Bonitas BonCap D medical aid plan: 2019

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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.

BonCap D
2018 Costs:
Total Cost pm:

Main member:

R2,235

Adult:

R1,990

Child: (Pay for all)

R847
Savings Account:
  • No savings option on this plan
2019 Costs:
Total Cost pm:

Main member:

R2,456
(9.89%)

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: Gap Benefits:
Specialists:
  • 100% scheme rate
  • You or gap cover pay the balance, if any
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Recommended for this plan: Plan Blue, R295pm per family where no member is older than 64yrs (otherwise, R435pm per family)
Hospital Choice:
  • Choose a BonCap Network hospital, or pay R6,700 co-payment if you voluntarily choose another hospital
  • No extra benefit
Specialised Radiology:
  • R 11,060 per family
  • Sublimit increased as necessary, subject to procedure being approved by medical aid
Supplementary Services: (Physio, etc)
  • R4,340 per family
  • Physical rehabilitation: R49,610 per family
  • Sublimit increased as necessary, subject to procedure being approved by medical aid
  • No extra benefit for rehabilitation
Transplants:
  • TBC
  • No extra benefit available (PMB benefits are paid in full by medical aid)
Co-payments:
  • None
  • No extra benefit necessary
Alternatives to hospitals:
  • Alternatives to hospitalisation: R14,280 per family
  • Terminal care: Unlimited, including hospice/private nursing, home oxygen, pain management, psychologists, social workers
  • No extra benefit available
Casualty:
  • Accident and trauma related costs covered if authorised within 24hrs
  • Pays up to R20,000 per person per year for emergency medical treatment not paid for by medical aid
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
  • Sublimits increased as necessary
  • No benefit for exclusions
  • No benefit for blood
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)
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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 Gap benefits
Main: 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)
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
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
  • No benefit, unless PMB
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • No extra benefit available
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
  • No extra benefit available
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
  • No extra benefit available
General radiology:
  • See pathology benefit, above
  • No extra benefit available
Specialised radiology:
  • See specialist benefit, above
  • Sublimit increased as necessary for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No extra benefit available
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MATERNITY BENEFITS:
BonCap D
Scheme Benefits Gap benefits
Hospital stay:
  • 100% scheme rate
  • Elective c-sections: no benefit
  • Neonatal care: R45,380, unless PMB
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • No benefit for exclusions
  • Sublimits increased as necessary
Consultations:
  • Part of GP and Specialist benefit
  • Bonitas pays for 4 consults with midwife after birth
  • No extra benefit available
Scans:
  • Part of GP and Specialist benefit
  • No benefit, unless PMB
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CANCER (ONCOLOGY):
BonCap D
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only, at DSP (designated service provider)
  • No benefit, unless PMB
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DENTISTRY:
BonCap D
Scheme Benefits Gap benefits
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
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)
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
  • Pays shortfalls and co-payments for any non-PMB in-hospital dentistry treatment approved by scheme. (PMB are paid in full by scheme if you use DSP)
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MEDICATION:
BonCap D
Scheme Benefits Gap benefits
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary: 40%
  • No extra benefit available
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
  • No extra benefit available
Over-the-counter:
  • R95 per event, and R265 per person
  • No benefit, unless PMB
Birth Control:
  • R1,050 per family, paid by Bonitas
  • No extra benefit available
On Discharge:
  • R380 per person per admission
  • No extra benefit available
Biological:
  • No benefit, unless PMB level of care
  • No extra benefit available
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OPTOMETRY:
BonCap D
Scheme Benefits Gap benefits
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
  • Pays shortfalls and co-payments for in-hospital or day-clinic treatment approved by scheme
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MENTAL HEALTH:
BonCap D
Scheme Benefits Gap benefits
In-hospital:
  • In-hospital: PMBs always paid in full at DSP, and include up to 21 days admission
  • No extra benefit available
Out-of-hospital:
  • Out-of-hospital: PMBs always paid in full at DSP
  • No extra benefit available
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
  • No extra benefit available
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OTHER BENEFITS:
BonCap D
Scheme Benefits Gap benefits
General Appliances:
  • R5,440 per family
  • No benefit
1.1. Hearing Aids:
  • See above
  • No benefit
1.2. Wheelchairs:
  • See above
  • No benefit
Dialysis:
  • Unlimited at DSP provider, or 20% co-payment
  • No extra benefit available
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
  • No benefit
Emergency Transport: ER24
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other:
  • No benefit, unless PMB
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WELLNESS/PREVENTATIVE BENEFITS:
BonCap D
Scheme Benefits Gap benefits
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
  • No benefit
Back Rehabilitation Programme:
  • No benefit, unless PMB
  • 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:
  • 1 mammogram every two years, for women 40yrs+
  • No benefit
PAS Test:
  • 1 test for men 45-69yrs, who are high risk for prostate cancer
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • One stool test for colon cancer, 50yrs-75yrs
  • No benefit
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PROSTHETICS:
BonCap D
Scheme Benefits Gap benefits
Overal Limit:
  • Internal: PMBs only
  • External: PMBs only
  • No benefit, unless PMB
Sub-limits:
  • No benefit, unless PMB
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    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