Bonitas BonComprehensive medical aid plan: 2017

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. 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: 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

Compare with these plans:
Hospital Choice:
  • Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.
Specialised Radiology:
  • Unlimited
Supplementary Services: (Physio, etc)
  • 100% scheme rate
  • Physical rehabilitation: R44,650 per family
Transplants:
  • Unlimited
Co-payments: n/a
Alternatives to hospitals:
  • R14,900 per family

.
.

OUT OF HOSPITAL BENEFITS:
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

Compare with these plans:

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:
  • R28,200 per family, in-and-out of hospital
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

.
.

MATERNITY BENEFITS:
Hospital stay:
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

Compare with these plans:

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

.
.

CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • R556,700 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: 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

Compare with these plans:

.
.

DENTISTRY:
Dentistry:
    • Standard dentistry: from day-to-day benefit, with sub-limits
    • Specialised dentistry: from day-to-day benefit, with sub-limits
    • Periodontics: limited to conservative, non-surgical therapy
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

Compare with these plans:

Orthodontics:
  • Benefit granted where function is impaired, not for cosmetic reasons, at 100% scheme rate, for 9yrs-18yrs. Only one member may begin treatment in a year.
Maxillo Facial Surgery:

.
.

MEDICATION:
Chronic:
  • No. of chronic conditions covered: 27 CDLs and PMBs plus 35 conditions
  • Co-payment if out of formulary: 40% co-payment
  • Overall limit:R12,450 per person and R24,800 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: 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

Compare with these plans:
Acute (presrcibed) medication:
  • Paid from day-to-day benefit
Over-the-counter:
  • Paid from day-to-day benefit
Birth Control:
On Discharge:
  • R490 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

.
.

OPTOMETRY:
Optometry:
  • R2,880 per person every two years, paid by scheme
  • Refractive surgery: R18,700 per family
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

Compare with these plans:

.
.

MENTAL HEALTH:
In-hospital:
  • R42,200 per family per year for hospitalisation
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

Compare with these plans:


Out-of-hospital:
  • R14,300 per family for in-hospital and out-of-hospital consultations

.
.

OTHER BENEFITS:
General Appliances:
  • General Appliances: R7,550 per family. paid by scheme.
  • Stoma products: Additional R5,550
  • Foot orthotics: paid from savings
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

Compare with these plans:

1.1. Hearing Aids:
  • R23,200 per family every 2 years, with a 10% 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:

.
.

WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
  • Covered
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

Compare with these plans:

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

.
.

PROSTHESIS:
Overal Limit:
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

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