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

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".

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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 (2026):

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

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: 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.	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):

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

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= R5,330 Main+1= R8,520 Main+2= R10,650 Main+3= R11,720 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.
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:	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
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	Gap Cover: Can pay for child ER visits (Plans coming soon)
Specialists consultations:	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
Pathology:	Shared with standard radiology and pathology: M= R2,330 M1= R2,910 M2+= R3,500 From day-to-day benefit
General radiology:	Shared with standard radiology and pathology: M= R2,330 M1= R2,910 M2+= R3,500 From day-to-day benefit
Specialised radiology:	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)
Scopes:		Gap Cover: Can pay co-payments and increase sublimits (Plans coming soon)
Supplementary Services: (Physio, etc)	From day-to-day benefit Main member = R2,330 Main +1 = R2,910 Main +2+= R3,500
General Appliances:	From day to day benefit Stoma products and CPAP: R8,560 per family
1.1. Hearing Aids:	From day-to-day benefit
1.2. Wheelchairs:	From day-to-day benefit
PMBs= Prescribed Minimum Benefits (more info) | DSP= Designated Service Provider

Medication Benefit (2026):

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

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= R5,330 Main+1= R8,520 Main+2= R10,650 Main+3= R11,720 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.
Chronic:	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
Acute (prescribed) medication:	M = R1,750 M1 = R2,910 M2+= R3,500 From day-to-day benefit
Over-the-counter:	R590 per person and R2,330 per family Shared with Acute medicine limit, see above From day-to-day- benefit
Birth Control:	R1,970 per family
On Discharge:	R470 per person per admission
Biological:	PMBs only
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