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

Bonitas Primary: 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 Primary. Please consult and verify with the scheme or your broker for full benefits, and an explanation of all the "fine print".

View all the Bonitas plans, with costs and brief summary.
View all open medical aid plans.
Compare any two plans side by side, instantly.

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: Primary (2026)
	Main member:	Adult member:	Child member:
Total Cost pm:	R3,588	R2,807	R1141
Savings:	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= R5,540 Main+1= R8,860 Main+2= R11,080 Main+3= R12,190
Children Rates:	Up to 24yrs Only pay for 3 children

FREE GUIDE!

How to choose the right Medical Aid plan

Instant download when you subscribe

In-hospital Procedures (2026):

Bonitas: Primary
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 long stay hospital: 30% penalty Use of non-network Day Hospital: R6,500 penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	Specialized radiology: R2,240 co-payment R2,020 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 R5,130 co-payment Arthroscopy Diagnostic laparoscopy Laparoscopic hysterectomy (except cancer and PMBs) Percutaneous rhizotomies R9,500 co-payment Laparoscopic pyeloplasty, Laparoscopic radical prostatectomy Nissen fundoplication (reflux surgery) 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: R15,960 per family, in and out of hospital R2,240 co-payment, unless PMB PET scans: PMB 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)	From day-to-day benefit , unless PMB Physical rehabilitation: R63,340 per family
Transplants:	PMBs only
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): R20,310 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 for children under 6 yrs, 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: Primary

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.
Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account	Main= R5,540 Main+1= R8,860 Main+2= R11,080 Main+3= R12,190
Other Day-to-Day Funds:	Benefit Booster: R4,000 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.

Main = R2,330
Main+ 1 = R4,080
Main+ 2+ = R5,240

From day-to-day benefit
Shared with: GPs and Specialist benefit
One extra GP consult per family when limit is reached

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)

Main = R2,330
Main+ 1 = R4,080
Main+ 2+ = R5,240

From day-to-day benefit
Shared with: GPs and Specialist benefit
One extra Specialist consult per family when limit is reached

Shared with standard radiology and pathology:
- M= R2,330
- M1= R2,910
- M2+= R3,500
From day-to-day benefit

Shared with standard radiology and pathology:
- M= R2,330
- M1= R2,910
- M2+= R3,500
From day-to-day benefit

R15,960 per family, in and out of hospital, with a R2,240 co-payment

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

From day-to-day benefit
- Main member = R2,330
- Main +1 = R2,910
- Main +2+= R3,500

From day to day benefit
Stoma products and CPAP: R8,560 per family

From day-to-day benefit

From day-to-day benefit

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: Primary

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.
Extended Fund: Extra funds from the scheme for (mostly) out of hospital claims, over and above any savings account	Main= R5,540 Main+1= R8,860 Main+2= R11,080 Main+3= R12,190
Other Day-to-Day Funds:	Benefit Booster: R4,000 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.

Addtional conditions covered: Depression, R165 per person per month
If you voluntarily use medicine that is not on Bonitas's list ("formulary"), you pay a 30% co-payment

M = R1,750
M1 = R2,910
M2+= R3,500
From day-to-day benefit

R590 per person and R2,330 per family
Shared with Acute medicine limit, see above
From day-to-day- benefit

R1,970 per family

R470 per person per admission

PMBs only

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

More benefits for this plan >>