Bonitas BonComplete 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.

BonComplete
2018 Costs:
Total Cost pm:

Main member:

R3,212

Adult:

R2,572

Child: (Pay only for first 3)

R873
Savings Account (yr): R5,772 R4,620 R1,572
Self Payment Gap:
R1,660 R1,400 R355
Above Threshold: 4,390 2,590 1,120
2019 Costs:
Total Cost pm:

Main member:

R3,581
(11.49%)

Adult:

R2,868

Child: (Pay only for first 3)

R973
Savings: R6,432 R5,148 R1,752
Self Payment Gap:
R1,740 R1,470 R375
Above Threshold: 4,610 2,720 1,180
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In brief (2018):
  • 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

IN HOSPITAL PROCEDURES:
BonComplete
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 100% scheme rate
  • Contracted 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:
  • Choose any hospital, but a 30% co-payment may apply for admission to certain hospitals
  • No benefit, unless PMB
Specialised Radiology:
  • R 22,220 per family
  • In and out of hospital
  • Sublimit increased as necessary, subject to procedure being approved by medical aid
  • Out of hospital, sublimit increased for MRIs and CT scans only
Supplementary Services: (Physio, etc)
  • Up to 100% scheme rate
  • Physical rehabilitation: R49,610 per family
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • No extra benefit for rehabilitation
Transplants:
  • 100% scheme rate
  • Corneal grafts: R31,500
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Sublimits increased as necessary, subject to procedure being approved by medical aid
Co-payments:
  • Spinal surgery: R6,000 co-payment if you do not go for assessment through back and neck program
  • Hip and knee replacements: R6,000 co-payment if you do not use the preferred provider
  • No benefit, unless PMB
Alternatives to hospitals:
  • Alternatives to hospitalisation: R16,550 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:
  • Cochlear implants: R277,700 per family
  • Internal Nerve Stimulators: R165,600
  • N/A
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):
BonComplete
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: 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
General info: This plan has a savings fund, a self payment gap (that you pay out of your pocket when your savings are depleted) and a limited Above Threshold Benefit (which means that Bonitas pays for some more out of hospital claims, if you have paid the self payment gap and still have more claims)
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • From day-to-day benefit, unless PMB
  • No benefit, unless PMB
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • Paediatric consult: 2 consults for child under 1yr; 1 consult for child 1-2yr
  • GP consult: 1 consult per child 2-12yrs
  • Vaccines: covered
  • No extra benefit available
Specialists consultations:
  • From day-to-day benefit, unless PMB
  • No extra benefit available
Pathology:
  • From day-to-day benefit, unless PMB
  • No extra benefit available
General radiology:
  • From day-to-day benefit, unless PMB
  • No extra benefit available
Specialised radiology:
  • Bonitas pays up to R23,330 per family, in and out of hospital
  • Sublimit increased as necessary for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
  • No extra benefit available
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MATERNITY BENEFITS:
BonComplete
Scheme Benefits Gap benefits
Hospital stay:
  • 100% scheme rate
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Consultations:
    Paid by Bonitas:
  • 6 consults with GP/gynae/midwife
  • 4 consults with midwife after delivery
  • Antenatal classes: R1,220
  • No extra benefit available
Scans:
    Bonitas pays for:
  • 2 x 2D scans
  • 1 amniocentesis
  • No benefit, unless PMB
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CANCER (ONCOLOGY):
BonComplete
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R344,500 per family, at a preferred provider
  • Brachytherapy: R44,220
  • Once you or the medical scheme have spent R200,000 per oncology treatment cycle from a private hospital, the gap cancer benefit will cover costs authorised but not paid by your medical scheme (up to the R150,000 per person per year gap limit) More info
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DENTISTRY:
BonComplete
Scheme Benefits Gap benefits
Standard 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:
  • 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
  • Peridontics: Conservative, non-surgical therapy 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)
In-Hospital Dentistry:
  • Hospitalisation: protocols apply, available for under 5yrs and for removal of impacted teeth, with R3,500 co-payment
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.
Maxillo Facial Surgery:
  • Covered if clinical criteria are met, with a possible R3,500 co-payment unless due to accident or trauma
  • 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:
BonComplete
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:
  • From day-to-day benefit
  • No extra benefit available
Over-the-counter:
  • From day-to-day benefit
  • No extra benefit available
Birth Control:
  • R1,580 per family, paid by Bonitas
  • No extra benefit available
On Discharge:
  • R410 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:
BonComplete
Scheme Benefits Gap benefits
Optometry:
Limit:Day-to-day benefit, every 24 months
Consult:1 per person
Frames:R740per person
Single lenses100% cost
Bifocals:R410
MultifocalsR710
ContactsR1,820
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:
BonComplete
Scheme Benefits Gap benefits
In-hospital:
  • In-hospital: R32,210 per family. PMBs always paid in full at DSP, and include up to 21 days admission
  • No extra benefit available
Out-of-hospital:
  • Out-of-hospital: R15,890 per family sublimit. 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:
BonComplete
Scheme Benefits Gap benefits
General Appliances:
  • From day-to-day benefit, unless PMB
  • No benefit
1.1. Hearing Aids:
  • See "General Appliances" limit
  • , available once every 2 years
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • No benefit
Dialysis:
  • Unlimited at DSP provider, or 20% co-payment
  • No extra benefit available
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: ER24
  • No benefit
International Insurance:
  • R5 million per person, per trip. R10 million per family
  • Includes mandatory vaccines
  • No benefit
Other: TBC
  • No benefit, unless PMB
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WELLNESS/PREVENTATIVE BENEFITS:
BonComplete
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 to 6 weeks, paid by scheme
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • Covered
  • No benefit
Pap Smear:
  • Covered 21yrs-65yrs
  • No benefit
Mammogram:
  • 1 mammogram every 2 years, women 40-74yrs
  • 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
  • One lipogram every 5yr, 20yrs+
  • Wellness Extender: R1,750 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
Scheme Benefits Gap benefits
Overal Limit:
  • Internal and external: R44,210 per family
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
Sub-limits:
  • Breast prosthesis: R5,250 per breast, limited to two per year
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
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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