Bonitas BonClassic 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:
BonClassic
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R4,009 R3,442 R990
Cost 2017: (R3,648) (R3,132) (R900)
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: R6,804 R5,844 R1,680
Children: Pay for maximum 3 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:
BonClassic
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:
  • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
  • No benefit
Specialised Radiology:
  • Co-payment: none
  • Sublimit: R 27,610 per family
  • Rate: 100% scheme rate
  • In and out of hospital
  • Up to 600% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • 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:
  • Covered
  • Corneal grafts: R30,000
  • Up to 600% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
Co-payments:
  • Spinal surgery: R5,650 co-payment if you do not go for assessment through back and neck program
  • Hip and knee replacements: R5,650 co-payment if you do not use the preferred provider
Fusion Gap:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Alternatives to hospitalisation: R15,760 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:
  • Cochlear implants: R264,500
  • Up to 500% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
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OUT OF HOSPITAL BENEFITS:
BonClassic
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • Paid from day-to-day benefit, unless PMB
  • Out of hospital treatment for conditions that are PMBs is always paid for by the scheme (not out of savings), but according to protocols
  • 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:
  • Paid from day-to-day benefit
  • No benefit
Pathology:
  • R2,960 per person, and> R6,560 per family, paid by scheme
  • No benefit
General radiology:
  • R2,960 per person, and R6,560 per family, paid by scheme
  • No benefit
Specialised radiology:
  • R27,610 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • Paid by scheme to these sub limits
  • Physical Therapy: R1,460 per person, and R2,960 per family
  • Otherwise:
    Main M+1 M+2 M+3 M+4
    R2,820 R4,330 R4,990 R5,330 R5,710
  • No benefit
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MATERNITY BENEFITS:
BonClassic
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • 100% scheme rate
  • 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

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Consultations:
  • 12 consults paid by scheme
  • 4 consults with midwife after delivery
  • Antenatal classes: R1,160 paid by scheme
  • No benefit
Scans:
  • 2 x 2D scans
  • 1 amniocentesis
  • No benefit
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CANCER (ONCOLOGY):
BonClassic
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • R390,900 per family, at a preferred provider
  • Brachytherapy: R42,110
  • Oncology Booster: Once the oncology limit is reached, gap pays for full cover thereafter
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:
BonClassic
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Standard Dentistry: paid by scheme (not from day-to-day).
  • Includes:
    • 2 annual checkups
    • X-rays. (Extra-oral 1 every 3 years)
    • 2 annual scale and polish treatments per person
    • Fissure sealants for under 16yr olds
    • Fluoride treatments for children 5-16yrs
    • One filling per tooth per year
    • Root canals, with protocols
    • Plastic dentures, 1 set per person every 4 years
  • Specialised dentistry: R5,350 per family. Includes:
    • Partial metal frame dentures: 2 frames per person every 5 years
    • Crowns and bridges: 1 crown per family per year
    • Implants: No benefit
  • Hospitalisation: protocols apply, available for under 5yrs and for removal of impacted teeth, with R3,000 co-payment
  • Conscious sedation in rooms: for extensive treatment only
  • 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:
  • Benefit granted where function is impaired, not for cosmetic reasons, at 100% scheme rate, for 9yrs-18yrs. Only one member may begin treatment in a year.
  • No benefit
Maxillo Facial Surgery:
  • Covered if clinical criteria are met, with a possible R3,000 co-payment unless due to accident or trauma
  • 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:
BonClassic
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 47
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: R10,790 per person and R22,320 per family. Once depleted, only PMBs will continue to be covered by scheme
  • No benefit

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Acute (presrcibed) medication:
  • Paid from day-to-day benefit
  • No benefit
Over-the-counter:
  • Paid from day-to-day benefit
  • No benefit
Birth Control:
  • R1,500 per family, from designated pharmacies. This is a new benefit.
  • No benefit
On Discharge:
  • R445 per person per admission
  • No benefit
Biological:
  • R116,800 per family, non-oncology. 10% co-payment.
  • No benefit
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OPTOMETRY:
BonClassic
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • R5,300 per family, every 2 years paid by scheme and includes:
    • Eye test: Every 2 years
    • Lenses: at network provider
    • Frames: R740 per person every 2 years
    • Contact lenses: R1,790 per person, subject to above limit and as alternative to glasses
  • No benefit

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MENTAL HEALTH:
BonClassic
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • R39,250 per family per year, at DSP

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Out-of-hospital:
  • R15,130 per family for in-hospital and out-of-hospital consultations. Paid by scheme.
  • Educational psychologists: No benefit for over 21yrs
  • No benefit
Trauma:
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OTHER BENEFITS:
BonClassic
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • General Appliances: R7,410 per family, paid by scheme.
  • No benefit

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1.1. Hearing Aids:
  • R16,080 per family every 3 years, with a 10% co-payment
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • Unlimited at DSP provider, or 20% co-payment
HIV:
  • In-hospital: Unlimited 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:
  • R5 million per person, per trip. R10 million per family
  • Includes mandatory vaccines
  • No benefit
Other: TBC
  • 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:
BonClassic
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 21yrs-65yrs
  • No benefit
Mammogram:
  • 1 mammogram every 2 years, women 40-74yrs
  • No benefit
PAS Test:
  • No benefit
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • One stool test for colon cancer, 50yrs-75yrs
  • One lipogram every 5yr, 20yrs+
  • One bone density screening every 5 years for women 65yrs+ and men 70yrs+
  • Wellness Extender: costs R1,670 per family and includes choice from following: GP consult(s), Biokineticist, Dietician, Physiotherapy consult and a smoking cessation program
  • 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:
  • Breast prosthesis: R5,000, two per year

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Sub-limits:
  • Internal and external: R52,000 per family
  • 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