Bonitas BonComplete medical aid plan: 2017

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. Pay for maximum 3 children .

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IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:	100% scheme rate Network specialists covered in full	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 Compare with these plans: Bonitas Standard 2017
Hospital Choice:	Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
Specialised Radiology:	R21,000 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 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 Compare with these plans: Bonitas Standard 2017
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:	R21,000 per family, in and out of hospital
Supplementary Services: (Physio, etc)	Paid from day-to-day benefit
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MATERNITY BENEFITS:
Hospital stay:	150% scheme rate	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 Compare with these plans: Bonitas Standard 2017
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: R2,923 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 Compare with these plans: Bonitas Standard 2017
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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: R2,923 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 Compare with these plans: Bonitas Standard 2017
Orthodontics:	Benefit granted where function is impaired, not for cosmetic reasons, at 65% 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 Co-payment if out of formulary: 40% co-payment	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 Compare with these plans: Bonitas Standard 2017
Acute (presrcibed) medication:	Paid from day-to-day benefit
Over-the-counter:	Paid from day-to-day benefit
Birth Control:	Paid from day-to-day benefit
On Discharge:	R370 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:	Paid 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 Compare with these plans: Bonitas Standard 2017
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MENTAL HEALTH:
In-hospital:	R29,000 per family per year, at DSP	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 Compare with these plans: Bonitas Standard 2017
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:	Paid 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 Compare with these plans: Bonitas Standard 2017
1.1. Hearing Aids:	See "General Appliances" limit
1.2. Wheelchairs:	See "General Appliances" limit
Dialysis:	Unlimited (in-hospital) at DSP
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: R2,923 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 Compare with these plans: Bonitas Standard 2017
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: R2,923 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 Compare with these plans: Bonitas Standard 2017
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