Bonitas Primary medical aid plan: 2020

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Primary
Total Cost pm:

Main member:

R2,429

Adult:

R1,900

Child:

R773
Savings (per year):
  • No savings option on this plan
Extended Fund: RM = R2,660
M1 = R4,760
M2= R5,590
M3= R6,010
M4= R6,510
R R

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IN HOSPITAL PROCEDURES:
Primary
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:
  • R 13,260 per family
  • In and out of hospital
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit, unless PMB
  • Physical rehabilitation: R50,600 per family
  • The Blue Plan gap cover will increase this to 500% scheme rate
Transplants:
  • PMBs only
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):
Primary
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: RM = R2,660
M1 = R4,760
M2= R5,590
M3= R6,010
M4= R6,510
R R
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: see below. Some of the funds may be used for non-Contracted GPs
MainM+1M+2M+3M4+
R1,900 R3,490 R4,130 R4,440 R5,030
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 R13,260 per family, in and out of hospital
  • Sublimit increased as necessary for authorised out of hospital MRI and CT Scans
Supplementary Services: (Physio, etc)
  • From day-to-day benefit, unless PMB

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MATERNITY BENEFITS:
Primary
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):
Primary
Scheme Benefits Notes and Links:
Overall coverage (in and out of hospital):
  • R165,500 per family, at a preferred provider
  • Brachytherapy: R44,220

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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 every 2 years
    • 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

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MEDICATION:
Primary
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:
  • From day-to-day 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:
    Paid from day-to-day benefit, limited to R500 per person and R1,460 per family
Birth Control:
  • R1,610 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:
Primary
Scheme Benefits: Notes and Links:
Optometry:
Limit:R4,710, every 24 months. Paid by scheme.
Consult:1 per person
Frames:R525 from network provider
Single lenses100% cost from network provider, or R185 per lens from non-network
Bifocals:100% cost from network provider, or R420 per lens from non-network
Multifocals100% cost from network provider, or R745 per lens from non-network
ContactsR1,295
Refractive Surgery:No benefit

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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
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:
Primary
Scheme Benefits Notes and Links:
General Appliances:
  • General Appliances:> R7,030 per family, paid by scheme.
  • Stoma products: Additional R6,680
1.1. Hearing Aids:
  • See "General Appliances" limit
1.2. Wheelchairs:
  • See "General Appliances" limit
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:
Primary
Scheme Benefits: Notes and Links:
Flu vaccination:
  • Covered
Pneumonia vaccines:
  • Covered, 65yrs+ every 5 yrs
Biometric Screening:
  • Covered
Child Immunisation:
  • Covered
Pap Smear:
  • Covered, every 3 years for women 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, x-rays as per formulary, blood tests as pre formulary

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