Bonitas BonComprehensive 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.

BonComprehensive
2018 Costs:
Total Cost pm:

Main member:

R5,774

Adult:

R5,446

Child: (Pay only for first 3)

R1,175
Savings Account (yr): R13,068 R12,324 R2,664
Self Payment Gap:
R3,810 R3,150 R1,450
Above Threshold:
  • Once your savings are depleted, and you have paid the self payment gap, scheme will cover most out of hospital expenses at scheme rate, with sublimits for some benefits.
2019 Costs:
Total Cost pm:

Main member:

R6,438
(11.50%)

Adult:

R6,072

Child: (Pay only for first 3)

R1,310
Savings: R14,568 R13,740 R2,964
Self Payment Gap:
R4,000 R3,310 R1,520
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In brief (2018):
  • Scheme rate is 300%, and most day-to-day expenses are paid by scheme, or from savings, or from threshold benefit.
  • 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, refractive eye surgery, in and out of hospital MRIs and mental health benefits
  • Cover for 60 chronic conditions
  • Cover for cochlear implants
  • 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:
BonComprehensive
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 300% scheme rate for specialists
  • 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:
  • 100% scheme rate
  • No benefit
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:
  • None
  • No extra benefit necessary
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:
  • Internal Nerve stimulators: R165,600 per family
  • Deep brain stimulation, excluding prosthesis: R233,300
  • Cochlear implants: R277,700 per family
  • Sublimits increased as necessary
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):
BonComprehensive
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: R13,068 R12,324 R2,664
Self Payment:
(per year, if you use up all your savings)
R3,810 R3,150 R1,450
Above Threshold: Once your savings are depleted, and you have paid the self payment gap, scheme will cover most out of hospital expenses at scheme rate, with sublimits for some benefits.
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 an unlimited 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: 3 consults for child under 1yr; 2 consults for child 1-2yr
  • GP consult: 2 consults per child 2-12yrs
  • Vaccines: South African Vaccines program, plus one flu vaccine
  • 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 R31,330 per family
  • 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:
BonComprehensive
Scheme Benefits Gap benefits
Hospital stay:
  • 300% scheme rate
  • Private ward
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Consultations:
    Paid by Bonitas:
  • 12 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
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CANCER (ONCOLOGY):
BonComprehensive
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R618,500 per family, at a preferred provider
  • Specialised drugs: R245,400, as part of above sublimit
  • Brachytherapy: R44,200
  • 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 cover limit). This includes extra cover for biological medicine short-payments or co-payments. More info
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DENTISTRY:
BonComprehensive
Scheme Benefits Gap benefits
Standard Dentistry:
  • Standard Dentistry: from day-to-day benefit.
Specialised Dentistry:
  • Specialised dentistry: from day-to-day benefit
  • 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:
  • Covered if clinical criteria are met
Orthodontics:
  • From day-to-day benefit
Maxillo Facial Surgery:
  • Covered if clinical criteria are met
  • 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:
BonComprehensive
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
  • An additional >33 non-CDL conditions> are covered on this plan
  • Overall limit: R13,830 per person and R27,550 per family. Once depleted, PMBs will continue to be covered by scheme
  • If you voluntarily use medicine that is not on Bonitas' list ("formulary"), you pay a 40% co-payment
  • 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:
  • R545 per person per admission
  • No extra benefit available
Biological:
  • Bonitas pays R196,200 per family for non-oncology specialised medicine
  • R245,400 of your oncology benefit can be used towards biological drugs
  • 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 not paid by your medical aid. More info
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OPTOMETRY:
BonComprehensive
Scheme Benefits Gap benefits
Optometry:
Limit:R3,020 per person, every 24 months. Paid by scheme.
Consult:from above limit
Frames:from above limit
Single lensesfrom above limit
Bifocals:from above limit
Multifocalsfrom above limit
Contactsfrom above limit
Refractive Surgery:R20,770 per family
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:
BonComprehensive
Scheme Benefits Gap benefits
In-hospital:
  • In-hospital: R46,880 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:
BonComprehensive
Scheme Benefits Gap benefits
General Appliances:
  • General Appliances: R8,390 per family, paid by scheme.
  • Stoma products and CPAP: Additional R6,160
  • No benefit
1.1. Hearing Aids:
  • R25,780 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
  • 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:
BonComprehensive
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+
  • 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
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PROSTHETICS:
BonComprehensive
Scheme Benefits Gap benefits
Overal Limit:
  • Internal: R55,100 per family
  • External: R55,100 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