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:

100% scheme rate
Network specialists covered in full

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

Bonitas Standard Select 2017

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+2	M+3	M4+
R3,750	R5,500	R6,100	R6,400	R6,950

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

Bonitas Standard Select 2017

Main	M+1	M+2	M+3	M4+
Fund:
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:

100% scheme rate

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

Bonitas Standard Select 2017

Main	M+1	M+2	M+3	M4+
Fund:
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.

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

Bonitas Standard Select 2017

Main	M+1	M+2	M+3	M4+
Fund:
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

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

Bonitas Standard Select 2017

Main	M+1	M+2	M+3	M4+
Fund:
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

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

Bonitas Standard Select 2017

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

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

Bonitas Standard Select 2017

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MENTAL HEALTH:

In-hospital:

R36,550 per family per year for hospitalisation

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

Bonitas Standard Select 2017

Main	M+1	M+2	M+3	M4+
Fund:
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

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

Bonitas Standard Select 2017

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

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

Bonitas Standard Select 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:

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

Bonitas Standard Select 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