Bonitas Standard medical aid plan: 2017

Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB. Pay for maximum 3 children .

View all plans in this scheme

IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Hospital Choice:
  • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
Specialised Radiology:
  • R23,500 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Physical rehabilitation: R44,650 per family
Transplants:
  • Unlimited
Co-payments:
Alternatives to hospitals:
  • R14,900 per family

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Paediatric consults: Two per child under 2yr; one GP consult per child 2-12yrs
  • Otherwise, GP consults limited as below, for network GPs. Some of the funds may be used for non-network GPs
Network GPs:
Main M+1 M+2M+3M4+
R3,750 R5,500 R6,100 R6,400 R6,950
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Fund:
Main M+1 M+2 M+3 M4+
R5,232 R7,970 R9,214 R10,062 R10,966
Specialists, medicine, radiology, pathology, etc
Specialists consultations:
  • Paid from day-to-day benefit
Pathology:
  • Paid from day-to-day benefit
General radiology:
  • Paid from day-to-day benefit
Specialised radiology:
  • R23,500 per family
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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MATERNITY BENEFITS:
Hospital stay:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Fund:
Main M+1 M+2 M+3 M4+
R5,232 R7,970 R9,214 R10,062 R10,966
Specialists, medicine, radiology, pathology, etc
Consultations:
  • 6 consults paid by scheme
  • 4 consults with midwife after delivery
  • Antenatal classes: R1,100 paid by scheme
Scans:
  • 2 x 2D scans
  • 1 amniocentesis

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • R310,150 per family, at a preferred provider

Note: 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.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Fund:
Main M+1 M+2 M+3 M4+
R5,232 R7,970 R9,214 R10,062 R10,966
Specialists, medicine, radiology, pathology, etc

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DENTISTRY:
Dentistry:
  • Standard dentistry: paid by scheme
  • Specialised dentistry: one partial metal frame per person every 5 yrs, 1 crown per family per year, paid by scheme
  • Implants: no benefit
  • Periodontics: limited to conservative, non-surgical therapy
  • In-hospital: R3,000 co-payment
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

Fund:
Main M+1 M+2 M+3 M4+
R5,232 R7,970 R9,214 R10,062 R10,966
Specialists, medicine, radiology, pathology, etc
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.
Maxillo Facial Surgery:
  • Hospitalisation: R3,000 co-payment

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MEDICATION:
Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 17 conditions
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit:R8,650 per person and R17,350 per family. Once depleted, only CDL and PMBs will continue to be covered by scheme
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Acute (presrcibed) medication:
  • Paid from day-to-day benefit
Over-the-counter:
  • Paid from day-to-day benefit, limited to R700 per person and R2,121 per family
Birth Control:
  • Paid from day-to-day benefit
On Discharge:
  • R420 per person per admission
Notes:
  • For PMBs chronic medication, there is a 40% co-payment if you do not use designated provider, or if you use medicine that is not on the formulary

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OPTOMETRY:
Optometry:
  • R5,550 per family every two years, paid by scheme and with sub-limits
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
  • R36,550 per family per year for hospitalisation
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:


Fund:
Main M+1 M+2 M+3 M4+
R5,232 R7,970 R9,214 R10,062 R10,966
Specialists, medicine, radiology, pathology, etc
Out-of-hospital:
  • R14,300 per family for in-hospital and out-of-hospital consultations. paid by scheme.

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OTHER BENEFITS:
General Appliances:
  • General Appliances: R6,900 per family. paid by scheme.
  • Stoma products: Additional R5,900
  • Foot orthotics: No benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:

1.1. Hearing Aids:
  • R14,400 per family every two years, with a 20% co-payment
1.2. Wheelchairs:
  • See "General Appliances" limit
Dialysis:
  • Unlimited
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
Emergency Transport:
International Coverage:
Other:

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
  • Covered
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
Back Rehabilitation Programme:
Biometric Screening:
  • Covered
Child Immunisation:
Pap Smear:
  • Covered 21yrs-65yrs
Mammogram:
  • Covered, 40yrs -74yrs
PAS Test:
HIV Test:
  • Covered

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,998 R2,600 R880
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

Compare with these plans:
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