Bonitas Primary Select:in-and-out of hospital benefits (2024)

This page has information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Bonitas Primary Select.

We also have information on: Dentistry, Optometry, Wellness and Preventative, Other, Maternity, Cancer, Mental Health and Prosthetics benefits.

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Monthly Costs:

Primary Select 2024 prices
Main member: Adult member: Child member:
Total Cost pm:
  • R2,619
  • R2,048
  • R832
  • Only pay for 3 children
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R5,300
  • Main+1= R8,520
  • Main+2= R10,650
  • Main+3= R11,720
Children Rates:
  • Child rates up to 24yrs
  • Only pay for 3 children
Note:
  • Exclusions: Note that all schemes have extensive exclusions. We've tried to list the major ones, but you must consult with your scheme to get the full list.
  • All treatments and procedures are subject to authorisation and protocols
  • All benefits are listed as an indication only. Please verify with your broker and scheme
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Bonitas plans, with costs and brief summary
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In-hospital Procedures for 2024:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Bonitas: Primary Select
Assume scheme pays all these costs, unless otherwise stated
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • Covered in full
non-Network GPs:
  • 100% scheme rate
network GPs:
  • Covered in full
Hospital Choice:
  • Network hospital
Day Hospitals:
  • Must use Day Hospitals for certain procedures
Penalty for using other hospital:
  • non-Network long stay hospital: 30% co-payment
  • non-Network Day Hospital: R2,590 co-payment
Other Co-payments:
  • Specialized radiology: R2,130 co-payment
  • In-hospital-dentistry: R2,500- R5,000
    R1,840 co-payment
  • 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
    R4,690 co-payment:
  • Arthroscopy,
  • Diagnostic laparoscopy,
  • Laparoscopic hysterectomy (except cancer and PMBs),
  • Percutaneous rhizotomies,
    R8,680 co-payment:
  • Laparoscopic pyeloplasty,
  • Laparoscopic radical prostatectomy,
  • Nissen fundoplication (reflux surgery)
Specialised Radiology:
  • MRI and CT Scans: R15,170 per family, in and out of hospital
  • R2,130 co-payment, unless PMB
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
  • Physical rehabilitation: R57,890 per family
Transplants:
  • PMBs only
Dialysis:
  • Covered
Exclusions: .
Alternatives to hospitals:
  • Alternatives to hospitalisation (hospice, step-down): R19,130 per family
  • Palliative care (oncology): Unlimited, including hospice/private nursing, home oxygen, pain management, psychologists, social workers
  • Home-care: Home based care as alternative to general ward admission
Casualty:
  • ER: 2 visits per family
Other: .
Note:
  • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
  • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Bonitas plans, with costs and brief summary
.
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.

Out-of-hospital Procedures for 2024:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Bonitas: Primary Select
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R5,300
  • Main+1= R8,520
  • Main+2= R10,650
  • Main+3= R11,720
PMBs out of hospital:
  • All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
  • This can include consults with specialists, blood or other tests, radiology and medicine
  • The benefit is paid by the scheme, and not out of your savings account
  • If you have no day-to-day funds, you still have cover for PMBs
  • Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
  • See our Guide to PMBs for more information.
General info:
  • This plan has an "extra" fund, so some out of hospital costs are paid from this, from sub-limits per benefit (see below)
  • Remember, out of hospital costs authorised as part of PMB treatment (eg. cancer, asthma or stroke) are always paid by the scheme, even on this plan.
  • Wellness Extender: Available after completing a wellness screening or online wellness assessment. Get up to R3,500 per family and use for out of hospital claims like : GP consult(s), OTC medicine, etc
GP consultations:
  • Network GPs: see below. Some of the funds may be used for non-network GPs:
    • M = R2,130
    • M1 = R3,730
    • M2 = R4,790
    • M3 = R4,790
  • From day-to-day benefit
  • Shared with Specialist benefit
Childcare:
  • Hearing screening: Newborns, in or out of hospital
  • Congenital hypothyroidism screening: Infants under 1 month old
  • Paediatric consult: 2 consults for child under 1yr; 1 consult for child 1-2yr
  • GP consult: 1 consult per child 2-12yrs
  • Immunisations: Covered
  • Dentistry: Fissure sealants on permanent teeth for children under 16yrs
Specialists consultations:
  • If referred by GP, 1 consult per family, otherwise:
    • M = R2,130
    • M1 = R3,730
    • M2 = R4,790
    • M3 = R4,790
  • From day-to-day benefit
  • Shared with GP benefit
Pathology:
  • Shared with standard radiology and pathology:
    • M = R2,130
    • M1 = R2,660
    • M2 = R3,200
  • From day-to-day benefit
General radiology:
  • Shared with standard radiology and pathology:
    • M = R2,130
    • M1 = R2,660
    • M2 = R3,200
  • From day-to-day benefit
Specialised radiology:
  • R15,170 per family, in and out of hospital, with a R2,130 co-payment
Supplementary Services: (Physio, etc)
  • M = R2,130
  • M1 = R2,660
  • M2+= R3,200
  • From day-to-day bebefit
General Appliances:
  • From day-to-day benefit
1.1. Hearing Aids:
  • From day-to-day benefit
1.2. Wheelchairs:
  • From day-to-day benefit
Note:
  • PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
  • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Bonitas plans, with costs and brief summary
.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

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Medication Benefit for 2024:

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Bonitas: Primary Select
Assume scheme pays all these costs, unless otherwise stated
Summary of day-to-day benefits:
Main Member: Adult: Child:
Savings (per year):
  • No savings account option on this plan
  • The scheme might still cover some or all day-to-day claims. See below, and see benefits.
Extended Fund:
Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account
  • Main= R5,300
  • Main+1= R8,520
  • Main+2= R10,650
  • Main+3= R11,720
Chronic:
  • If you voluntarily use medicine that is not on Bonitas's list ("formulary"), you pay a 40% co-payment
Acute (presrcibed) medication:
  • M = R2,130
  • M1 = R2,660
  • M2+= R3,200
  • From day-to-day bebefit
Over-the-counter:
  • R535 per person and R2,130 per family
  • Shared with Acute medicine limit, see above
  • From day-to-day- benefit
Birth Control:
  • R1,870 per family
On Discharge:
  • R420 per person per admission
Biological:
  • PMBs only
Note:
  • Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
  • Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
  • PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
  • DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
♦️View all the other benefits for this plan:♦️
Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics

You can also:
♦️Compare any two plans, side by side | ♦️View all the Bonitas plans, with costs and brief summary
.

All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.

Also see these: