Bonitas out-of-hospital benefits: 2017

By Staff Writer -

Below is a full list of how each Bonitas plan pays for Out-of-hospital benefits.

Click here to compare out-of-hospital benefits across all schemes, or use the menu bar above for more options. Or go to the Bonitas home page.

Bon series

Bonitas BonFit 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some co-payments. Over and above the savings fund, scheme pays out-of-hospital claims for: maternity, infant paediatrics, preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
1. GP consultations:
  • Paediatric consults: Two per infant under 1yr; one per child 1-2yrs; one GP consult per child 2-12yrs
  • All else: paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,789 R1,385 R535
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R3,228 R2,496 R960

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2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • Paid from day-to-day benefit
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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Bonitas BonSave 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some co-payments. Over and above the savings fund, scheme pays out-of-hospital claims for: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
1. GP consultations:
  • Paediatric consults: Two per infant under 1yr; one per child 1-2yrs; one GP consult per child 2-12yrs
  • Otherwise, from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,135 R1,654 R640
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R4,104 R3,180 R1,236

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2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R21,000 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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Bonitas BonComplete 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Over and above the savings/threshold fund, scheme pays out-of-hospital claims for: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings, or from above threshold benefit or from out of pocket, unless PMB.
1. GP consultations:
  • Paediatric consults: Two per infant under 1yr; one per child 1-2yrs; one GP consult per child 2-12yrs
  • Otherwise, from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R2,923 R2,340 R794
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, mental health, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings, or from above threshold benefit or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R5,256 R4,200 R1,428
(SP) Self Payment: R1,568 R1,326 R336
Threshold (S+SP): R6,824 R5,526 R1,764
Above Threshold: R4,150 R2,450 R1,060

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2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R21,000 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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Bonitas BonClassic 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Over and above the savings fund, scheme pays out-of-hospital claims for: specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
1. GP consultations:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R3,648 R3,132 R900
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, mental health, medical appliances, hearing aids, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings or from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R6,192 R5,316 R1,524

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2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • R2,800 per person, and R6,200 per family, paid by scheme
4. General radiology:
  • R2,800 per person and R4,340 per family, paid by scheme
5. Specialised radiology:
  • R26,100 per family, in-and-out of hospital
6. Supplementary Services: (Physio, etc)
  • Paid by scheme to these sub limits
  • Physical Therapy: R2,800 per person, and R14,300 per family
  • Otherwise:
    Main M+1 M+2 M+3 M+4
    R2,670 R4,090 R4,720 R5,040 R5,400

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Bonitas BonComprehensive 2017: Out Of Hospital Benefits
In brief: 300% scheme rate. Over and above the savings/threshold benefit, scheme pays out-of-hospital claims for: specialised radiology, mental health, refractive surgery, medical appliances, hearing aids, optometry, maternity, infant paediatrics and preventative benefits. Limits apply. Unlimited threshold with a self payment gap and sub-limits. All else paid from savings or from out of pocket, unless PMB.
1. GP consultations:
  • Paediatric consults: Three per infant under 1yr; two per child 1-2yrs; two GP consults per child 2-12yrs
  • Otherwise, from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R5,254 R4,956 R1,069
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: specialised radiology, mental health, refractive surgery, medical appliances, hearing aids, optometry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from savings, above threshold or from out of pocket.
Main: Adult: Child:
(S) Savings: R11,892 R11,220 R2,424
(SP) Self Payment: R3,600 R2,980 R1,370
Threshold (S+SP): R15,492 R14,200 R3,794
Above Threshold: No limit No limit No limit

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2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R28,200 per family, in-and-out of hospital
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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Other Plans

Bonitas Essential 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some co-payments. Scheme pays out-of-hospital claims for: maternity and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
1. GP consultations:
  • GP: 1 consult per child aged 2yrs-12 yrs
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,473 R1,127 R432
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: maternity and preventative benefits. Limits apply. All else paid from out of pocket, unless PMB.
Main: Adult: Child:
(S) Savings: R0- R0- R0-

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2. Specialists consultations:
  • No benefit, unless PMB
3. Pathology:
  • No benefit, unless PMB
4. General radiology:
  • No benefit, unless PMB
5. Specialised radiology:
  • No benefit, unless PMB
6. Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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Bonitas Primary 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Some co-payments. Over and above the fund, scheme pays out-of-hospital claims for: GPs, mental health, specialised radiology, optometry, dentistry, maternity, infant paediatrics and preventative benefits. Limits apply. All else paid from fund or from out of pocket, unless PMB.
1. GP consultations:
  • Paediatric consults: One per child 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:
MainM+1M+2M+3M4+
R1,800 R3,300 R3,900 R4,200 R4,750
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R1,924 R1,505 R613
Children: Pay for maximum 3 children
Day-to-Day Benefit:
Out-of-hospital, scheme pays for some: GPs, mental health, specialised radiology, 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+
R1,900 R3,400 R4,000 R4,300 R4,650
Specialists, medicine, radiology, pathology, etc
2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R11,700 per family, in and out of hospital
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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Bonitas Standard 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Over and above the fund, scheme pays out-of-hospital claims for: 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.
1. 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-

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
2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R23,500 per family
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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Bonitas Standard Select 2017: Out Of Hospital Benefits
In brief: 100% scheme rate for specialists. Network hospitals. Over and above the fund, scheme pays out-of-hospital claims for: 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.
1. GP consultations:
  • Paediatric consults: Two per child under 2yr; one GP consult per child 2-12yrs
  • Otherwie, GP consults limited to sub-limits below, for network GPs. Some of the funds may be used for non-network GPs
Network GPs:
Main M+1 M+2 M+3 M4+
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: R2,597 R2,247 R760
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
2. Specialists consultations:
  • Paid from day-to-day benefit
3. Pathology:
  • Paid from day-to-day benefit
4. General radiology:
  • Paid from day-to-day benefit
5. Specialised radiology:
  • R23,500 per family
6. Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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