Bonitas Primary 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.

Primary
2018 Costs:
Total Cost pm:

Main member:

R2,076

Adult:

R1,624

Child: (Pay only for first 3)

R661
Savings Account:
  • 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
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 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
  • 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:
Primary
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 12,380 per family
  • In and out of hospital
  • Sublimit increased as necessary, subject to procedure being approved by medical aid
  • Out of hospital, sublimit increased for MRIs and CT scans only
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:
  • No extra benefit available (PMB benefits are paid in full by medical aid)
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
  • 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):
Primary
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: 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
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:
  • Bonitas pays for network GP consults limited as below. 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
  • No extra benefit available
Specialists consultations:
  • Paid from day-to-day benefit
  • No extra benefit available
Pathology:
  • Paid from day-to-day benefit
  • No extra benefit available
General radiology:
  • Paid from day-to-day benefit
  • No extra benefit available
Specialised radiology:
  • Bonitas pays up to R12,380 per family, in and out of hospital
  • Sublimit increased as necessary for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit
  • No extra benefit available

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

.
.
MATERNITY BENEFITS:
Primary
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):
Primary
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R157,600 per family, at a 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:
Primary
Scheme Benefits Gap benefits
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
  • 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:
  • Covered if clinical criteria are met, with a possible R3,000 co-payment unless due to accident or trauma
  • 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:
Primary
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:
  • Paid from day-to-day benefit
  • No extra benefit available
Over-the-counter:
    Paid from day-to-day benefit, limited to R465 per person and R1,360 per family
  • No extra benefit available
Birth Control:
  • Bonitas pays R1,500 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:
Primary
Scheme Benefits Gap benefits
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
  • 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:
Primary
Scheme Benefits Gap benefits
In-hospital:
  • Bonitas pays up to R15,080 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:
  • Bonitas pays up to R9,100 per family for in-hospital and out-of-hospital consultations
  • Cover for PMB mental conditions is always paid for by scheme, in and out of hospital. See full list here
  • Educational psychologists: No benefit for over 21yrs
  • 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:
Primary
Scheme Benefits Gap benefits
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
  • 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

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

.
.
WELLNESS/PREVENTATIVE BENEFITS:
Primary
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 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

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

.
.
PROSTHETICS:
Primary
Scheme Benefits Gap benefits
Overal Limit:
  • Internal: R30,000 per family, excluding joint replacement prostheses
  • External: no benefit
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
Sub-limits:
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid

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