Bonitas BonEssential medical aid plan: 2020

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

Essential
2020 Costs:
Total Cost pm:

Main member:

R1,877

Adult:

R1,436

Child:

R550
Savings (per year):
  • No savings option on this plan



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IN HOSPITAL PROCEDURES:
Essential
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • The Blue Plan gap cover will increase this to 500% scheme rate
network Specialists:
  • Covered in full, at 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:
  • Covered in full, at scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Hospital Choice:
  • Choose any hospital
Penalty for using other hospital:
  • n/a
Specialised Radiology:
  • R 16,070 per family, in and out of hospital
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:
  • 100% scheme rate
Co-payments:
  • 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:
  • R1,520 co-payment paid by you or your gap cover
  • Arthroscopy,
  • Diagnostic laparoscopy,
  • Laparoscopic hysterectomy (except cancer and PMBs),
  • Percutaneous rhizotomies,
  • R3,850 co-payment paid by you or your gap cover
  • Back surgery including spinal fusion,
  • Joint replacements,
  • Laparoscopic pyeloplasty,
  • Laparoscopic radical prostatectomy,
  • Nissen fundoplication (reflux surgery),
  • R7,580 co-payment paid by you or your gap cover
Alternatives to hospitals:
  • Alternatives to hospitalisation: R16,880 per family paid by Bonitas
  • 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:
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):
Essential
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
General info:
  • Consider getting Primary Health Care (PHC) (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
GP consultations:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • GP consult: one per child 2-12yrs
Specialists consultations:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Pathology:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
General radiology:
  • No benefit, unless PMB
  • See Primary Health Care benefit above
Specialised radiology:
  • R 16,070 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB



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MATERNITY BENEFITS:
Essential
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% scheme rate
  • The Blue Plan gap cover will increase this to 500% scheme rate
Consultations:
    Paid by Bonitas:
  • 6 consults with GP/gynae/midwife
  • 4 consults with midwife after delivery
Scans:
    Bonitas pays for:
  • 2 x 2D scans
  • 1 amniocentesis



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CANCER (ONCOLOGY):
Essential
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R344,500 per family at preferred provider
  • Brachytherapy: R44,220



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DENTISTRY:
Essential
Scheme Benefits Notes and Links:
Standard Dentistry:
  • No benefit
  • Consider getting Primary Health Care (medical insurance) that will cover you for a lot of out of hospital claims, including standard dentistry like scaling, polishing, fillings, extractions, root canals and more. It's an excellent complement to a hospital plan.
  • R370/main | R245/adult | R110/child
  • Read more here
Specialised Dentistry:
  • No benefit
In-Hospital Dentistry:
  • Dental and oral surgery: no benefit, unless PMB
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB



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MEDICATION:
Essential
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:
  • No benefit
  • 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:
  • No benefit
Birth Control:
  • R1,290 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:
Essential
Scheme Benefits: Notes and Links:
Optometry:
Limit:No benefit
Consult:n/a
Frames:n/a
Single lensesn/a
Bifocals:n/a
Multifocalsn/a
Contactsn/a
Refractive Surgery:n/a
Notes:n/a
  • 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



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MENTAL HEALTH:
Essential
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: R32,210 per family. 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:
Essential
Scheme Benefits Notes and Links:
General Appliances:
  • No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Dialysis:
  • Unlimited (in-hospital) at DSP. 20% co-payment if DSP is not used.
International Insurance:
  • Cover for medical emergencies when you travel outside South Africa. You must register for this benefit.
Other: .



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WELLNESS/PREVENTATIVE BENEFITS:
Essential
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
  • Wellness Extender: costs R910 per family and includes choice from following: GP consult(s), Biokineticist, Dietician, Physiotherapy consult and a smoking cessation program, x-rays as per formulary, blood tests as pre formulary



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PROSTHETICS:
Essential
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R32,130 per family, excluding joint replacement prosthesis
  • 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