Bonitas BonComprehensive medical aid plan: 2019

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BonComprehensive
2019 Costs:
Total Cost pm:

Main member:

R6,438

Adult:

R6,072

Child: (Pay only for first 3)

R1,310
Savings: R14,568 R13,740 R2,964
Self Payment Gap:
R4,000 R3,310 R1,520
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IN HOSPITAL PROCEDURES:
BonComprehensive
Scheme Benefits: Notes and Links:
Specialists:
  • Up to 300% scheme rate for specialists
  • Contracted Specialists: covered in full
  • You or gap cover pay the balance, if any
Gap Cover
  • Gap cover is available for this plan. Budget about R350 for a fully comprehensive gap cover that will increase the scheme rate to 500% and pay most co-payments and increase sublimits.
Hospital Choice:
  • Choose any hospital, but a 30% co-payment may apply for admission to certain hospitals
Specialised Radiology:
  • 100% scheme rate
Supplementary Services: (Physio, etc)
  • Up to 100% scheme rate
  • Physical rehabilitation: R49,610 per family
Transplants:
  • 100% scheme rate
  • Corneal grafts: R31,500
Co-payments:
  • None
Alternatives to hospitals:
  • Alternatives to hospitalisation: R16,550 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
Other:
  • Internal Nerve stimulators: R165,600 per family
  • Deep brain stimulation, excluding prosthesis: R233,300
  • Cochlear implants: R277,700 per family
Note:
  • Gap cover is an add-on to your medical aid, not a stand alone product
  • Gap cover has a maximum benefit payout of R150,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R150,000 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)
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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):
BonComprehensive
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: R14,568 R13,740 R2,964
Self Payment Gap:
R4,000 R3,310 R1,520
Above Threshold: Once your savings are depleted, and you have paid the self payment gap, scheme will cover most out of hospital expenses at scheme rate, with sublimits for some benefits.
General info: This plan has a savings fund, a self payment gap (that you pay out of your pocket when your savings are depleted) and an unlimited Above Threshold Benefit (which means that Bonitas pays for some more out of hospital claims, if you have paid the self payment gap and still have more claims)
GP consultations:
  • From day-to-day benefit, unless PMB
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • Paediatric consult: 3 consults for child under 1yr; 2 consults for child 1-2yr
  • GP consult: 2 consults per child 2-12yrs
  • Vaccines: South African Vaccines program, plus one flu vaccine
  • Vaccines: Covered
Specialists consultations:
  • From day-to-day benefit, unless PMB
Pathology:
  • From day-to-day benefit, unless PMB
General radiology:
  • From day-to-day benefit, unless PMB
Specialised radiology:
  • Bonitas pays up to R31,330 per family
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MATERNITY BENEFITS:
BonComprehensive
Scheme Benefits Notes and Links:
Hospital stay:
  • 300% scheme rate
  • Private ward
Consultations:
    Paid by Bonitas:
  • 12 consults with GP/gynae/midwife
  • 4 consults with midwife after delivery
  • Antenatal classes: R1,220
Scans:
    Bonitas pays for:
  • 2 x 2D scans
  • 1 amniocentesis
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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CANCER (ONCOLOGY):
BonComprehensive
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R618,500 per family, at a preferred provider
  • Specialised drugs: R245,400, as part of above sublimit
  • Brachytherapy: R44,200
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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DENTISTRY:
BonComprehensive
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard Dentistry: from day-to-day benefit.
Specialised Dentistry:
  • Specialised dentistry: from day-to-day benefit
In-Hospital Dentistry:
  • Covered if clinical criteria are met
Orthodontics:
  • From day-to-day benefit
Maxillo Facial Surgery:
  • Covered if clinical criteria are met
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MEDICATION:
BonComprehensive
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
  • An additional >33 non-CDL conditions> are covered on this plan
  • Overall limit: R13,830 per person and R27,550 per family. Once depleted, PMBs will continue to be covered by scheme
  • If you voluntarily use medicine that is not on Bonitas' list ("formulary"), you pay a 40% co-payment
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
  • From day-to-day benefit
Birth Control:
  • R1,580 per family, paid by Bonitas
On Discharge:
  • R545 per person per admission
Biological:
  • Bonitas pays R196,200 per family for non-oncology specialised medicine
  • R245,400 of your oncology benefit can be used towards biological drugs
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OPTOMETRY:
BonComprehensive
Scheme Benefits: Notes and Links:
Optometry:
Limit:R3,020 per person, every 24 months. Paid by scheme.
Consult:from above limit
Frames:from above limit
Single lensesfrom above limit
Bifocals:from above limit
Multifocalsfrom above limit
Contactsfrom above limit
Refractive Surgery:R20,770 per family
Notes:Above benefits from network provider
What next?
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Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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MENTAL HEALTH:
BonComprehensive
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: R46,880 per family. PMBs always paid in full at DSP, and include up to 21 days admission
Out-of-hospital:
  • Out-of-hospital: R15,890 per family sublimit. PMBs always paid in full at DSP
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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
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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OTHER BENEFITS:
BonComprehensive
Scheme Benefits Notes and Links:
General Appliances:
  • General Appliances: R8,390 per family, paid by scheme.
  • Stoma products and CPAP: Additional R6,160
  • No benefit
1.1. Hearing Aids:
  • R25,780 per family every 2 years, with a 10% co-payment
1.2. Wheelchairs:
  • See "General Appliances" limit
Dialysis:
  • Unlimited at DSP provider, or 20% co-payment
HIV:
  • In-hospital: Unlimited if you register on the HIV/AIDS programme
  • Since HIV is a PMB certain out-of-hospital benefits are automatically covered by all schemes according to protocols
Emergency Transport: ER24
International Insurance:
  • R5 million per person, per trip. R10 million per family
  • Includes mandatory vaccines
Other: TBC
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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WELLNESS/PREVENTATIVE BENEFITS:
BonComprehensive
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
Back Rehabilitation Programme:
  • Managed back and neck program offers personalised treatment plan for up to 6 weeks, paid by scheme
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered 21yrs-65yrs
Mammogram:
  • 1 mammogram every 2 years, women 40-74yrs
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
  • One lipogram every 5yr, 20yrs+
  • One bone density screening every 5 years for women 65yrs+ and men 70yrs+
  • Wellness Extender: costs R2,420 per family and includes choice from following: GP consult(s), Biokineticist, Dietician, Physiotherapy consult and a smoking cessation program
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.

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PROSTHETICS:
BonComprehensive
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R55,100 per family
  • External: R55,100 per family
Sub-limits:
  • Breast prosthesis: R5,250 per breast, limited to two per year
What next?
We will email you a quote for this and two other comparable plans. No phone calls.

Together with a financial advisor, we can help you with unpaid claims, findinging a gap cover, general advice, plan changes, cheaper options and more. FREE.


    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