly to Bestmed (bulk billing)
- You pay only your portion (co-payment if applicable)
Option 2: Non-Network Provider
- Pay the full session fee upfront to your therapist
- Get a detailed invoice with the following information:
- Your membership number
- Provider's practice number
- Date of service
- ICD-10 diagnosis code
- Procedure code (usually 0134 for psychology consultation)
- Amount charged
- Submit your claim within 4 months via:
- Bestmed app (fastest)
- Online member portal
- Email to claims@bestmed.co.za
- Post to Bestmed Claims, PO Box 2297, Pretoria, 0001
Required Documentation for Claims
- Detailed tax invoice from your therapist
- Proof of payment (if paying upfront)
- Referral letter (if required by your plan)
- Diagnosis confirmation (may be requested)
Claims Processing Time
- Electronic claims: 5-7 working days
- Manual claims: 10-15 working days
- Complex claims: Up to 30 days
The Verdict: Is Bestmed a Good Choice for Mental Health?
Bestmed is a good choice for individuals and families who are looking for a straightforward and easy-to-understand approach to mental health care. The clear, session-based structure removes the guesswork and makes it easy to know what you are covered for. The likelihood of getting your mental health treatment paid for by Bestmed is moderate, as the annual limits are lower than some other schemes, but the benefits are clear and consistent. If you are looking for a medical aid that provides a simple and predictable level of mental health cover, Bestmed is a solid option.Global Helplines & Emergency Services
If you are in immediate distress, please reach out for help. You are not alone.- Find a helpline, suicide hotline, or crisis line in your country: https://www.therapyroute.com/article/helplines-suicide-hotlines-and-crisis-lines-from-around-the-world
- Find an emergency ambulance number in your country: https://www.therapyroute.com/article/ambulance-emergency-numbers-worldwide-list-by-therapyroute
References
Council for Medical Schemes Annual Report 2022/23 (Official)
Comprehensive PMB Conditions Overview
Disclaimer: The information in this article is based on 2024/2025 policy documents. Benefit amounts and contact details can change. Always verify current details with your medical aid scheme before making any healthcare decisions.
Important: TherapyRoute does not provide medical advice. All content is for informational purposes and cannot replace consulting a healthcare professional. If you face an emergency, please contact a local emergency service. For immediate emotional support, consider contacting a local helpline.
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About The Author
TherapyRoute
Cape Town, South Africa
“Our in-house team, including world-class mental health professionals, publishes high-quality articles to raise awareness, guide your therapeutic journey, and help you find the right therapy and therapists. All articles are reviewed and written by or under the supervision of licensed mental health professionals.”
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