Bonitas Hospital Standard 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.

COSTS and OVERVIEW:
Hospital Standard
Quick Overview
Main: Adult: Child:
Total Cost pm: R1,830 R1,543 R696
Savings (per year): No savings option on this plan
Gap (optional): KaeloXelus: R350 per family
(R600 per family if anyone is 60yrs+)
Overal Limit: Unlimited
PMBs: Day-to-day expenses for PMBs (eg. cancer) are always paid for by the scheme, according to protocols. Find out more
Children: Pay for maximum 3 children
  • 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

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IN HOSPITAL PROCEDURES:
Hospital Standard
Benefits Gap benefits
Payout Rate for Specialists:
  • 100% scheme rate
  • Network specialists covered in full
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.
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: R 24,860 per family
  • Rate: 100% scheme rate
  • In and out of hospital
  • 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
  • Corneal grafts: R30,000
  • 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:
  • Deep brain stimulation: R222,200
  • 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:
Hospital Standard
Benefits Gap benefits
GP consultations:
  • 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
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: 2 consults for child under 1yr; 1 consult for child 1-2yr;
  • GP consult: 1 consult 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:
  • R24,860 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB
  • No benefit
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MATERNITY BENEFITS:
Hospital Standard
Benefits Gap benefits
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
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):
Hospital Standard
Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R328,100 per family, at a preferred provider
  • Brachytherapy: R42,110
  • Oncology Booster: Once the oncology limit is reached, gap pays for full cover thereafter
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DENTISTRY:
Hospital Standard
Benefits Gap benefits
Dentistry:
  • Hospitalisation: protocols apply, available for under 5yrs and for removal of impacted teeth, with R3,000 co-payment
  • 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
Orthodontics:
  • No benefit
  • No benefit
Maxillo Facial Surgery:
  • Covered if clinical criteria are met, with a possible R3,000 co-payment unless due to accident or trauma
  • Dental reconstruction as result of trauma or oncology: R40,000 per event
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MEDICATION:
Hospital Standard
Benefits Gap benefits
Chronic:
  • No. of chronic conditions covered: 27 PMBs from Pharmacy Direct
  • Co-payment if out of formulary: 40% co-payment
  • No benefit
Acute (presrcibed) medication:
  • No benefit
  • No benefit
Over-the-counter:
  • No benefit
  • No benefit
Birth Control:
  • R1,500 per family, from designated pharmacies
  • No benefit
On Discharge:
  • R445 per person per admission
  • No benefit
Biological:
  • No benefit
  • No benefit
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OPTOMETRY:
Hospital Standard
Benefits Gap benefits
Optometry:
  • No benefit
  • No benefit
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MENTAL HEALTH:
Hospital Standard
Benefits Gap benefits
In-hospital:
  • R30,680 per family per year, at DSP
Out-of-hospital:
  • PMBs only. In and out-of-hospital consultations (included in in-hospital benefit, above).
  • Educational psychologists: No benefit for over 21yrs
  • No benefit
Trauma:
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OTHER BENEFITS:
Hospital Standard
Benefits Gap benefits
General Appliances:
  • No benefit
  • No benefit
1.1. Hearing Aids:
  • No benefit
  • No benefit
1.2. Wheelchairs:
  • No benefit
  • 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:
Hospital Standard
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
  • No benefit
Mammogram:
  • 1 mammogram every 2 years, women 40-74yrs
  • 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 R1,210 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:
Hospital Standard
Benefits Gap benefits
Overal Limit:
  • Joint repllacements: no benefit, unless PMB
Sub-limits:
  • Internal: R42,100 per family
  • 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