Bonitas Standard Select medical aid plan: 2020

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Standard Select
Total Cost pm:

Main member:

R3,368

Adult:

R2,914

Child:

R986
Savings (per year):
  • No savings option on this plan
Extended Fund: R R R

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IN HOSPITAL PROCEDURES:
Standard Select
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 a Network hospital
Penalty for using other hospital:
  • 30% co-payment for use of non-network hospital
  • n/a
Specialised Radiology:
  • R26,620 per family
  • In and out of hospital
Supplementary Services: (Physio, etc)
  • Up to 100% scheme rate
  • 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:
  • Spinal surgery: R10,000 co-payment if you do not go for assessment through back and neck program
  • Hip and knee replacements: R10,000 co-payment if you do not use the preferred provider
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):
Standard Select
Scheme Benefits Notes and Links:
Main Member: Adult: Child:
Savings /yr: No savings option on this plan
Extended Fund: R 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+
R4,250 R6,230 R6,910 R7,250 R7,870
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; 2 consults 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 R26,620 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:
Standard Select
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:
  • 12 consults with GP/gynae/midwife
  • 4 consults with midwife after delivery
  • Antenatal classes: R1,240
Scans:
    Bonitas pays for:
  • 2 x 2D scans
  • 1 amniocentesis

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CANCER (ONCOLOGY):
Standard Select
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:
Standard Select
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, with protocols
    • Plastic dentures, 1 set per person every 4 years
Specialised Dentistry:
  • Partial metal frame dentures: 1 frame per person every 5 years
  • Crowns and bridges: 1 crown per family per year
  • Peridontics: Conservative, non-surgical therapy only
In-Hospital Dentistry:
  • Hospitalisation: protocols apply, available for under 5yrs and for removal of impacted teeth, with R3,500 co-payment
Orthodontics:
  • Benefit granted where function is impaired, not for cosmetic reasons, at 80% scheme rate, for 9yrs-18yrs. Only one member may begin treatment in a year.
Maxillo Facial Surgery:
  • Covered if clinical criteria are met, with a possible R3,500 co-payment unless due to accident or trauma

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MEDICATION:
Standard Select
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 18 non-CDL conditions are covered on this plan
  • Overall limit: R9,800 per person and R19,670 per family. Once depleted, only CDLs 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
  • 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:
  • From day-to-day benefit, limited to R790 per person and R2,400 per family
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:
Standard Select
Scheme Benefits: Notes and Links:
Optometry:
Limit:R6,115 per family, every 24 months. Paid by scheme.
Consult:1 per person
Frames:R1,275 per person
Single lenses100% cost
Bifocals:R420 per lens
MultifocalsR745 per lens
ContactsR1,870
Refractive Surgery:no benefit
Notes:Above benefits from network provider

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MENTAL HEALTH:
Standard Select
Scheme Benefits Notes and Links:
In-hospital:
  • In-hospital: R40,600 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
  • Educational psychologist for under 21yr olds
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:
Standard Select
Scheme Benefits Notes and Links:
General Appliances:
  • General Appliances: R7,820 per family, paid by scheme.
  • Stoma products: Additional R6,680
1.1. Hearing Aids:
  • R16,320 per family every five years, with a 20% co-payment
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:
Standard Select
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
  • One lipogram every 5yr, 20yrs+
  • Wellness Extender: costs R1,750 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:
Standard Select
Scheme Benefits: Notes and Links:
Overal Limit:
  • Internal and external: R45,090 per family
Sub-limits:
  • Breast prosthesis: R5,360 per breast, limited to two per year

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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