Bonitas 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:
Standard
Quick Overview
Main: Adult: Child:
Total Cost pm: R3,265 R2,831 R958

(Pay only for first 3)

Savings (per year):
  • No savings option on this plan
Extended Fund: RM = R5,540
M1 = R8,430
M2= R9,750
M3= R10,650
M4= R11,600
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Gap (optional):
  • Varies. See below for specific recommendation for this plan.
In brief:
  • 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 specialised dental, optometry, GPs and mental health benefits
  • Cochlear implants and internal nerve stimulators
  • Cover for 45 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:
Standard
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 benefit
Specialised Radiology:
  • R 24,860 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:
  • Paid at 100% scheme rate
  • Corneal grafts: R30,000
  • Gap tops this up to 500% scheme rate for in-hospital specialists, GPs and other medical professionals
  • Sublimits increased as necessary, subject to procedure being approved by medical aid
Co-payments:
  • Spinal surgery: R5,650 co-payment if you do not go for assessment through back and neck program
  • Hip and knee replacements: R5,650 co-payment if you do not use the preferred provider
  • No benefit
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.

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OUT OF HOSPITAL BENEFITS (non-PMB):
Standard
Scheme Benefits Gap benefits
Main: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: RM = R5,540
M1 = R8,430
M2= R9,750
M3= R10,650
M4= R11,600
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+
R3,970 R5,820 R6,450 R6,770 R7,350
  • 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; 2 consults 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 R24,860 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

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MATERNITY BENEFITS:
Standard
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:
  • 12 consults
  • 4 consults with midwife after delivery
  • Antenatal classes: R1,160
  • 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

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CANCER (ONCOLOGY):
Standard
Scheme Benefits Gap benefits
Overall coverage (in and out of hospital):
  • R328,100 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

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DENTISTRY:
Standard
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, with protocols
    • Plastic dentures, 1 set per person every 4 years
  • Specialised dentistry:
    • Partial metal frame dentures: 1 frame per person every 5 years
    • Crowns and bridges: 1 crown per family per year
    • Implants: 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:
  • Benefit granted where function is impaired, not for cosmetic reasons, at 80% scheme rate, for 9yrs-18yrs. Only one member may begin treatment in a year.
  • 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

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MEDICATION:
Standard
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
  • An additional 18 non-CDL conditions are covered on this plan
  • Overall limit: R9,150 per person and R18,360 per family. Once depleted, only CDLs will continue to be covered by scheme
  • If you voluntarily use 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 R740 per person and R2,240 per family
  • No extra benefit available
Birth Control:
  • Bonitas pays R1,500 per family, from designated pharmacies
  • No extra benefit available
On Discharge:
  • R445 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

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OPTOMETRY:
Standard
Scheme Benefits Gap benefits
Optometry:
  • R5,550 per family, every 2 years paid by scheme and includes:
    • Eye test: Every 2 years
    • Lenses: at network provider
    • Frames: R850 per person every 2 years
    • Contact lenses: R1,850 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

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MENTAL HEALTH:
Standard
Scheme Benefits Gap benefits
In-hospital:
  • Bonitas pays up to R38,670 per family per year, at DSP
  • 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 R15,130 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

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OTHER BENEFITS:
Standard
Scheme Benefits Gap benefits
General Appliances:
  • General Appliances: R7,300 per family, paid by scheme.
  • Stoma products: Additional R6,240
  • No benefit
1.1. Hearing Aids:
  • R15,240 per family every two years, with a 20% co-payment
  • 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

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WELLNESS/PREVENTATIVE BENEFITS:
Standard
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
  • One lipogram every 5yr, 20yrs+
  • Wellness Extender: costs R1,670 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

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PROSTHETICS:
Standard
Scheme Benefits Gap benefits
Overal Limit:
  • Internal and external: R42,100 per family
  • Sublimit increased by up to R150,000 per person
  • No benefit for procedures excluded by medical aid
Sub-limits:
  • Breast prosthesis: R5,000, two per year
  • 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