Bonitas Primary medical aid plan: 2017

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. Pay for maximum 3 children .

View all plans in this scheme

IN HOSPITAL PROCEDURES:

Payout Rate for Specialists:

100% scheme rate
Network specialists covered in full

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

Hospital Choice:

Unlimited, but a co-payment may apply for admission to certain hospitals. Speak to scheme.

Specialised Radiology:

R11,700 per family, in and out of hospital

Supplementary Services: (Physio, etc)

100% scheme rate
Physical rehabilitation: R44,650 per family

Transplants:

PMBs only

Co-payments:

Colonoscopy,
Conservative back treatment
Cystoscopy,
Facet joint injections,
Flexible sigmoidoscopy,
Functional nasal surgery,
Gastroscopy,
Hysteroscopy,
Myringotomy,
Tonsillectomy and adenoidectomy
Umbilical hernia repair
Varicose vein surgery:
R1,300 co-payment

Arthroscopy,
Diagnostic laparoscopy,
Laparoscopic hysterectomy (except cancer and PMBs),
Laparoscopic appendectomy,
Percutaneous rhizotomies,
R3,300 co-payment

Back surgery including spinal fusion,
Joint replacements,
Laparoscopic pyeloplasty,
Laparoscopic radical prostatectomy,
Nissen fundoplication (reflux surgery),
R6,500 co-payment

Alternatives to hospitals:

R14,900 per family

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OUT OF HOSPITAL BENEFITS:

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:

Main	M+1	M+2	M+3	M4+
R1,800	R3,300	R3,900	R4,200	R4,750

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

Main	M+1	M+2	M+3	M4+
Fund:
R1,900	R3,400	R4,000	R4,300	R4,650
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:

R11,700 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:

100% scheme rate

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

Main	M+1	M+2	M+3	M4+
Fund:
R1,900	R3,400	R4,000	R4,300	R4,650
Specialists, medicine, radiology, pathology, etc

Consultations:

6 consults, paid by scheme
4 consults with midwife after delivery

Scans:

2 x 2D scans
1 amniocentesis

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CANCER (ONCOLOGY):

Overall coverage (in and out of hospital):

R149,000 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.

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

Main	M+1	M+2	M+3	M4+
Fund:
R1,900	R3,400	R4,000	R4,300	R4,650
Specialists, medicine, radiology, pathology, etc

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DENTISTRY:

Dentistry:

Standard dentistry: paid by scheme
Specialised dentistry: no benefit
In-hospital: R3,000 co-payment

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

Main	M+1	M+2	M+3	M4+
Fund:
R1,900	R3,400	R4,000	R4,300	R4,650
Specialists, medicine, radiology, pathology, etc

Orthodontics:

No benefit

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

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

Acute (presrcibed) medication:

Paid from day-to-day benefit

Over-the-counter:

Paid from day-to-day benefit, limited to R440 per person and R1,290 per family

Birth Control:

Paid from day-to-day benefit

On Discharge:

R340 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:

R4,270 per family every two years, with sub limits. Paid by scheme.

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

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MENTAL HEALTH:

In-hospital:

R14,250 per family per year for hospitalisation. paid by scheme.
This includes R8,600 per family for in-hospital and out-of-hospital consultations

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

Main	M+1	M+2	M+3	M4+
Fund:
R1,900	R3,400	R4,000	R4,300	R4,650
Specialists, medicine, radiology, pathology, etc

Out-of-hospital:

R8,600 per family for in-hospital and out-of-hospital consultations. paid by scheme.

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OTHER BENEFITS:

General Appliances:

General Appliances: R6,200 per family. paid by scheme.
Stoma products: Additional R5,900
Foot orthotics: No benefit

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

1.1. Hearing Aids:

See "General Appliances" limit

1.2. Wheelchairs:

See "General Appliances" limit

Dialysis:

PMBs only

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

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 2017

Pneumonia vaccines:

Covered, 65yrs+ every 5 yrs

Back Rehabilitation Programme:

Biometric Screening:

Covered

Child Immunisation:

Pap Smear:

Covered 21yrs-65yrs

Mammogram:

PAS Test:

HIV Test:

Covered

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PROSTHESIS:

Overal Limit:

	Main:	Adult:	Child:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
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:

Bonitas BonSave 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