Bonitas BonComplete 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:
BonComplete
Quick Overview
Main: Adult: Child:
Total Cost pm: R3,212 R2,572 R873
Savings: R5,772 R4,620 R1,572
Self Payment:
(per year, if you use up all your savings)
R1,660 R1,400 R355
Above Threshold: 4,390 2,590 1,120
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 maximum 3 children
  • Scheme rate is 100%, and day-to-day expenses are paid by scheme, or from savings or from threshold or from out of pocket
  • There is a self payment gap before threshold is reached
  • Bonitas does pay for most maternity expenses, most preventative benefits such as mammograms and pap smears, contraceptives, terminal care, in and out of hospital MRIs and mental health benefits
  • Cover for 31 chronic conditions
  • Generous benefits for travel insurance
  • 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:
BonComplete
Benefits Gap benefits
Payout Rate for Specialists:
  • 100% scheme rate
  • Network specialists covered in full
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:
  • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
  • No benefit
Specialised Radiology:
  • Co-payment: none
  • Sublimit: R 22,220 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: TBC
  • N/A
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OUT OF HOSPITAL BENEFITS:
BonComplete
Benefits Gap benefits
GP consultations:
  • Some children consults paid by scheme (see below) otherwise, paid from day-to-day benefit
  • 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
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • 24/7 access to Babyline
  • Paediatric consult: 2 consults for child under 1yr; 1 consult for child 1-2yr
  • GP consult: 1 consult per child 2-12yrs
  • Immunisation: one flu vaccine
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit
  • No benefit
Pathology:
  • Paid from day-to-day benefit
  • No benefit
General radiology:
  • Paid from day-to-day benefit
  • No benefit
Specialised radiology:
  • R22,220 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • No benefit
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MATERNITY BENEFITS:
BonComplete
Benefits Gap benefits
Hospital stay:
  • 150% 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
Consultations:
  • 6 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):
BonComplete
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R328,100 per family, at a preferred provider
  • Brachytherapy: R42,110
  • Oncology Booster: Once the oncology limit is reached, gap pays for full cover thereafter
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DENTISTRY:
BonComplete
Benefits Gap benefits
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, except for primary teeth
    • Plastic dentures, 1 set per person every 4 years
  • Specialised dentistry:
    • Partial metal frame dentures: 1 frame 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
Orthodontics:
  • Benefit granted where function is impaired, not for cosmetic reasons, at 65% 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
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MEDICATION:
BonComplete
Benefits Gap benefits
Chronic:
  • No. of chronic conditions covered: 31
  • Co-payment if out of formulary: 40% co-payment
  • No benefit
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:
  • R360 per person per admission
  • No benefit
Biological:
  • No benefit
  • No benefit
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OPTOMETRY:
BonComplete
Benefits Gap benefits
Optometry:
  • Every 2 years from day-to-day benefit. Includes:
    • Eye test: Every 2 years
    • Lenses: R215for single lens; R500 for bifocal lens; R865 per multifocal lens
    • Frames: R740 per person every 2 years
    • Contact lenses: R1,820 per person, subject to above limit and as alternative to glasses
  • No benefit
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MENTAL HEALTH:
BonComplete
Benefits Gap benefits
In-hospital:
  • R30,680 per family per year, at DSP
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:
BonComplete
Benefits Gap benefits
General Appliances:
  • Paid from day-to-day benefit
  • No benefit
1.1. Hearing Aids:
  • See "General Appliances" limit
  • 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:
BonComplete
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 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+
  • 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
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PROSTHETICS:
BonComplete
Benefits Gap benefits
Overal Limit:
  • Breast prosthesis: R5,000, two per year
Sub-limits:
  • Internal and external: R42,100 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