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

Bonitas Standard: 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 Standard. 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: Standard (2026)
	Main member:	Adult member:	Child member:
Total Cost pm:	R5,929	R5,139	R1,740
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= R13,980 Main+1= R20,980 Main+2= R23,310 Main+3= R25,640
Children Rates:	Up to 24yrs Only pay for 3 children

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In-hospital Procedures (2026):

Bonitas: Standard
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: Any hospital Day procedure: Day network
Penalty for using other hospital:	Use of non-network Day Hospital: R2,590 penalty	Gap Cover: Can cover the penalty in full (Plans coming soon)
Co-payments:	Specialized radiology: R1,860 co-payment In-hospital-dentistry: R2,500- R5,000 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: R34,020 per family, in and out of hospital R1,860 co-payment, unless PMB PET scan: One scan per family	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): R20,500 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:	Internal Nerve stimulators: R224,400 per family
PMBs = Prescribed Minimum Benefits (more info) \| DSP = Designated Service Provider

Out-of-hospital Procedures (2026):

Bonitas: Standard

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= R13,980 Main+1= R20,980 Main+2= R23,310 Main+3= R25,640
Other Day-to-Day Funds:	Benefit Booster: R5,000 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 = R3,500
Main+1 = R5,240
Main+2 = R5,830
Main+3 + = R6,990

From day-to-day benefit
Shared with specialist benefit
When above limit is reached, additional 2 consults, per family

Hearing screening: Newborns, in or out of hospital
Vision screening: 2, for premature newborns up to 6 weeks, in or out of hospital
Congenital hypothyroidism screening: Infants under 1 month old
Paediatric consult: 2 consults for child under 1yr; 2 consults for child 1-2yr
GP consult: 2 consults 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 = R3,500
Main+1 = R5,240
Main+2 = R5,830
Main+3 + = R6,990

From day-to-day benefit
Shared with specialist benefit
When above limit is reached, additional 2 consults, per family

Main = R3,370
Main+ 1 = R5,040
Main+ 2 = R5,610
Main+ 3+ = R6,720
Shared with standard radiology benefit
From day-to-day benefit

Main = R3,370
Main+ 1 = R5,040
Main+ 2 = R5,610
Main+ 3+ = R6,720
Shared with standard radiology benefit
From day-to-day benefit

R34,020 per family, in and out of hospital, with a R1,860 co-payment

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

From day-to-day benefit
- Main = R3,370
- Main + 1 = R5,040
- Main + 2 = R5,610
- Main + 3+ = R6,720

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 , with following sublimits:

Stoma products and CPAP: R8,890 per family
Blood Pressure Monitor: R1,250 per family, every 2 years

R9,460 per device every 3 years
Maximum 2 devices per family
All tests and consultations from Hearing Loss Management Programme are paid by Bonitas

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: Standard

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= R13,980 Main+1= R20,980 Main+2= R23,310 Main+3= R25,640
Other Day-to-Day Funds:	Benefit Booster: R5,000 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.

An additional 18 non-PMB conditions are covered on this plan
Overall limit: R13,030 per person and R26,150 per family. Once depleted, only PMBs will continue to be covered by scheme
If you voluntarily use medicine that is not on Bonitas' list ("formulary"), you pay a 30% co-payment

Main= R3,370
Main+ 1 = R5,040
Main+ 2 = R5,610
Main+ 3+ = R6,720

From day to day benefit
Shared with over-the-counter benefit

R895 per person and R2,800 per family
From day to day benefit and shared with Acute Medicine benefit

R2,050 per family

7 day supply, up to R605 per person per admission

Oncology drugs: R164,100, from oncology limit

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

More benefits for this plan >>