Bonitas BonCap A medical aid plan: 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 A
Quick Overview
Main: Adult: Child:
Total Cost pm: R918 R870 R432
Savings (per year): No savings option on this plan
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children: Pay for all children
  • 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

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IN HOSPITAL PROCEDURES:
BonCap A
Benefits Gap benefits
Payout Rate for Specialists:
  • 100% scheme rate
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.
Hospital Choice:
  • Boncap network, or R6,500 co-payment if you voluntarily choose another hospital
  • R12,800 per family 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 A
Benefits Gap benefits
GP consultations:
  • Unlimited, using two network GPs
  • No benefit
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 A
Benefits Gap benefits
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
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 A
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only, at DSP
  • No benefit
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DENTISTRY:
BonCap A
Benefits Gap benefits
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
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
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MEDICATION:
BonCap A
Benefits Gap benefits
Chronic:
  • No. of chronic conditions covered: 27 PMBs from Pharmacy Direct
  • Co-payment if out of formulary: 40% co-payment
  • No benefit
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 A
Benefits Gap benefits
Optometry:
  • Managed protocols from contracted service provider
  • No benefit
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MENTAL HEALTH:
BonCap A
Benefits Gap benefits
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 A
Benefits Gap benefits
General Appliances:
  • R5,180 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
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 A
Benefits Gap benefits
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
  • No benefit
Back Rehabilitation Programme:
  • Managed back and neck program offers personalised treatment plan for up tp 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
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PROSTHETICS:
BonCap A
Benefits Gap benefits
Overal Limit:
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