Bonitas Primary 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:
Primary
2018 costs Gap
In brief: On Primary in 2018:
  • Scheme rate is 100%, and day-to-day expenses are paid by scheme or from fund or 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, basic and dental, optometry, GPs and mental health benefits
  • Cover for 27 chronic conditions
  • Generous benefits for travel insurance
See full benefits below
For this plan, our recommended Gap Cover:
  • increases payout for in-hospital claims to 500% scheme rate
  • pays for ER treatment,
  • covers the 20% co-payment for cancer claims and
  • covers other in-hospital co-payments
See more benefits below, or full benefits here.
What’s new in 2018?
    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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Contributions:
Main: Adult: Child:
Cost 2018: R2,076 R1,624 R661
Cost 2017: (R1,924) (R1,505) (R613)
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
Savings: No savings option on this plan
Extended Fund: RM = R2,010
M1 = R3,600
M2= R4,230
M3= R4,550
M4= R4,920
R R
Children: Pay for maximum 3 children
2018 Gap prices are to be confirmed, will be about R300 per family of under 65yrs, and R400 per family with a member who is 65yrs+.
Find out more
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IN HOSPITAL PROCEDURES:
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Payout Rate for Specialists:
  • 100% scheme rate
  • Network specialists covered in full
  • Up to 500% of scheme rate
  • In case of admission related to accident:
    • R300 per day, for days 1-13
    • R600 per day for days 14-20
    • R1,200 per day for days 21-30
Hospital Choice:
  • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
  • N/A
Specialised Radiology:
  • R12,380 per family, in and out of hospital
  • Up to 500% of scheme rate
  • Certain inhospital sublimits increased by R44,000 per event, unlimited for the year
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Physical rehabilitation: R47,250 per family
  • Up to 500% of scheme rate
  • Certain inhospital sublimits increased by R44,000 per event, unlimited for the year
Transplants:
  • PMBs only
  • Up to 500% of scheme rate for service providers
Co-payments:
  • Colonoscopy,
  • Conservative back treatment
  • Cystoscopy,
  • Facet joint injections,
  • Flexible sigmoidoscopy,
  • Functional nasal surgery,
  • Gastroscopy,
  • Hysteroscopy,
  • Myringotomy,
  • Tonsillectomy and adenoidectomy
  • Umbilical hernia repair
  • Varicose vein surgery:
  • R1,380 co-payment
  • Arthroscopy,
  • Diagnostic laparoscopy,
  • Laparoscopic hysterectomy (except cancer and PMBs),
  • Laparoscopic appendectomy,
  • Percutaneous rhizotomies,
  • R3,500 co-payment
  • Back surgery including spinal fusion,
  • Joint replacements,
  • Laparoscopic pyeloplasty,
  • Laparoscopic radical prostatectomy,
  • Nissen fundoplication (reflux surgery),
  • R6,900 co-payment
  • Gap covers co-payments for most scopes and a defined list of other procedures, incl MRIs etc See full list
Alternatives to hospitals:
  • Alternatives to hospitalisation: R15,760 per family
  • $$ 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.
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OUT OF HOSPITAL BENEFITS:
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
GP consultations:
  • GP consults limited as below, for network GPs. Some of the funds may be used for non-network GPs
Network GPs:
MainM+1M+2M+3M4+
R1,900 R3,490 R4,130 R4,440 R5,030
  • No benefit
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • 24/7 access to Babyline
  • Paediatric consult: 1 consults for child under 1yr; 1 consult for child 1-2yr;
  • GP consult: 1 consult per child 2-12yrs
  • Immunisation: one flu vaccine
  • No benefit
Specialists consultations:
  • Paid from day-to-day benefit
  • No benefit
Pathology:
  • Paid from day-to-day benefit
  • No benefit
General radiology:
  • Paid from day-to-day benefit
  • No benefit
Specialised radiology:
  • R12,380 per family, in and out of hospital
n/a
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • No benefit
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MATERNITY BENEFITS:
Primary
2017 v 2018 benefits
($$ next to major changes)
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
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):
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overall coverage (in and out of hospital):
  • R157,600 per family, at a preferred provider
  • Brachytherapy: R42,110
  • Oncology Booster: Once the oncology limit is reached, gap pays for full cover thereafter
All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
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DENTISTRY:
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Dentistry:
  • Standard Dentistry: paid by scheme (not from day-to-day).
  • 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
    • Plastic dentures, 1 set per person every 4 years
  • Specialised dentistry: no benefit
  • 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
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 due to due to trauma or oncology treatment: R40,000 per event
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MEDICATION:
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Chronic:
  • No. of chronic conditions covered: 27 PMBs from Pharmacy Direct
  • Co-payment if out of formulary: 40% co-payment
  • No benefit
Acute (presrcibed) medication:
  • Paid from day-to-day benefit
  • No benefit
Over-the-counter:
    Paid from day-to-day benefit, limited to R465 per person and R1,360 per family
  • No benefit
Birth Control:
  • R1,500 per family, from designated pharmacies. This is a new benefit.
  • No benefit
On Discharge:
  • R360 per person per admission
  • No benefit
Biological:
  • No benefit
  • No benefit
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OPTOMETRY:
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Optometry:
  • R4,270 per family, every 2 years paid by scheme and includes:
    • Eye test: Every 2 years
    • Lenses: at network provider
    • Frames: R350 per person every 2 years
    • Contact lenses: R1,225 per person, subject to above limit and as alternative to glasses
  • No benefit
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MENTAL HEALTH:
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
In-hospital:
  • R15,080 per family per year for hospitalisation, paid by scheme.
Out-of-hospital:
  • R9,100 per family for in-hospital and out-of-hospital consultations. Paid by scheme.
  • Educational psychologists: No benefit for over 21yrs
  • No benefit
Trauma:
  • No benefit
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OTHER BENEFITS:
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
General Appliances:
  • General Appliances:> R6,560 per family, paid by scheme.
  • Stoma products: Additional R6,240
  • No benefit
1.1. Hearing Aids:
  • See "General Appliances" limit
  • No benefit
1.2. Wheelchairs:
  • See "General Appliances" limit
  • 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:
Primary
2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Flu vaccination:
  • Covered
  • No benefit
Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
  • No benefit
Back Rehabilitation Programme:
  • Managed back and neck program offers personalised treatment plan for up to 6 weeks, paid by scheme
  • No benefit
Biometric Screening:
  • Covered
  • No benefit
Child Immunisation:
  • No benefit
  • No benefit
Pap Smear:
  • Covered 21yrs-65yrs
  • No benefit
Mammogram:
  • 1 mammogram every 2 years, women 40-74yrs
  • No benefit
PAS Test:
  • No benefit
  • No benefit
HIV Test:
  • Covered
  • No benefit
Other:
  • One stool test for colon cancer, 50yrs-75yrs
  • Wellness Extender: costs R1,210 per family and includes choice from following: GP consult(s), Biokineticist, Dietician, Physiotherapy consult and a smoking cessation program
  • No benefit
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2017 v 2018 benefits
($$ next to major changes)
Gap benefits Notes
Overal Limit:
Sub-limits:

    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