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

(Pay for all)

Savings (per year):
  • No savings option on this plan
Gap (optional):
  • Varies. See below for specific recommendation for this plan.
In brief:
  • 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 A
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 100% scheme rate
  • Network specialists covered in full
  • 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:
  • Boncap network, or R6,500 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)
  • R4,130 per family
  • Physical rehabilitation: R47,250 per family
  • Sublimit increased as necessary, subject to procedure being approved by medical aid
  • No extra benefit for rehabilitation
Transplants:
  • 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: R13,600 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: 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
  • 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)

No phone calls!
Our quote will include the right gap cover for this plan

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 A
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • Bonitas pays for unlimited consults, provided you use 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
  • No extra benefit available
Specialists consultations:
  • Bonitas pays for 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 extra benefit available
Pathology:
  • Bestmed pays this benefit, which is shared with acute medicine, xrays and blood tests
MainM+1M+2M+3M4+
R1,750 R2,910 R3,490 R3,810 R4,230
  • 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)
  • You pay this from out of pocket
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

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MATERNITY BENEFITS:
BonCap A
Scheme Benefits Gap benefits
Hospital stay:
  • 100% scheme rate
  • No benefit for elective c-sections
  • Neonatal care: R43,220 except for PMBs
  • 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

No phone calls!
Our quote will include the right gap cover for this plan

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CANCER (ONCOLOGY):
BonCap A
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • PMBs only, at DSP
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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DENTISTRY:
BonCap A
Scheme 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
  • 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)
Orthodontics:
  • You pay this out of pocket
  • No extra benefit available
Maxillo Facial Surgery:
  • Orthognathic surgery: no benefit
  • Maxillo-facial surgery: PMB 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)

No phone calls!
Our quote will include the right gap cover for this plan

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MEDICATION:
BonCap A
Scheme Benefits Gap benefits
Chronic:
  • All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. Find out more
  • If you voluntarily use a PMB medicine that is not on Bonitas' list ("formulary"), you pay a 40% co-payment
  • No extra benefit available
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 extra benefit available
Over-the-counter:
  • R90 per event, and R250 per person
  • No benefit
Birth Control:
  • Bonitas pays R1,000 per family, from designated pharmacies
  • No extra benefit available
On Discharge:
  • R360 per person per admission
  • No extra benefit available
Biological:
  • You pay this out of pocket
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

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OPTOMETRY:
BonCap A
Scheme Benefits Gap benefits
Optometry:
  • Managed protocols from contracted service provider
  • Pays shortfalls and co-payments for in-hospital or day-clinic treatment approved by scheme

No phone calls!
Our quote will include the right gap cover for this plan

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MENTAL HEALTH:
BonCap A
Scheme Benefits Gap benefits
In-hospital:
  • Bonitas will pay for 21 days per person as part of PMB benefit
  • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
  • No extra benefit available
Out-of-hospital:
  • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
  • Otherwise, you pay for this out of pocket
  • 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

No phone calls!
Our quote will include the right gap cover for this plan

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OTHER BENEFITS:
BonCap A
Scheme 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
  • No extra benefit available
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: ER24
  • No benefit
International Insurance:
  • No benefit
  • No benefit
Other:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

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WELLNESS/PREVENTATIVE BENEFITS:
BonCap A
Scheme 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

No phone calls!
Our quote will include the right gap cover for this plan

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PROSTHETICS:
BonCap A
Scheme Benefits Gap benefits
Overal Limit:
  • Internal: PMB only
  • External: PMB only
  • No benefit
Sub-limits:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan


    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