Benefits, Bonitas Plan, in-hospital, out-hospital, Scheme Plans

Bonitas BonComplete: in-and-out of hospital benefits (2026)

January 6, 2025

This page has overview information on: Costs, In-hospital, Out of Hospital and Medicine benefits for Bonitas BonComplete. 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 Providers. Where stipulated, you must use 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.

Monthly Costs (2026)

Bonitas: BonComplete (2026)
	Main member:	Adult member:	Child member:
Total Cost pm:	R6,614	R5,298	R1,794
Savings:	R11,880	R9,516	R3,216
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R2,350	R1,990	R510
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	6,250	3,660	1,600
Children Rates:	Up to 24yrs Only pay for 3 children

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In-hospital Procedures (2026):

Bonitas: BonComplete
Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated
GPs and Specialists:	GPs: 100% scheme rate network Specialists: paid in full non-network Specialists: 100% scheme rate	Gap Cover: Can push payout up to 700% scheme rate (Plans coming soon)
Hospital Choice:	Long stay: Network hospital Day procedure: Day network hospital
Penalty for using other hospital:	Use of non-network Hospital: 30% penalty Use of non-network Day Hospital: R5,440 penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	Specialized radiology: R2,800 co-payment Dental admission: R2,600 -R5,200 co-payment Note: 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, especially if you don't use a DSP for a PMB or when buying medicine.	Gap Cover: Can cover most co-payments (Plans coming soon)
Specialised Radiology:	MRI and CT Scans: R30,430 per family, in and out of hospital R2,800 co-payment, unless PMB PET scans: PMBs only	Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Scopes:		Gap Cover: Can cover most co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	100% scheme rate Physical rehabilitation: R67,270 per family
Transplants:	100% scheme rate Corneal grafts: R42,710
Dialysis:	Covered
Exclusions:	. NB: See scheme's rules for all exclusions. All schemes have plenty!	Gap Cover: Coming soon
Alternatives to hospitals:	Alternatives to hospitalisation (hospice, step-down): R21,570 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:	ER: 2 visits per family, paid by Bonitas	Gap Cover: Can cover ER claims (Plans coming soon)
Other:
PMBs = Prescribed Minimum Benefits (more info) \| DSP = Designated Service Provider

Out-of-hospital Procedures (2026):

Bonitas: BonComplete

Assume scheme pays all these costs, at 100% scheme rate, unless otherwise stated

	Main Member:	Adult:	Child:
Savings:	R11,880	R9,516	R3,216
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R2,350	R1,990	R510
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	6,250	3,660	1,600
Other Day-to-Day Funds:	Benefit Booster: R2,070 per family and use for out of hospital claims like GP consult(s), OTC medicine, etc Available after completing a wellness screening and mental health assessment.

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.

From day-to-day benefit

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

Gap Cover:
Can pay for child ER visits
(Plans coming soon)

From day-to-day benefit

From day-to-day benefit

From day-to-day benefit

MRI and CT Scans: R30,430 per family, in and out of hospital, with a R2,800 co-payment

Gap Cover:
Can pay co-payments and increase sublimits
(Plans coming soon)

From day-to-day benefit

Insulin pump: R65,000 per family, every 5 years for type 1 diabetic beneficiaries younger than 18yrs. Paid by Bonitas.
Continous Glucose Monitor: R28,000 per family, per year for type 1 diabetic beneficiaries younger than 18yrs. Paid by Bonitas.
Otherwise, from day to day benefit

R10,900 per device every 3 years, with a 10% co-payment
Two devices per person

See above

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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.

Medication Benefit (2026):

Bonitas: BonComplete

Assume scheme pays all these costs, unless otherwise stated

	Main Member:	Adult:	Child:
Savings:	R11,880	R9,516	R3,216
Self Payment Gap: (What you need to pay out of pocket before you can access the "Above Threshold" benefit)	R2,350	R1,990	R510
"Above Threshold" benefit (ATB): Additional cover the scheme makes available to you, once you've paid* the self payment gap.*	6,250	3,660	1,600
Other Day-to-Day Funds:	Benefit Booster: R2,070 per family and use for out of hospital claims like GP consult(s), OTC medicine, etc Available after completing a wellness screening and mental health assessment.

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
Additional 4 conditions covered for children under 21yrs
Addtional conditions covered: Depression, R165 per person per month

From day-to-day benefit

From day-to-day benefit

R2,050 per family

R535 per person per admission

Oncology drugs: Subject to protocols
Non-Cancer: PMBs only

PMBs = Prescribed Minimum Benefits (more info) | DSP = Designated Service Provider

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