Bonitas Primary medical aid plan: 2019

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Primary
2019 Costs:
Total Cost pm:

Main member:

R2,240

Adult:

R1,752

Child: (Pay only for first 3)

R713
Savings (per year):
  • No savings option on this plan
Extended Fund: RM = R2,310
M1 = R4,140
M2= R4,860
M3= R5,230
M4= R5,660
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IN HOSPITAL PROCEDURES:
Primary
Scheme Benefits: Notes and Links:
Specialists:
  • Up to 100% scheme rate
  • 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:
  • R 12,380 per family
  • In and out of hospital
Supplementary Services: (Physio, etc)
  • Up to 100% scheme rate
  • Physical rehabilitation: R49,610 per family
Transplants:
  • PMBs only
  • Cochlear implants: R277,700 per family
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:
  • R1,450 co-payment paid by you or your gap cover
  • Arthroscopy,
  • Diagnostic laparoscopy,
  • Laparoscopic hysterectomy (except cancer and PMBs),
  • Laparoscopic appendectomy,
  • Percutaneous rhizotomies,
  • R3,680 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),
  • R7,250 co-payment paid by you or your gap cover
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:
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):
Primary
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: RM = R2,310
M1 = R4,140
M2= R4,860
M3= R5,230
M4= R5,660
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General info:
  • This plan has an "extra" fund ("day-to-day benefit"), so most out of hospital costs are paid by this, subject to sub-limits per benefit (see below)
GP consultations:
  • Contracted GPs: see below. Some of the funds may be used for non-Contracted GPs
MainM+1M+2M+3M4+
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Childcare:
  • Hearing screening for newborns, in or out of hospital
  • Congenital hypothyroidism screening for infants under 1 month old
  • Paediatric consult: 1 consults for child under 1yr; 1 consult for child 1-2yr;
  • GP consult: 1 consult per child 2-12yrs
  • 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 R13,000 per family, in and out of hospital
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB
What next?
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MATERNITY BENEFITS:
Primary
Scheme Benefits Notes and Links:
Hospital stay:
  • 100% 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
What next?
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CANCER (ONCOLOGY):
Primary
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R165,000 per family, at a preferred provider
  • Brachytherapy: R44,220
What next?
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DENTISTRY:
Primary
Scheme Benefits Notes and Links:
Standard Dentistry:
  • Standard Dentistry: paid by scheme (not from day-to-day).
  • Includes:
    • 2 annual checkups
    • X-rays. (Extra-oral 1 every 3 years)
    • 2 annual scale and polish treatments per person
    • Fissure sealants for under 16yr olds
    • Fluoride treatments for children 5-16yrs
    • One filling per tooth per year
    • Root canals, except for primary teeth
    • Plastic dentures, 1 set per person every 4 years
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
What next?
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MEDICATION:
Primary
Scheme Benefits: Notes and Links:
Chronic:
  • Conditions covered:27 CDL conditions
  • Co-payment for use of non-formulary: 40%
Acute (presrcibed) medication:
  • From day-to-day benefit
Over-the-counter:
    Paid from day-to-day benefit, limited to R490 per person and R1,430 per family
Birth Control:
  • R1,580 per family, paid by Bonitas
On Discharge:
  • R380 per person per admission
Biological:
  • No benefit, unless PMB level of care
What next?
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OPTOMETRY:
Primary
Scheme Benefits: Notes and Links:
Optometry:
Limit:R4,480, every 24 months. Paid by scheme.
Consult:1 per person
Frames:R525
Single lenses100% cost
Bifocals:R410
MultifocalsR710
ContactsR1,235
Refractive Surgery:R8,546
Notes:Above benefits from network provider
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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MENTAL HEALTH:
Primary
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: R15,830 per family. PMBs always paid in full at DSP, and include up to 21 days admission
Out-of-hospital:
  • Out-of-hospital: R9,560 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?
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OTHER BENEFITS:
Primary
Scheme Benefits Notes and Links:
General Appliances:
  • General Appliances:> R6,890 per family, paid by scheme.
  • Stoma products: Additional R6,550
  • No benefit
1.1. Hearing Aids:
  • See "General Appliances" limit
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?
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WELLNESS/PREVENTATIVE BENEFITS:
Primary
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
  • Wellness Extender: costs R1,270 per family and includes choice from following: GP consult(s), Biokineticist, Dietician, Physiotherapy consult and a smoking cessation program
What next?
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PROSTHETICS:
Primary
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal: R44,210 per family. excluding joint replacement prosthesis
  • External: No benefit
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