Bonitas BonEssential 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:
Essential
2018 costs In brief:
What’s new in 2018?
Main: Adult: Child:
Cost 2018: R1,604 R1,227 R470
Cost 2017: (R1,473) (R1,127) (R432)
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: No savings option on this plan
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:
Essential
2017 v 2018 benefits Gap benefits Notes
Payout Rate for Specialists: 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.

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Hospital Choice:
  • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
  • N/A
Specialised Radiology:
  • Co-payment: none
  • $$ Sublimit: R 15,000 per family. This is a new sublimit
  • Rate: 100% scheme rate
  • Up to 600% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Physical rehabilitation: R47,250 per family
  • Up to 600% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
Transplants:
  • Covered
  • Up to 600% of scheme rate
  • Certain in-hospital sublimits increased by R44,000 per event, unlimited for the year
Co-payments:
  • Colonoscopy,
  • Conservative back treatment
  • Cystoscopy,
  • Facet joint injections,
  • Flexible sigmoidoscopy,
  • Functional nasal surgery,
  • Gastroscopy,
  • Hysteroscopy,
  • Myringotomy,
  • Tonsillectomy and adenoidectomy
  • Umbilical hernia repair
  • Varicose vein surgery:
  • R1,380 co-payment
  • Arthroscopy,
  • Diagnostic laparoscopy,
  • Laparoscopic hysterectomy (except cancer and PMBs),
  • Laparoscopic appendectomy,
  • Percutaneous rhizotomies,
  • R3,500 co-payment
  • Back surgery including spinal fusion,
  • Joint replacements,
  • Laparoscopic pyeloplasty,
  • Laparoscopic radical prostatectomy,
  • Nissen fundoplication (reflux surgery),
  • R6,900 co-payment
Fusion Gap:
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Alternatives to hospitalisation: R15,760 per family
  • $$ 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:
  • N/A
  • N/A
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OUT OF HOSPITAL BENEFITS:
Essential
2017 v 2018 benefits Gap benefits Notes
GP consultations:
  • GP: no benefit, unless PMB
  • 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
  • GP consult: one per child 2-12yrs
  • Immunisation: one flu vaccine
  • No benefit
Specialists consultations:
  • No benefit, unless PMB
  • No benefit
Pathology:
  • No benefit, unless PMB
  • No benefit
General radiology:
  • No benefit, unless PMB
  • No benefit
Specialised radiology:
  • No benefit, unless PMB
  • No benefit
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No benefit
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MATERNITY BENEFITS:
Essential
2017 v 2018 benefits Gap benefits Notes
Hospital stay:
  • 100% 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

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Consultations:
  • 6 consults, paid by scheme
  • 4 consults with midwife after delivery
  • No benefit
Scans:
  • 2 x 2D scans
  • 1 amniocentesis
  • No benefit
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CANCER (ONCOLOGY):
Essential
2017 v 2018 benefits Gap benefits Notes
Overall coverage (in and out of hospital):
  • R328,100 per family at preferred provider
  • Brachytherapy: 42,110. This is a new sub limit.
  • 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:
Essential
2017 v 2018 benefits Gap benefits Notes
Dentistry:
  • No benefit, unless PMB
  • 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:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB
  • 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:
Essential
2017 v 2018 benefits Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27 PMBs from Pharmacy Direct
  • Co-payment if out of formulary: 40% co-payment
  • No benefit

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Acute (presrcibed) medication:
  • No benefit
  • No benefit
Over-the-counter:
  • No benefit
  • No benefit
Birth Control:
  • R1,200 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:
Essential
2017 v 2018 benefits Gap benefits Notes
Optometry:
  • No benefit
  • No benefit

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MENTAL HEALTH:
Essential
2017 v 2018 benefits Gap benefits Notes
In-hospital:
  • R30,680 per family per year, at preferred provider
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Out-of-hospital:
  • No benefit, unless PMB
  • No benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
Essential
2017 v 2018 benefits Gap benefits Notes
General Appliances:
  • No benefit
  • No benefit

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1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • No benefit
Dialysis:
  • Unlimited (in-hospital) at DSP. 20% co-payment if DSP is not used.
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: .
  • 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:
Essential
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, 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

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:
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Sub-limits:
  • Internal: PMB only
  • External: PMB only
  • 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