Bonitas BonCap A medical aid plan: 2020

View all plans in this scheme.
Always consult with your broker before making final decisions regarding your healthcare cover.

BonCap A
2020 Costs:
Total Cost pm:

Main member:

R1,159

Adult:

R1,098

Child:

R546
Savings (per year):
  • No savings option on this plan
Income band:



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IN HOSPITAL PROCEDURES:
BonCap A
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • The Blue Plan gap cover will increase this to 500% scheme rate
network Specialists:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
non-Network GPs:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
network GPs:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Hospital Choice:
  • Choose a BonCap Network hospital
Penalty for using other hospital:
  • R10,000 co-payment for use of non-network hospital or for not getting authorisation
Specialised Radiology:
  • R 11,840 per family
Supplementary Services: (Physio, etc)
  • PMB only
  • Physical rehabilitation: R50,600 per family
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • Unlimited
Co-payments:
  • None
Alternatives to hospitals:
  • Alternatives to hospitalisation: R14,570 per family
  • Terminal care: Unlimited, including hospice/private nursing, home oxygen, pain management, psychologists, social workers
Casualty:
  • Accident and trauma related costs covered if authorised within 24hrs
  • Both the Blue Plan and Red Plan gap cover will pay up to R20,000 per person for unpaid casualty costs in event of emergency
Other:
  • Blood tests: R25,950 per family
  • Blood transfusions: R18,850 per family

    Excluded:
  • 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
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R157,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R157,000 limit)
  • Gap only supplements payment for procedures approved or authorised by your medical aid, and does not cover “penalties” (such as if, for example, you choose a non-DSP doctor for your procedure when the plan required a DSP doctor)



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All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme.
The gap benefits listed are for AskAdam gaps, unless otherwise stated. Actual benefits depend on gap choice option.

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OUT OF HOSPITAL BENEFITS (non-PMB):
BonCap A
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Our recommended gap cover does not pay out-of-hospital claims, unless it is for cancer treatment, dialysis, or MRI/CT scans
GP consultations:
  • Contracted GPs: unlimited consults
  • Non-Contracted GPs: 1 consult per person and 2 consults per family, limited to R1,070 with a 20% co-payment
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
Specialists consultations:
  • 3 consults or R3,170 per person and 5 consults and R4,710 per family
  • Includes: acute medicine, blood tests, MRIs and CT scans, x-rays
Pathology:
  • Bestmed pays this benefit, which is shared with acute medicine, x-rays and blood tests
MainM+1M+2M+3M4+
R1,880 R3,120 R3,730 R4,080 R4,530
General radiology:
  • See pathology benefit, above
Specialised radiology:
  • See specialist benefit, above
  • Sublimit increased as necessary for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB



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MATERNITY BENEFITS:
BonCap A
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% scheme rate
  • Elective c-sections: no benefit
  • Neonatal care: R46,290, unless PMB
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
  • Part of GP and Specialist benefit
  • Bonitas pays for 4 consults with midwife after birth
Scans:
  • Part of GP and Specialist benefit



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CANCER (ONCOLOGY):
BonCap A
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • PMBs only, at DSP (designated service provider)



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DENTISTRY:
BonCap A
Scheme Benefits Notes and Links:
Standard Dentistry:
  • 1 annual checkup, and 1 emergency consultation for pain
  • 4 intra-oral x-rays per person
  • 1 extra-oral per person per lifetime
  • 1 scale or polish treatments per person
  • Fissure sealants for under 16yr olds
  • Fluoride treatments for unde 16yrs
  • 4 fillings per person per year
  • Extractions
  • Root canals, for emergency treatment only
  • 1 set of plastic dentures per family every 2 years, with 20% co-payment
Specialised Dentistry:
  • Specialised dentistry: no benefit
In-Hospital Dentistry:
  • Dental and oral surgery: no benefit, unless PMB
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • Orthognathic surgery: no benefit
  • Osseo-integrated implants: no benefit
  • Maxillo-facial surgery: PMBs only



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MEDICATION:
BonCap A
Scheme Benefits: Notes and Links:
Chronic:
  • All medical aid plans pay for treatment of the 27 CDL conditions as required by law. This includes medicine as well as GP or specialist consults, tests etc. Find out more
  • If you voluntarily use medicine that is not on Bonitas's list ("formulary"), you pay a 40% co-payment
Acute (presrcibed) medication:
  • Bestmed pays this benefit, which is shared with acute medicine, x-rays and blood tests
MainM+1M+2M+3M4+
R1,880 R3,120 R3,730 R4,080 R4,530
  • Consider getting Primary Health Care (medical insurance) that will cover you for all GP visits, some specialist visits, acute meds, minor out of hospital procedures, some radiology and pathology, dentistry, optometry and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Over-the-counter:
  • R95 per event, and R270 per person
Birth Control:
  • R1,070 per family, paid by Bonitas
On Discharge:
  • R390 per person per admission
Biological:
  • No benefit, unless PMB level of care



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OPTOMETRY:
BonCap A
Scheme Benefits: Notes and Links:
Optometry:
Limit:Paid by scheme, every 24 months
Consult:1 per person
Frames:R225
Single lenses100% cost
Bifocals:
Multifocals
ContactsR1,085
Refractive Surgery:no benefit
Notes:Above benefits from network provider



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MENTAL HEALTH:
BonCap A
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: PMBs always paid in full at DSP, and include up to 21 days admission
Out-of-hospital:
  • PMBs always paid in full at DSP, and include consultations
Trauma:
  • PMB conditions are covered for in and out of hospital treatment. For a full list see here.
  • Example of PMB condition: Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse. Treatment includes hospital admission for psychotherapy / counselling up to 3 days, or up to 12 outpatient psychotherapy / counselling contacts



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OTHER BENEFITS:
BonCap A
Scheme Benefits Notes and Links:
General Appliances:
  • R5,550 per family
1.1. Hearing Aids:
  • See above
1.2. Wheelchairs:
  • See above
Dialysis:
  • Unlimited at DSP provider, or 20% co-payment
International Insurance:
  • No benefit
Other:



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WELLNESS/PREVENTATIVE BENEFITS:
BonCap A
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
Biometric Screening:
  • Covered
Child Immunisation:
  • No benefit
Pap Smear:
  • Covered, every 3 years for women 21yrs-65yrs
Mammogram:
  • 1 mammogram every two years, for women 40yrs+
PAS Test:
  • 1 test for men 45-69yrs, who are high risk for prostate cancer
HIV Test:
  • Covered
Other:
  • One stool test for colon cancer, 50yrs-75yrs



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PROSTHETICS:
BonCap A
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: PMBs only
  • External: PMBs only
Sub-limits:



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    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised