Bonitas BonCap D medical aid plan: 2019

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BonCap D
2019 Costs:
Total Cost pm:

Main member:

R2,456

Adult:

R2,187

Child: (Pay for all)

R931
Savings (per year):
  • No savings option on this plan
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In brief (2018):
  • Scheme rate is 100%, and premiums depend on your income. Day-to-day expenses are paid by scheme or from out of pocket
  • There are excluded procedures
  • This is an entry level plan with basic day-to-day benefits and hospital cover using a network
  • Cover for 27 chronic conditions
  • Diagnosis and treatment of the 270 PMBs is always paid by scheme, in and out of hospital, according to protocols.
See full benefits below

IN HOSPITAL PROCEDURES:
BonCap D
Scheme Benefits: Notes and Links:
Specialists:
  • 100% scheme rate
  • You or gap cover pay the balance, if any
 Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Choose a BonCap Network hospital, or pay R6,700 co-payment if you voluntarily choose another hospital
Specialised Radiology:
  • R 11,060 per family
Supplementary Services: (Physio, etc)
  • R4,340 per family
  • Physical rehabilitation: R49,610 per family
Transplants:
  • TBC
Co-payments:
  • None
Alternatives to hospitals:
  • Alternatives to hospitalisation: R14,280 per family
  • Terminal care: Unlimited, including hospice/private nursing, home oxygen, pain management, psychologists, social workers
Casualty:
  • Accident and trauma related costs covered if authorised within 24hrs
Other:
  • Blood tests: R25,440 per family
  • Blood transfusions: R18,480 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
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
BonCap D
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • This plan has an "extra" fund ("day-to-day benefit"), so most out of hospital costs are paid by this, subject to sub-limits per benefit (see below)
GP consultations:
  • Contracted GPs: unlimited consults
  • Non-Contracted GPs: 1 consult per person and 2 consults per family, limited to R1,050 with a 20% co-payment
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
Specialists consultations:
  • 3 consults or R3,110 per person and 5 consults and R4,620 per family
  • Includes: acute medicine, blood tests, MRIs and CT scans, x-rays
Pathology:
  • Bestmed pays this benefit, which is shared with acute medicine, x-rays and blood tests
MainM+1M+2M+3M4+
R1,840 R3,060 R3,660 R4,000 R4,440
General radiology:
  • See pathology benefit, above
Specialised radiology:
  • See specialist benefit, above
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
What next?
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MATERNITY BENEFITS:
BonCap D
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% scheme rate
  • Elective c-sections: no benefit
  • Neonatal care: R45,380, unless PMB
Consultations:
  • Part of GP and Specialist benefit
  • Bonitas pays for 4 consults with midwife after birth
Scans:
  • Part of GP and Specialist benefit
What next?
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CANCER (ONCOLOGY):
BonCap D
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, at DSP (designated service provider)
What next?
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DENTISTRY:
BonCap D
Scheme Benefits Notes and Links:
Standard Dentistry:
  • 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 or polish treatments per person
  • Fissure sealants for under 16yr olds
  • Fluoride treatments for unde 16yrs
  • 4 fillings per person per year
  • Extractions
  • Root canals, for emergency treatment only
  • 1 set of plastic dentures per family every 2 years, with 20% co-payment
Specialised Dentistry:
  • Specialised dentistry: no benefit
In-Hospital Dentistry:
  • Dental and oral surgery: no benefit, unless PMB
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • Orthognathic surgery: no benefit
  • Osseo-integrated implants: no benefit
  • Maxillo-facial surgery: PMBs only
What next?
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MEDICATION:
BonCap D
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary: 40%
Acute (presrcibed) medication:
  • Benefit shared with acute medicine, xrays and blood tests
MainM+1M+2M+3M4+
R1,840 R3,060 R3,660 R4,000 R4,440
Over-the-counter:
  • R95 per event, and R265 per person
Birth Control:
  • R1,050 per family, paid by Bonitas
On Discharge:
  • R380 per person per admission
Biological:
  • No benefit, unless PMB level of care
What next?
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OPTOMETRY:
BonCap D
Scheme Benefits: Notes and Links:
Optometry:
Limit:Paid by scheme, every 24 months
Consult:1 per person
Frames:R225
Single lenses100% cost
Bifocals:
Multifocals
ContactsR1,035
Refractive Surgery:no benefit
Notes:Above benefits from network provider
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MENTAL HEALTH:
BonCap D
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: PMBs always paid in full at DSP, and include up to 21 days admission
Out-of-hospital:
  • Out-of-hospital: PMBs always paid in full at DSP
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Trauma:
  • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

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OTHER BENEFITS:
BonCap D
Scheme Benefits Notes and Links:
General Appliances:
  • R5,440 per family
  • No benefit
1.1. Hearing Aids:
  • See above
1.2. Wheelchairs:
  • See above
Dialysis:
  • Unlimited at DSP provider, or 20% co-payment
HIV:
  • In-hospital: PMBs 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
Emergency Transport: ER24
International Insurance:
  • No benefit
Other:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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WELLNESS/PREVENTATIVE BENEFITS:
BonCap D
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
Back Rehabilitation Programme:
  • No benefit, unless PMB
Biometric Screening:
  • Covered
Child Immunisation:
  • No benefit
Pap Smear:
  • Covered, every 3 years for women 21yrs-65yrs
Mammogram:
  • 1 mammogram every two years, for women 40yrs+
PAS Test:
  • 1 test for men 45-69yrs, who are high risk for prostate cancer
HIV Test:
  • Covered
Other:
  • One stool test for colon cancer, 50yrs-75yrs
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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PROSTHETICS:
BonCap D
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: PMBs only
  • External: PMBs only
Sub-limits:
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    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