Bonitas BonEssential 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.

Essential
2018 Costs:
Total Cost pm:

Main member:

R1,604

Adult:

R1,227

Child: (Pay only for first 3)

R470
Savings Account:
  • No savings option on this plan
2019 Costs:
Total Cost pm:

Main member:

R
(%)

Adult:

R

Child: (Pay only for first 3)

R
In brief (2018):
  • Scheme rate is 100%, and most day-to-day expenses are paid from out of pocket
  • There are co-payment for 22 procedures
  • Bonitas does pay for most maternity expenses, preventative benefits such as mammograms and pap smears, contraceptives, terminal care, in and out of hospital MRIs, and mental health benefits
  • Cover for 27 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:
Essential
Scheme Benefits: Gap Benefits:
Specialists:
  • Up to 100% scheme rate
  • Network 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 extra benefit
Specialised Radiology:
  • R 15,000 per family
  • Sublimit increased as necessary, subject to procedure being approved by medical aid
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Physical rehabilitation: R47,250 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:
  • Paid at 100% scheme rate
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
Co-payments:
  • Colonoscopy,
  • Conservative back treatment
  • Cystoscopy,
  • Facet joint injections,
  • Flexible sigmoidoscopy,
  • Functional nasal surgery,
  • Gastroscopy,
  • Hysteroscopy,
  • Myringotomy,
  • Tonsillectomy and adenoidectomy
  • Umbilical hernia repair
  • Varicose vein surgery:
  • R1,380 co-payment paid by you or your gap cover
  • Arthroscopy,
  • Diagnostic laparoscopy,
  • Laparoscopic hysterectomy (except cancer and PMBs),
  • Laparoscopic appendectomy,
  • Percutaneous rhizotomies,
  • R3,500 co-payment paid by you or your gap cover
  • Back surgery including spinal fusion,
  • Joint replacements,
  • Laparoscopic pyeloplasty,
  • Laparoscopic radical prostatectomy,
  • Nissen fundoplication (reflux surgery),
  • R6,900 co-payment paid by you or your gap cover
  • Gap cover pays co-payments for procedures approved by medical aid
Alternatives to hospitals:
  • Alternatives to hospitalisation: R15,760 per family paid by Bonitas
  • 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:
  • N/A
  • 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)

No phone calls!
Our quote will include the right gap cover for this plan

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.

.
.
.
.
OUT OF HOSPITAL BENEFITS (non-PMB):
Essential
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • You pay this from out of pocket
  • No extra benefit available
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • 24/7 access to Babyline
  • GP consult: one per child 2-12yrs
  • No extra benefit available
Specialists consultations:
  • You pay this from out of pocket
  • No extra benefit available
Pathology:
  • You pay this from out of pocket
  • No extra benefit available
General radiology:
  • You pay this from out of pocket
  • No extra benefit available
Specialised radiology:
  • You pay this from out of pocket
  • No extra benefit available
Supplementary Services: (Physio, etc)
  • You pay this from out of pocket
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

.
.
MATERNITY BENEFITS:
Essential
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:
  • Bonitas pays for 6 consults
  • Bonitas pays for 4 consults with midwife after delivery
  • No extra benefit available
Scans:
    Bonitas pays for:
  • 2 x 2D scans
  • 1 amniocentesis
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

.
.
CANCER (ONCOLOGY):
Essential
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R328,100 per family at preferred provider
  • Brachytherapy: R42,110
  • 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

No phone calls!
Our quote will include the right gap cover for this plan

.
.
DENTISTRY:
Essential
Scheme Benefits Gap benefits
Dentistry:
  • You pay this from out of pocket
  • 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)
Orthodontics:
  • You pay this out of pocket
  • No extra benefit available
Maxillo Facial Surgery:
  • No benefit, unless PMB
  • 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)

No phone calls!
Our quote will include the right gap cover for this plan

.
.
MEDICATION:
Essential
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
  • If you voluntarily use a PMB medicine that is not on Bonitas' list ("formulary"), you pay a 40% co-payment
  • No extra benefit available
Acute (presrcibed) medication:
  • You pay this out of pocket
  • No extra benefit available
Over-the-counter:
  • You pay this out of pocket
  • No extra benefit available
Birth Control:
  • Bonitas pays R1,200 per family, from designated pharmacies
  • No extra benefit available
On Discharge:
  • R360 per person per admission
  • No extra benefit available
Biological:
  • You pay this out of pocket
  • No extra benefit available

No phone calls!
Our quote will include the right gap cover for this plan

.
.
OPTOMETRY:
Essential
Scheme Benefits Gap benefits
Optometry:
  • You pay this out of pocket
  • Pays shortfalls and co-payments for in-hospital or day-clinic treatment approved by scheme

No phone calls!
Our quote will include the right gap cover for this plan

.
.
MENTAL HEALTH:
Essential
Scheme Benefits Gap benefits
In-hospital:
  • Bonitas pays up to R30,680 per family per year, at preferred provider
  • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
  • No extra benefit available
Out-of-hospital:
  • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
  • Otherwise, you pay for this out of pocket
  • 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

No phone calls!
Our quote will include the right gap cover for this plan

.
.
OTHER BENEFITS:
Essential
Scheme Benefits Gap benefits
General Appliances:
  • You pay this out of pocket
  • No benefit
1.1. Hearing Aids:
  • You pay this out of pocket
  • No benefit
1.2. Wheelchairs:
  • You pay this out of pocket
  • No benefit
Dialysis:
  • Unlimited (in-hospital) at DSP. 20% co-payment if DSP is not used.
  • 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: .
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

.
.
WELLNESS/PREVENTATIVE BENEFITS:
Essential
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:
  • No benefit
  • No benefit
Pap Smear:
  • Covered, every 3 years for women 21yrs-65yrs. This is a new benefit.
  • No benefit
Mammogram:
  • No benefit
  • No benefit
PAS Test:
  • No benefit
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • One stool test for colon cancer, 50yrs-75yrs
  • Wellness Extender: costs R860 per family and includes choice from following: GP consult(s), Biokineticist, Dietician, Physiotherapy consult and a smoking cessation program
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan

.
.
PROSTHETICS:
Essential
Scheme Benefits Gap benefits
Overal Limit:
  • Internal: PMB only
  • External: PMB only
  • No benefit
Sub-limits:
  • No benefit

No phone calls!
Our quote will include the right gap cover for this plan


    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