Bonitas BonFit 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.

BonFit
2018 Costs:
Total Cost pm:

Main member:

R1,930

Adult:

R1,495

Child: (Pay only for first 3)

R578
Savings Account (yr): R3,480 R2,700 R1,044
2019 Costs:
Total Cost pm:

Main member:

R2,027
(5.03%)

Adult:

R1,570

Child: (Pay only for first 3)

R607
Savings: R3,660 R2,832 R1,092
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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 out of pocket
  • There are co-payment for 22 procedures
  • Hospital network must be used
  • Bonitas does pay for most maternity expenses, preventative benefits such as pap smears, contraceptives, terminal care, basic dental, 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:
BonFit
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 a BonFit Network hospital, or pay a 30% co-payment if you voluntarily choose another hospital
  • 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)
  • 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
  • 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:
  • R1,450 co-payment paid by you or your gap cover
  • Arthroscopy,
  • Diagnostic laparoscopy,
  • Laparoscopic hysterectomy (except cancer and PMBs),
  • Laparoscopic appendectomy,
  • Percutaneous rhizotomies,
  • R3,680 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),
  • R7,250 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: 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:
  • 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):
BonFit
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: R3,480 R2,700 R1,044
General info:
  • This plan has a savings fund, so some out of hospital costs are paid by this
  • Remember, out of hospital costs authorised as part of PMB treatment (eg. cancer, asthma or stroke) are always paid by the scheme, not out of savings.
  • 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:
  • From day-to-day benefit, unless PMB
  • No benefit, unless PMB
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
  • No extra benefit available
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MATERNITY BENEFITS:
BonFit
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):
BonFit
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:
BonFit
Scheme Benefits Gap benefits
Standard Dentistry:
  • Standard Dentistry, paid by Bonitas (not out of savings) and 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
Specialised Dentistry:
  • Specialised dentistry: no 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:
  • Dental and oral surgery: no benefit, unless PMB
Orthodontics:
  • No benefit
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)
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MEDICATION:
BonFit
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:
  • R380 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:
BonFit
Scheme Benefits Gap benefits
Optometry:
Limit:From day-to-day benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
  • Pays shortfalls and co-payments for in-hospital or day-clinic treatment approved by scheme
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MENTAL HEALTH:
BonFit
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: 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:
BonFit
Scheme Benefits Gap benefits
General Appliances:
  • From day-to-day benefit, unless PMB
  • No benefit
1.1. Hearing Aids:
  • From day-to-day benefit, unless PMB
  • No benefit
1.2. Wheelchairs:
  • From day-to-day benefit, unless PMB
  • 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:
BonFit
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:
  • Unchanged
  • 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
  • Wellness Extender: costs R1,270 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:
BonFit
Scheme Benefits Gap benefits
Overal Limit:
  • Internal: PMBs only
  • External: PMBs only
  • No benefit, unless PMB
Sub-limits:
  • No benefit, unless PMB
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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