Bonitas Hospital Standard medical aid plan: 2020

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Always consult with your broker before making final decisions regarding your healthcare cover.

Hospital Standard
Total Cost pm:

Main member:

R2,284

Adult:

R1,925

Child:

R869
Savings (per year):
  • No savings option on this plan

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IN HOSPITAL PROCEDURES:
Hospital Standard
Scheme Benefits: Notes and Links:
non-Network Specialists:
  • 100% scheme rate
network Specialists:
  • Paid in full
non-Network GPs:
  • 100% scheme rate
network GPs:
  • Paid in full
Hospital Choice:
  • Choose any hospital
Penalty for using other hospital:
  • n/a
  • n/a
Specialised Radiology:
  • R26,620 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
  • Corneal grafts: R32,130
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
  • 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 R10,000 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 R165,000 per person per year for all gap benefits (except dread disease and premium waiver benefits which do not count towards the R165,000 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):
Hospital Standard
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
  • Paediatric consult: 2 consults for child under 1yr; 1 consult for child 1-2yr
  • GP consult: 1 consult 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:
  • Bonitas pays up to R26,620 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • No benefit, unless PMB

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MATERNITY BENEFITS:
Hospital Standard
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):
Hospital Standard
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R344,500 per family, at a preferred provider
  • Brachytherapy: R44,220

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DENTISTRY:
Hospital Standard
Scheme Benefits Notes and Links:
Standard Dentistry:
  • 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:
  • Specialised dentistry: no benefit
In-Hospital Dentistry:
  • Hospitalisation: protocols apply, available for under 5yrs and for removal of impacted teeth, with R3,500 co-payment
Orthodontics:
  • No benefit
Maxillo Facial Surgery:
  • No benefit, unless PMB

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MEDICATION:
Hospital Standard
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:
  • R1,610 per family, paid by Bonitas
On Discharge:
  • R475 per person per admission
Biological:
  • No benefit, unless PMB level of care

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OPTOMETRY:
Hospital Standard
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:
Hospital Standard
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:
Hospital Standard
Scheme Benefits Notes and Links:
General Appliances:
  • No benefit
1.1. Hearing Aids:
  • No benefit
1.2. Wheelchairs:
  • No benefit
Dialysis:
  • Unlimited at DSP provider, or 20% co-payment
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:
Hospital Standard
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 2 years, women 40+yrs
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 R1,270 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:
Hospital Standard
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R45,090 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