Bonitas Boncap D:
in-and-out of hospital benefits (2025)

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Bonitas BonCap D. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

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Terminology:

• 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
• All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

In-hospital Procedures (2025):

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

Bonitas: BonCap D
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	network Doctors: 100% scheme rate non-network Doctors: 70% scheme rate
Hospital Choice:	Network hospital Day procedure: Day network hospital
Penalty for using other hospital:	Use of non-network hospital: 30% penalty
Co-payments:	Specialized radiology: R1,170 co-payment Note: A co-payment is a fee your medical aid can insist you pay, regardless of how much the doctor/charges. It's not the same as an "excess" payment (which is when a doctor charges more than the medical aid rate). If you use a DSP (designated service provider), you never have to pay a co-payment for protocol treatment of a PMB (Prescribed Minimum Benefit). More info here There might be other co-payments if you don't use a DSP, especially if you are being treated for a PMB or when buying medicine.
Specialised Radiology:	MRI and CT Scans: R14,250 per family R1,170 co-payment unless PMB
Scopes:	PMBs only
Supplementary Services: (Physio, etc)	PMBs only Physical rehabilitation: R60,900 per family
Transplants:	PMBs only
Dialysis:	Covered
Exclusions:	Back and neck surgery Joint replacement surgery C-sections for non-medical reasons Functional nasal and sinus surgery Varicose vein surgery Hernia repair surgery Laparoscopic surgery All endoscopies Bunion surgery In-hospital dental surgery NB: See scheme's rules for all exclusions. All schemes have plenty!
Alternatives to hospitals:	Alternatives to hospitalisation: R17,550 per family Terminal care: Unlimited, including hospice/private nursing, home oxygen, pain management, psychologists, social workers Physical rehab, in-hospital: R60,900 per family
Casualty/ER:	ER: 2 visits per family
Other:	Blood tests: R31,230 per family, unless PMB Blood transfusions: R22,690 per family, unless PMB
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Out-of-hospital Procedures (2025):

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

Bonitas: BonCap D
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
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.
PMBs out of hospital:	All schemes 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 PMB benefits must never be paid from your savings account 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.
GP consultations:	Network GPs: Unlimited Non-network GPs: 1 consult per person and 2 consults per family, limited to R400 per visit with a 30% co-payment
Childcare:	Hearing screening: Newborns, in or out of hospital Vaccinations: Up to age 12 Congenital hypothyroidism screening: Infants under 1 month old Dentistry: Fissure sealants on permanent teeth for children under 16yrs
Specialists consultations:	Network: 3 consults, R3,900 per person and 5 consults, R5,800 per family Non-Network: PMBs only Benefit pays for: acute medicine, blood tests, MRIs and CT scans, x-rays
Pathology:	Bonitas pays this benefit, which is shared with acute medicine, x-rays and blood tests, up to: M = R2,300 M1 = R3,840 M2 = R4,600 M3 = R5,020 M4+ = R5,570
General radiology:	Bonitas pays this benefit, which is shared with acute medicine, x-rays and blood tests, up to: M = R2,300 M1 = R3,840 M2 = R4,600 M3 = R5,020 M4+ = R5,570
Specialised radiology:	See specialist benefit, above
Scopes:	PMBs only
Supplementary Services: (Physio, etc)	PMBs only
General Appliances:	R7,090 per family
1.1. Hearing Aids:	See above
1.2. Wheelchairs:	See above
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2025):

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

Bonitas: BonCap D
Assume scheme pays all these costs, unless otherwise stated
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.
Chronic:	27 PMB conditions: Covered. You can see the full PMB list here. If you voluntarily use medicine that is not on Bonitas's list ("formulary"), you pay a 40% co-payment
Acute (prescribed) medication:	Bonitas pays this benefit, which is shared with acute medicine, x-rays and blood tests, up to: M = R2,300 M1 = R3,840 M2 = R4,600 M3 = R5,020 M4+ = R5,570
Over-the-counter:	R115 per event, and R330 per person per year
Birth Control:	R1,330 per family
On Discharge:	R470 per person and max 7 days, per admission
Biological:	PMBs only level of care
View other benefits for this plan: In-hospital | 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. Find all other open medical aid plans here.
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider