Bonitas BonCap C medical aid plan: 2017 vs 2018

View all plans in this scheme.
Please note that these benefits are still being updated as more information is made available to us. Always consult with your broker before making final decisions regarding your healthcare cover.

COSTS and OVERVIEW:
BonCap C
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R1,820 R1,620 R689
Cost 2017: (R) (R) (R)
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited overall, with sub-limits
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Savings: No savings option on this plan
Children: Pay for all children
    In 2018, Bonitas will:
  • Pay for contraceptives
  • Provide terminal care cover
  • Pay for a hearing test and a congenital hypothyroidism screening for your newborn
See below for other changes
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Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family


IN HOSPITAL PROCEDURES:
BonCap C
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: Fusion Gap:
  • Up to 600% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
  • R350pm per family. More Info or download application below.

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Hospital Choice:
  • Boncap network, or R6,500 co-payment if you voluntarily choose another hospital
  • R12,800 per person per year for use of a non-network hospital
Specialised Radiology:
  • Co-payment: none
  • Sublimit: R 11,060 per family
  • Rate: 100% scheme rate
  • Up to 600% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
Supplementary Services: (Physio, etc)
  • R4,130 per family
  • Physical rehabilitation: R47,250 per family
  • Up to 600% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
Transplants:
  • PMBs only
  • Up to 600% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
Co-payments:
  • N/A
  • N/A
Alternatives to hospitals:
  • Alternatives to hospitalisation: R13,600 per family
  • $$ Terminal care: Unlimited, including hospice/private nursing, home oxygen, pain management, psychologists, social workers. This is a new benefit.
  • No benefit
Casualty:
  • Accident and trauma related costs covered if authorised within 24hrs
  • Casualty costs not covered by medical aid, in case of emergency treatment: R12,800 per incident. Cover also applies to costs covered by savings account.
Other:
  • Blood tests: R24,230 per family
  • Blood transfusions: R17,600 per family
    Excluded:
  • Back and neck surgery
  • Joint replacement surgery
  • C-sections for non-medical reasons
  • Functional nasal and sinus surgery
  • Varicose vein surgery
  • Hernia repair surgery
  • Laparoscopic surgery
  • All endoscopies
  • Bunion surgery
  • In-hospital dental surgery
  • Up to 500% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
  • No benefit for exclusions
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OUT OF HOSPITAL BENEFITS:
BonCap C
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Unlimited, using two network GPs
  • No benefit


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Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • 24/7 access to Babyline
  • Immunisation: one flu vaccine
  • No benefit
Specialists consultations:
  • 3 consults or R2,960 per person and 5 consults and R4,400 per family
  • Includes: acute medicine, blood tests, MRIs and CAT scans, xrays
  • No benefit
Pathology:
  • Benefit shared with acute medicine, xrays and blood tests
MainM+1M+2M+3M4+
R1,750 R2,910 R3,490 R3,810 R4,230
  • No benefit
General radiology:
  • Benefit shared with acute medicine, xrays and blood tests
MainM+1M+2M+3M4+
R1,750 R2,910 R3,490 R3,810 R4,230
  • No benefit
Specialised radiology:
  • See specialist benefit, above
  • No benefit
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No benefit
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MATERNITY BENEFITS:
BonCap C
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • No benefit for elective c-sections
  • Neonatal care: R43,220 except for PMBs
  • Premature birth, more than 6 weeks:R12,000 lump payment
  • In case of admission related to premature birth:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
  • Sublimits increased by R44,000 per event, unlimited for the year

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Consultations:
  • Part of GP and Specialist benefit
  • 4 consults with midwife after birth
  • No benefit
Scans:
  • Part of GP and Specialist benefit
  • No benefit
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CANCER (ONCOLOGY):
BonCap C
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • PMBs only, at DSP
  • No benefit
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
BonCap C
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Standard Dentistry: from day-to-day benefit.
  • Includes:
    • 1 annual checkup, and 1 emergency consultation for pain
    • 4 intra-oral x-rays per person
    • 1 extra-oral per person per lifetime
    • 1 scale and polish treatments per person
    • Fissure sealants for under 16yr olds
    • Fluoride treatments for children 5-16yrs
    • 4 fillings per person per year
    • Root canals, for emergency treatment only
    • 1 set of plastic dentures per family every 2 years, with 20% co-payment
  • Specialised dentistry: no benefit
  • Hospitalization: pre-authorisation required
  • Dental reconstruction due to due to trauma or oncology treatment: R40,000 per event
  • Full cover for in-hospital co-payments

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Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • Orthognathic surgery: no benefit
  • Maxillo-facial surgery: PMB only
  • Dental reconstruction as result of trauma or oncology: R40,000 per event

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

MEDICATION:
BonCap C
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27 PMBs from Pharmacy Direct
  • Co-payment if out of formulary: 40% co-payment
  • No benefit

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Acute (presrcibed) medication:
  • Benefit shared with acute medicine, xrays and blood tests
MainM+1M+2M+3M4+
R1,750 R2,910 R3,490 R3,810 R4,230
  • No benefit
Over-the-counter:
  • R90 per event, and R250 per person
  • No benefit
Birth Control:
  • R1,000 per family, from designated pharmacies
  • No benefit
On Discharge:
  • R360 per person per admission
  • No benefit
Biological:
  • No benefit
  • No benefit
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OPTOMETRY:
BonCap C
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • Managed protocols from contracted service provider
  • No benefit

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MENTAL HEALTH:
BonCap C
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • PMBs only
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Out-of-hospital:
  • PMBs only
  • No benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
BonCap C
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • R5,180 per family
  • No benefit

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1.1. Hearing Aids:
  • See above
  • No benefit
1.2. Wheelchairs:
  • See above
  • No benefit
Dialysis:
  • Unlimited at DSP provider, or 20% co-payment
HIV:
  • In-hospital: PMB only if you register on the HIV/AIDS programme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
  • No benefit
Emergency Transport:
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other:
  • Death or permanent disability: R12,000. If cause of death was accidental: R24,000.
  • If Principal member of medical aid passes away or becomes disabled: Medical aid contributions will be paid for six months, up to R4,400 per month. Gap premium is also waived for 6 months
  • In event of vehicle accident where policy holder was not at fault: Gap will provide all legal assistance, fully covered.
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WELLNESS/PREVENTATIVE BENEFITS:
BonCap C
2017 v 2018 benefits Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit

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Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
  • No benefit
Back Rehabilitation Programme:
  • Managed back and neck program offers personalised treatment plan for up to 6 weeks, paid by scheme
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • No benefit
  • No benefit
Pap Smear:
  • Covered, every 3 years for women 21yrs-65yrs
  • No benefit
Mammogram:
  • No benefit
  • No benefit
PAS Test:
  • No benefit
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • One stool test for colon cancer, 50yrs-75yrs
  • No benefit

Avoid bills! Get up to: 800% scheme rate;  R12,800 per ER visit; unlimited cancer cover;  

co-payments paid and cash payout for hospital stay. R350pm per family

2017 v 2018 benefits Gap benefits Notes
Overal Limit:
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Sub-limits:
  • Internal: PMB only
  • External: PMB only
  • An additional R40,000 per sublimit, per event

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised