Bonitas BonComprehensive 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:
BonComprehensive
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R5,774 R5,446 R1,175
Cost 2017: (R5,254) (R4,956) (R1,069)
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: R13,068 R12,324 R2,664
Self Payment: R3,810 R3,150 R1,450
Above Threshold: Unlimited overall, with sublimits for some benefits. Find out more
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:
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: Fusion Gap:
  • Up to 800% 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: none
  • Rate: 100% scheme rate
  • N/A
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Physical rehabilitation: R47,250 per family
  • Up to 500% 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 500% of scheme rate for service providers
Co-payments:
  • N/A
  • N/A
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:
  • Internal Nerve stimulators: R157,700 per family
  • Deep brain stimulation, excluding prosthesis: R222,220
  • Cochlear implants: R264,500 per family
  • 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:
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • 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


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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
  • Paediatric consult: 3 consults for child under 1yr; 2 consults for child 1-2yr;
  • GP consult: 2 consults per child 2-12yrs
  • Immunisation: South African immunisation program, plus 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:
  • R29,840 per family
  • Paid from day-to-day benefit
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • No benefit
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MATERNITY BENEFITS:
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • 300% scheme rate
  • Private ward
  • 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):
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • R589,000 per family, at a preferred provider
  • Specialised drugs: R233,700, as part of above sublimit
  • 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:
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • Standard Dentistry: paid from day-to-day benefit.
  • 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: paid from day-to-day benefit. Includes:
    • Partial metal frame dentures: 2 frames per person every 5 years
    • Crowns and bridges: 3 crowns per family per year
    • Implants: Two implants per beneficiary, once every 5 years, limited to R2,490 per implant
  • Hospitalisation: protocols apply, available for under 5yrs and for removal of impacted teeth
  • 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, at100% 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
  • 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:
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 60
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit: R13,170 per person and R26,240 per family. Once depleted, 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:
  • R520 per person per admission
  • No benefit
Biological:
  • R186,900 per family, non-oncology.
  • No benefit
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OPTOMETRY:
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • R2,880 per person, paid by scheme
  • Refractive surgery: R19,780 per family
  • No benefit

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MENTAL HEALTH:
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • R44,650 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:
BonComprehensive
2017 v 2018 benefits Gap benefits Notes
General Appliances:
    General Appliances: R7,990 per family, paid by scheme. Stoma products and CPAP: Additional R5,870
  • No benefit

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1.1. Hearing Aids:
  • R24,550 per family every 2 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:
BonComprehensive
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:
  • 1 test for men 55-69yrs who are considered 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+
  • One bone density screening every 5 years for women 65yrs+ and men 70yrs+
  • Wellness Extender: costs R2,420 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: R52,480 per family
  • External: R52,480 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